Disparities Associated with Shared Decision-making in Prostate Cancer Screening

Prostate-specific antigen (PSA) is a commonly used tool in screening for prostate cancer. The clinical effectiveness of using PSA in regard to prostate cancer–specific mortality has been the topic of great debate [1]. Multiple trials have consistently shown that PSA screening leads to an increased incidence of prostate cancer [1], [2], [3]. This raises concerns about the potential harm of increased detection and treatment of early-stage, nonclinically significant prostate cancer [4]. Owing to the conflicting findings in mortality reduction and potential risks and benefits associated with early treatment, urologic guidelines recommend the practice of shared decision-making when considering PSA screening [5], [6], [7]. Shared decision-making involves a meaningful discussion between the patient and the provider regarding the risks and benefits of a decision based on the patient’s values, as well as the patient being able to fully understand them.

Despite current recommendations, multiple studies found that a large percentage of men who received PSA screening did not undergo shared decision-making, although the rates have been increasing over the years [8], [9]. However, there is evidence that sociodemographic disparities exist between patients who participate in shared decision-making, with racial minorities being less likely than White men but gay men being more likely than straight men to participate [10], [11], [12]. The objective of this study was to examine the sociodemographic differences in shared decision-making for prostate cancer screening in the USA.

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