Prostate Cancer and Young Black Men: Can Early Communication Avoid Later Health Disparities?

Background/Purpose: Incidence of prostate cancer (PCa) among black men continues to be significantly higher than that of white men. Black men are more than twice as likely to die from the disease as white men. Current controversy surrounds the use of prostate-specific antigen (PSA) screening for PCa given the potential for overdiagnosis and overtreatment of indolent disease along with the possibility of inducing anxiety, stress, and potential morbidity (e.g., incontinence and erectile dysfunction) from additional biopsies.  Data suggest healthcare providers are not adequately communicating the advantages and disadvantages of PSA screening to men. Inadequate patient counseling leading to failure to adopt screening could contribute to a greater risk of discovering the disease at an advanced stage, especially among minority men. The overwhelming majority of research focuses on men 50 and over since the guidelines recommend that is when screening should occur, yet there is scant research regarding counseling of men below age 50. This presentation highlights the results of a study in which men between the ages of 18-49 were asked of their communication with physicians regarding PSA screening and family cancer history.   

Methods: Data and samples: Data were taken from the 2011-2012 Health Information National Trends Survey [HINTS] conducted by the National Cancer Institute. This is a nationally representative cross-sectional survey of noninstitutionalized adults in the US. An analytic population of 518 men aged 18-49 years was included in this study.  

Measures: Men were asked questions measuring if their physician provided them with essential information to make an informed decision as to whether to undergo or forgo PSA screening and the provision of information regarding the test’s controversy. For example, men were asked, “have you ever had a PSA test?” or “has a doctor ever told you that you could choose whether or not to have the PSA test?  

Statistical Analysis: We computed descriptive statistics for each of the PSA questions taking into account survey weights of the HINTS sample. We modelled the association between sociodemographic characteristics and each PSA question using logistic regression models.  

Results: Sample was primarily 18-34 years old (53.6%), non-Hispanic white race/ethnicity (61.1%), had a family history of cancer (69.4%), and trusted their doctor a lot (70.4%). For PSA questions, 8.5% reported having a PSA test, 11% reported their doctor told them they could choose to have the PSA test, and 4.3% reported they knew that some doctors recommend PSA testing and others do not. Compared to non-Hispanic white men, non-Hispanic black men were non-statistically significantly more likely to report having had a PSA test (OR: 2.28, 95% CI: 0.64-8.15), and be told they could choose to have a PSA test (OR: 3.13, 95% CI: 0.88-11.18); however, they were statistically significantly less likely to have been told that some doctors recommend PSA testing and others do not (OR: 0.16, 95% CI: 0.07-0.37).

Conclusions/Implications: Our findings suggest early communication may be an effective tool in reducing racial disparities associated with cancer deaths. Research on factors influencing or inhibiting communication regarding preventative approaches is necessary.