Reducing Prostate Cancer Racial Disparity: Evidence for Aggressive Early Prostate Cancer PSA Testing of African American Men

Since prostate cancer continues to disproportionately affect African American men in terms of incidence, morbidity, and mortality, prostate-specific antigen (PSA) screening plays an important role in early detection, especially when men engage in informed decision making to accept or decline this test. The authors evaluated utilization of PSA testing among African American men based on factors that are important components of making informed decisions. Utilization of PSA testing was evaluated based on whether men had ever had PSA testing and PSA testing during the past year in a community-based sample of African American men ages 50 to 75 ( n = 132). Overall, 64% of men ( n = 85) reported that they had ever had a PSA test; the mean ( SD) age for first use of PSA testing was 47.7 ( SD = 7.4). The likelihood of ever having a PSA test increased significantly with physician communication (odds ratio [OR] = 14.2; 95% confidence interval [CI] = 4.20, 48.10; p = .0001) and with having an annual household income that was greater than $20,000 (OR = 9.80; 95% CI = 3.15, 30.51; p = .0001). The odds of ever having a PSA test were also decreased with each unit increase in future temporal orientation (OR = 0.66; 95% CI = 0.47, 0.93; p = .02). Of the men who had ever had PSA testing, 57% were screened during the past year. Only health insurance status had a significant independent association with having annual PSA testing (OR = 5.10; 95% CI = 1.67, 15.60; p = .004). Different factors were associated significantly with ever having PSA testing and annual testing among African American men. African American men may not be making an informed decision about prostate cancer screening.

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Contemporary racial disparities in PSA screening in a large, integrated health care system.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.308 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 308-308

Author(s):

James T. Kearns ◽

Oluwaseun Adeyemi ◽

William E. Anderson ◽

Timothy C. Hetherington ◽

Yhenneko J. Taylor ◽

...

Keyword(s):

Prostate Cancer ◽

African American ◽

Cancer Screening ◽

Racial Disparities ◽

African American Men ◽

Prostate Cancer Screening ◽

Psa Screening ◽

Psa Testing ◽

Caucasian Men ◽

Clinical Records

308 Background: The USPSTF prostate cancer screening guidelines have changed significantly in the past decade, from a recommendation of do not screen in 2012 to a 2018 recommendation that focuses on shared decision making. Additionally, most guidelines further acknowledge that African American men should be screened more intensively than Caucasian men due to increased incidence of prostate cancer and increased prostate cancer mortality. Our objective was to characterize racial disparities in PSA screening in a large healthcare system with a diverse patient population to understand contemporary trends. Methods: This retrospective cohort study used data from the Atrium Health Enterprise Data Warehouse, which includes clinical records from over 900 care locations across North Carolina, South Carolina, and Georgia. Participants included all men ≥ 40 years seen in the ambulatory or outpatient setting during 2014-2018. PSA testing was determined through laboratory data. Clinical and demographic data were collected. Between-group comparisons were conducted using generalized estimating equations models to account for within-subject correlation. Statistical significance was defined as p < 0.05. Results: There were 582,846 individual men seen from 2014-2018, including 416,843 Caucasians (71.5%) and 85,773 African Americans (14.7%). Screening rates declined among all groups from 2014-2018 (see table). African American men were screened at a similar or lower rate than Caucasian men in each year (from 18.6% vs 19.0% in 2014 to 11.9% vs 12.2% in 2018, respectively). Conclusions: PSA screening declined significantly between 2014 and 2018. African American men screened at a similar or lower rate than Caucasian men each year. Given the consensus that African American men should be more intensively screened for prostate cancer, significant racial disparities remain in prostate cancer screening. Further study is warranted to understand patient, provider, and system factors that contribute to disparities in prostate cancer care and outcomes.[Table: see text]

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Multi-institution analysis of racial disparity among African-American men eligible for prostate cancer active surveillance

Oncotarget ◽

10.18632/oncotarget.25103 ◽

2018 ◽

Vol 9 (30) ◽

pp. 21359-21365 ◽

Cited By ~ 4

Author(s):

Michael Dinizo ◽

Weichung Shih ◽

Young Suk Kwon ◽

Daniel Eun ◽

Adam Reese ◽

...

