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A nationwide survey of prostate specific antigen based screening and counseling for prostate cancer
David F. Friedlander, MD, MPH1, Christian P. Meyer, MD2, Kevin Choi, BA2, Alexander P. Cole, MD1, Julian Hanske, MD2, Michael Zavaski, MD1, Gally Reznor, MS2, Maxine Sun, MPH2, Adam S. Kibel, MD1, Stuart R. Lipsitz, ScD2, Quoc-Dien Trinh, MD2.
1Brigham and Women's Hospital, Boston, MA, USA, 2Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.

BACKGROUND:
Controversy surrounds the use of PSA screening following the 2012 United States Preventive Services Task Force’s grade D recommendation. There is limited evidence evaluating patterns of PSA counseling and patient perceptions of the PSA test since 2012. We evaluated the association between prostate cancer screening counseling and patient sociodemographic factors in a nationally representative sample.

METHODS:
Using data from the 2013 Health Information National Trends Survey, we identified 768 male respondents aged 40-75 and without a prior prostate cancer diagnosis. Using logistical regression, we assessed trends in prostate cancer screening, counseling and PSA utilization.
RESULTS:

54.1% of respondents reported ever having a PSA test. Men undergoing PSA testing were more likely to have had a prior cancer diagnosis other than prostate cancer (OR 3.58, 95% CI 1.09-11.72), to have at least some college education (OR 10.58, 95% CI 3.10-36.12), and were older (OR 10.17, 95% CI 3.98-26.03). Prior cancer history (OR 2.47, 95% CI 1.15-5.31) and older age (OR 4.82, 95% CI 1.49-15.59) were associated with greater odds of being counseled on the potential adverse effects of prostate cancer treatment. Older men were more likely to discuss the PSA test with a healthcare professional (OR 5.32, 95% CI 2.15-13.16) and to be informed of the controversy surrounding PSA screening (OR 5.34, 95% CI 1.03-11.51).
CONCLUSIONS:
We show that certain men receive substantially different PSA screening counseling. Healthcare providers should be aware of these potential biases and their impact on shared patient-provider decision making prior to PSA counseling.


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