Prior Colorectal Cancer Screening and Shared Decision Making Influence the Likelihood of PSA Screening
Borivoj Golijanin, BS, Vikas Bhatt, MD, Alexander Homer, BS, Rebecca Wales, BS, Elias Hyams, MD.
Minimally Invasive Urology Institute at the Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.
BACKGROUND:Despite stronger evidence for the benefits of colorectal cancer (CRC) screening and vaguer recommendations for prostate-specific antigen (PSA) screening, it is unclear how men eligible for prostate cancer early detection may be more or less likely to pursue this based on participation in other screening practices. This study aims to compare the rates of PSA and CRC screening and assess the odds of having PSA screening based on race, education, SDM, and use of CRC screening, hypothesizing that PSA screening is associated with other early detection efforts but also demographic factors. METHODS:The 2020 Behavioral Risk Factor Surveillance Survey (BRFSS) was queried for records providing a definite history of SDM or PSA screening. Records between the ages of 50-75 were included. Information on CRC screening habits, SDM, and demographics were captured. Data were weighted and adjusted odds, of having SDM or PSA testing according to the individual traits, calculated. RESULTS:30,958 records met inclusion criteria. 12.1% were excluded due to missing data. Average age was 62 years, and all were male at birth. All other reported results for this cohort are weighted. Screening recommendations were met in 62% for PSA and 88% for CRC. Rates of SDM were 39.1% in those who met PSA screening requirements, and 16.2% in those who did not. Odds of PSA screening were higher when SDM was present (AOR=2.68, CI= 2.67 - 2.68) or when CRC screening recommendations were met (AOR=1.94, CI=1.94 - 1.94). History of CRC screening was associated with higher odds of SDM (AOR=1.16, CI=1.15 - 1.16). Subset analysis of CRC screening identified that VR colonoscopy is associated with lower odds of SDM (AOR=0.98, CI=0.98-0.99) and PSA testing (AOR=0.95, CI=0.95-0.95). Rates of any level of college education were 85.3% for individuals with SDM, 79.2% for those without, 85.5% for those with PSA testing, and 76.7% for those without. Higher levels of education were associated with higher odds of SDM (AOR=1.93, CI=1.92 - 1.94) and PSA screening (AOR=3.38, CI=3.36 - 3.39). Patients who received PSA identified as: 81. 3% White, 7.6% Black, 6.6% Hispanic, 1.6% Asian, 1.1% Multiracial, 0.8% American Indian/Pacific-Islander, 0.2% Native Hawaiian, and 1.1% Other. Compared to White, Black patients had higher odds of SDM (AOR=1.6, CI=1.59 - 1.6) and decreased odds of PSA testing (AOR=0.94, CI=0.94 - 0.95). Hispanic patients had increased odds of SDM (AOR=1.16, CI=1.15 - 1.16) and PSA screening (AOR=1.05, CI=1.05 - 1.06). CONCLUSIONS:Within a weighted nationwide surveyed sample of the US population, PSA screening rates remain far lower than those of CRC screening rates in men ages 50-75. Prior CRC screening was associated with PSA early detection efforts, suggesting that certain men partake in both practices. SDM at the provider level appears to be associated with both practices. Concerningly, SDM for PSA screening remains low, with disparities based on race and education. Further work to improve compliance with screening guidelines and use of SDM efforts at the provider level are needed.
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