Most primary care clinicians do not see value in screening Black men for prostate cancer, despite recommendations to do so from the American Cancer Society (ACS) and the American Urological Association (AUA), according to a new qualitative study of interviews with clinicians and patients.
Similarly, the consensus among Black men in the study was that their primary care clinician never told them about their increased risk of developing prostate cancer or that they were told they did not need the screening. Researchers sought to evaluate physician and patient factors that impeded or facilitated access to prostate-specific antigen (PSA) testing for Black men.
Black men have double the risk for death from prostate cancer compared with the average man in the US. Testing for PSA is shown to reduce mortality from prostate cancer from 8% to 30% at 16-25 years’ follow-up, although benefits are greater in Black men, some studies suggest. The screening is generally administered in primary care settings, said Jenney R. Lee, MA, a senior research scientist at the University of Washington in Seattle, who led the study.
“We were surprised by the extent to which Black men in our interview sample reported difficulty accessing PSA testing,” Lee told Medscape Medical News. “Some reported being actively discouraged or directly turned down by primary care providers [PCPs] when they requested PSA testing.”
In the new analysis, published in JAMA Network Open, Lee and her colleagues interviewed 29 Black men aged between 32 and 72 years, 31 primary care clinicians (30 physicians and 1 physician assistant), and 32 urologists about their perceptions and knowledge of current guidelines for prostate cancer screening, use of PSA in practice, and attitudes regarding the utility of the screening to detect the cancer early.
Many patients reported dissatisfaction with their doctors’ reluctance to discuss or administer PSA testing.