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Prevalence and determinants of shared decision-making for PSA testing in the United States

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

Background

Shared decision-making (SDM) is recommended for prostate-specific antigen (PSA) testing but appears underutilized. This population-based study assessed the prevalence and determinants of SDM for PSA testing among US men.

Methods

We assessed PSA testing rates and SDM engagement in men aged 40 and older without prostate cancer history using the 2019 National Health Interview Survey. SDM was defined as discussing the advantages and disadvantages of PSA testing with a physician. We used multivariable logistic regression with machine learning to identify factors associated with lack of SDM.

Results

Among 9723 eligible participants (mean age 58 years), lifetime PSA testing prevalence was 45.9% and the 1-year testing incidence was 29.1%. Only 24.1% reported engaging in SDM with a physician, while 62.9% never discussed PSA testing. Younger age and lower education levels were the primary determinants of decreased SDM engagement. Men with less education engaged in SDM less than half as often as those with higher education levels across all age groups.

Conclusions

Societal guidelines recommend SDM for PSA testing. However, most men, regardless of age, have never engaged in SDM conversations with a healthcare provider about PSA testing, especially those with less education. More efforts are needed to improve patient-provider conversations about the potential benefits and harms of PSA testing.

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Fig. 1: Lifetime prevalence and 1-year incidence of PSA testing by age group among US men aged 40 and older.
Fig. 2: Frequency of shared decision-making regarding PSA testing by age group among US men aged 40 and older.
Fig. 3: Frequency of shared decision-making regarding PSA testing by race among US men aged 40 and older.
Fig. 4: Prevalence of PSA testing by age and shared decision-making among US men aged 40 and older.
Fig. 5: Frequency of shared decision-making regarding PSA testing by age and education among US men aged 40 and older.

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Data availability

The 2019 NHIS data are publicly available at https://www.cdc.gov/nchs/nhis/2019nhis.htm.

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Funding

Funding

Boston Scientific (Marlborough, MA, United States) supported this research.

Author information

Authors and Affiliations

  1. Division of Urology, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada

    Naeem Bhojani & Kevin C. Zorn

  2. Department of Biostatistics, Miller Scientific, Johnson City, TN, USA

    Larry E. Miller

  3. Department of Urology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA

    Bilal Chughtai

  4. Division of Urology, University Health Network, Toronto, ON, Canada

    Dean S. Elterman

  5. Health Economics and Market Access, Boston Scientific, Marlborough, MA, USA

    Samir Bhattacharyya

  6. Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada

    Ben H. Chew

Authors
  1. Naeem Bhojani
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Contributions

The authors confirm their contribution to the paper as follows: study conception and design: LM, SB; data collection: LM; analysis and interpretation of results: all authors; draft manuscript preparation: LM; reviewed and approved the final version of the manuscript: all authors.

Corresponding author

Correspondence to Larry E. Miller.

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Competing interests

N Bhojani is a consultant for Olympus, Boston Scientific, and Procept BioRobotics. L Miller is a consultant for Boston Scientific. K Zorn is a consultant and proctor for Boston Scientific, Procept BioRobotics, and investigator for Zenflow. B Chughtai is a consultant for Olympus, Boston Scientific, Ferring Pharmaceuticals, and Allergan. D Elterman reports grants and personal fees from Boston Scientific, grants from Olympus, grants from Urotronic, grants from Procept Biorobotics, and grants from Zenflow. S Bhattacharyya is an employee of Boston Scientific. B Chew is a consultant for Boston Scientific.

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Bhojani, N., Miller, L.E., Zorn, K.C. et al. Prevalence and determinants of shared decision-making for PSA testing in the United States. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00843-x

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