Abstract Title: The Relationship between Perceived Personal Risk of getting Prostate cancer and Prostate-Specific Antigen (PSA) Screening Yeatoe G. McIntosh, MPH Candidate Advisor: Emmanuel Anum, MBChB, MPH, PHD Preceptor: Emmanuel Anum, MBChB, MPH, PHD Background: Prostate cancer is one of the most common cancer diagnoses in the United States. The American Cancer Society estimates that in 2008 28,660 deaths would be attributed to prostate cancer, projecting it to be the leading cause of cancer deaths in U.S. men. Despite the potential threat this cancer presents to men and the potential for improved disease outcomes from early detection, guidelines for screening for prostate cancer are varied, and disparities in screening prevalence exist. In addition, disparities in knowledge about prostate cancer screening and misconceptions about the disease seem widespread. The main purpose of this study was to determine the relationship between perceived personal risk of getting prostate cancer and prostate cancer screening with the Prostate-specific antigen (PSA) test. Methods: Data were collected from the 2003 Health Information National Trends Survey (HINTS). Overall, 1,815 men ages 35 and above were included in the sample after exclusion of men ages 18-34. Logistic regression analyses were conducted to assess the association between perceived personal risk and prostate cancer screening with PSA test, while testing for interaction and further adjusting for possible confounders. A reduced model, in which variables with non-significant Wald chi-squared statistic had been excluded, was compared to the full model to access the change in parameter estimates. Using the model-based approach, we compared models with interaction terms to the one without interaction terms using the likelihood ratio test. Parameter estimates from the best fitting model were reported using the design-based method. SAS version 9.1 statistical software was used for analyses. Results: Among men ages 35-49, those who perceived their risk as high, were significantly less likely to screen than those who perceived their risk as low (OR: 0.20 95% CI: 0.05-0.78). Within ages 50-64 and 65 and above, there were no significant differences between perceived risk levels and PSA testing. Men, who did receive healthcare provider recommendation for screening, were more likely to obtain prostate cancer (PSA) screening than men who did not receive such recommendation (OR: 92.56 95% CI 36.56, 234.36). Conclusions: The relationship between perceived personal risk of getting prostate cancer and PSA screening is modified by age. As men aged, their odds of screening increased. The most significant predictor of PSA screening was health provider recommendation. PSA screening showed no association with either race or household income.

The national recommendations for use of the prostate specific antigen (PSA) test for prostate cancer screening have been modified over the years as scientific evidence emerged. Current screening recommendations discourage widespread PSA screening for men at low to average risk, but provide specific guidelines for shared-decision making between men and their health providers about the benefits and risks of PSA testing. This study was an examination of relationships between men’s assessment of the quality of their care and communication with their health providers, the extent to which providers engage men in recommended discussions about PSA testing, and factors associated with shared-decision making and PSA testing. Secondary data from the U.S. Health Information National Trends Survey 4, Cycle 2 that included men with no history of prostate cancer and in the recommended age ranges for prostate cancer screening were analyzed (N=777). Non-Hispanic white men rated their quality of care higher than men of other races (c2 (49, n=635) = 7.23, p = 0.0098), whereas Hispanic men gave the lowest ratings compared to other men (c2 (49, n=635) = 5.42, p = 0.024). Previous PSA testing was reported by 64% of the men, 56% of whom stated that they discussed screening with their provider and 80% reported that they were asked if they wanted to have the test done. However, only 21% - 39% reported having ever discussed the pros and cons of PSA testing. Discussing PSA testing with a provider was the strongest predictor of obtaining the test (OR=69.5, CI = 23.6 – 204.6) but the effect was significantly modified when providers and patients engaged in the shared-decision making process (OR = 47.42, CI = 14.91 – 150.74). Age, education level and perceived quality of care were consistent, positive predictors of PSA testing. These results indicate there is a gap in provider-patient discussions about PSA screening and suggest that health providers may not be following the recommended guidelines for the content of the discussions needed to facilitate shared-decision making. Effective provider-based interventions to increase shared-decision-making about PSA testing are needed if the national objectives for prostate cancer screening are to be met.