Keyword(s):

Prostate Cancer ◽

African American ◽

Active Surveillance ◽

Racial Disparity ◽

African American Men

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Physician Consultations, Prostate Cancer Knowledge, and PSA Screening of African American Men in the Era of Shared Decision-Making

American Journal of Men s Health ◽

10.1177/1557988318763673 ◽

2018 ◽

Vol 12 (4) ◽

pp. 751-759 ◽

Cited By ~ 8

Author(s):

Leanne Woods-Burnham ◽

Laura Stiel ◽

Colwick Wilson ◽

Susanne Montgomery ◽

Alfonso M. Durán ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

African American ◽

Black Men ◽

Shared Decision Making ◽

African American Men ◽

Shared Decision ◽

Psa Testing ◽

Incidence And Mortality ◽

Physician Patient

African American (AA)/Black men are more likely to develop aggressive prostate cancer (PCa), yet less likely to be screened despite guidelines espousing shared decision-making regarding PCa screening and prostate-specific antigen (PSA) testing. Given the documented racial disparities in PCa incidence and mortality, engaging interactions with physicians are especially important for AA/Black men. Thus, this study evaluated occurrence of physician–patient conversations among AA/Black men, and whether such conversations were associated with PCa knowledge. We also quantified the serum PSA values of participants who had, and had not, discussed testing with their physicians. Self-identified AA/Black men living in California and New York, ages 21–85, donated blood and completed a comprehensive sociodemographic and health survey ( n = 414). Less than half (45.2%) of participants had discussed PCa screening with their physicians. Multivariate analyses were used to assess whether physician–patient conversations predicted PCa knowledge after adjusting for key sociodemographic/economic and health-care variables. Increased PCa knowledge was correlated with younger age, higher income and education, and having discussed the pros and cons of PCa testing with a physician. Serum PSA values were measured by ELISA. Higher-than-normal PSA values were found in 38.5% of men who had discussed PCa screening with a physician and 29.1% who had not discussed PCa screening. Our results suggest that physician–AA/Black patient conversations regarding PCa risk need improvement. Encouraging more effective communication between physicians and AA/Black men concerning PCa screening and PSA testing has the potential to reduce PCa health disparities.

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Predictors of prostate cancer screening among African American men treated at an Academic Medical Center in the Southern United States

Current Cancer Reports ◽

10.25082/ccr.2021.01.003 ◽

2021 ◽

Vol 3 (1) ◽

pp. 81-94

Author(s):

Steven S. Coughlin ◽

◽

Deepak Nag Ayyala ◽

John S. Luque ◽

Justin Xavier Moore ◽

...

Keyword(s):

Prostate Cancer ◽

African American ◽

Cancer Screening ◽

African American Men ◽

Prostate Cancer Screening ◽

Decision Making Process ◽

Cancer Knowledge ◽

Psa Test ◽

Psa Testing ◽

Prostate Cancer Knowledge

Background: The controversy surrounding prostate cancer screening, coupled with the high rates of incidence and mortality among African American men, increase the importance of African American men engaging in an informed decision-making process around prostate cancer screening. Purpose: To examine predictors of prostate cancer screening via the prostatespecific antigen (PSA) test. Secondary objectives were to examine whether African American men have been screened for prostate cancer; their confidence in making an informed choice about whether PSA testing is right for them; and whether they have talked with their provider about PSA testing and engaged in an informed decision-making process around prostate cancer screening. Methods: We conducted a study among a sample of African American men patients ages > 40 years. Results: A total of 65 men completed the questionnaire (response rate = 6.5%). The mean age of the men was 64.4 years. Most of the participants (90.8%) reported a regular healthcare provider and that their provider had discussed the PSA test with them (81.3%). About 84.1% of the men ever had a PSA test, but only 38.0% had one in the past year. Most of the men reported that they make the final decision about whether to have a PSA test on their own (36.5%) or after seriously considering their doctor’s opinion (28.6%). About 31.8% of the men reported that they share responsibility about whether to have a PSA test with their doctor. About half of the participants (49.2%) reported that they have made a decision about whether to have a PSA test and they are not likely to change their mind. The majority of the men (75%) perceived their risk of prostate cancer to be about the same level of risk as other men who were their age. The men’s knowledge of prostate cancer was fair to good (mean prostate cancer knowledge scale = 10.37, SD 1.87). Knowledge of prostate cancer was positively associated with receipt of a PSA test (p < 0.0206). Discussion: The modest overall prostate cancer knowledge among these participants, including their risk for prostate cancer, indicates a need for prostate cancer educational interventions in this patient population.

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