Racial Disparities in Prostate Cancer Screening: The Role of Shared Decision-Making.

INTRODUCTION: The 2018 United States Preventive Services Task Force recommendations endorsed shared decision-making (SDM) for men aged 55-69, encouraging consideration of patient race/ethnicity for prostate-specific antigen (PSA) screening. This study aimed to assess whether a proxy SDM variable modified the effect of race/ethnicity on the likelihood of PSA screening.

METHODS: A cross-sectional analysis of men between 55 and 69 years, who responded to the PSA screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System survey, was performed between September and December 2022. Complex sample multivariable logistic regression models with an interaction term combining race and estimated SDM were used to test whether SDM modified the effect of race/ethnicity on screening.

RESULTS: Out of a weighted sample of 26.8 million men eligible for PSA screening, 25.7% (6.9 million) reported PSA screening. In adjusted analysis, estimated SDM was a significant predictor of PSA screening (aOR:2.65, 95%CIs: 2.36-2.98, p<0.001). The interaction between race/ethnicity and estimated SDM on the receipt of PSA screening was significant (pint =0.001). Among those who did not report estimated SDM, both non-Hispanic Black (OR: 0.77, 95%CIs: 0.61-0.97, p=0.026) and Hispanic (OR: 0.51, 95%CIs: 0.39-0.68, p<0.001) men were significantly less likely to undergo PSA screening than non-Hispanic White men. On the contrary, among respondents who reported estimated SDM, no race-based differences in PSA screening were found.

CONCLUSIONS: While much disparities research focuses on race-based differences in PSA screening, research on strategies to mitigate these disparities is needed. SDM might attenuate the effect of race/ethnic disparities on the likelihood of PSA screening.