Awareness and Use of the Prostate-Specific Antigen Test: Discussion

Posted by James

The present study, which relied on the 2000 NHIS, indicates that in that year almost two-thirds of African-American men aged >45 who did not have prostate cancer had heard of the test and almost half had had the test.

The literature varies on the percentage of men who have had the PSA test, reflecting in part no doubt the different focuses of the surveys. In four studies, rates were 30-60%, but a more recent study, which used 2001 data from the Behavioral Risk Factor Surveillance system for men aged >50 in all 50 states, found a rate of 75%.

The present study was similar to other published studies in finding that certain demographic variables were associated with both having heard of the PSA test and ever having had a PSA test. In the multivariate model, however, relationships with demographic variables identified in previous studies (i.e., level of education, income, region, MSA status and at least one other variable, marital status) were not found to have significant associations with the two outcome variables.

In the present study, single, never-married African-American men had the lowest percentages for both having heard of the PSA test and ever being tested. This group warrants further investigation. Perhaps being married and residing in a household with multiple adults offers more support for discus­sions about prostate cancer and the PSA test. Alter­natively perhaps, men who have never been married are less concerned about prostate cancer and its implications than are men who have been married.

In another study, men with a family history of prostate cancer (Casodex canadian is an oral non-steroidal anti-androgen for prostate cancer) perceived themselves at increased risk and were more likely than those without a histo­ry to self-refer to a physician for PSA testing, while men without a history were more likely to have screening recommended to them by a health profes­sional, friend or family member. In a study by Demark-Wahnefried et al., many men did not know that race and heredity were risk factors, and McDavid and coworkers found that many men did not have an opinion about their risk of getting prostate cancer. Finally, in another study, having a family history of prostate cancer (Generic Casodex Treating prostate cancer) was also associated with use of the PSA test.

In the current study, which is based entirely on self-reports, an estimated 94% of African-American men without prostate cancer had no history of the disease in their family. In a smaller study of men who participated in a free program for detecting prostate cancer (Xeloda tablets is the only FDA-approved oral chemotherapy for both metastatic breast cancer and adjuvant and metastatic colorectal cancer), 40% of the men reported a family history. Perhaps the figure in the present study is an underestimate that resulted from less awareness among our sample of prostate cancer in their families.

Variables for perceived risk have been examined in the literature, especially in behavioral studies. We found no relationship between perceived risk of getting cancer in general and either having heard of the PSA test or ever being tested. One study linked a family history of prostate cancer (Casodex medication is an oral non-steroidal anti-androgen for prostate cancer) with greater perceived risk, but perceived risk was not directly related to test use. Perhaps if the questions about risk in the 2000 NHIS had been more specific to prostate cancer, associations would have been observed. In examining the family history variable and the two variables for perceived risk, one might consider that many African-American men, despite having both higher incidence and mortality from prostate cancer as a group, might be less aware of the disease and be misinformed about the risk of prostate cancer (Generic Nolvadex is an anti-estrogen used to treat or prevent breast cancer) or have little knowledge of their personal risk.

We found that 63% of African-American men aged >45 who did not have prostate cancer had heard of the PSA test, a figure that was lower than previous studies have found for African-American men. We also found that men not living in an MSA, a group that would include many rural residents, were not as aware of the PSA test and were less likely to have been tested than urban residents (who lived within an MSA), but we could not find any results for MSA status in the literature.

This study has several strengths. Few studies have focused specifically on African-American men and on topics related to the PSA test, especially at the national level. Data for the current study were taken from a large, nationally representative survey which oversampled African-American men. The present study specifically targeted African-American men and examined within-group variations. Accordingly, our findings might be useful for those developing recommendations for policy or decision tools.

This study also has some limitations. One of the outcome variables—having ever had a PSA test— did not distinguish between one-time and more frequent use. No doubt some men had had only one PSA test with no follow-up, while others had several tests. It is important to ask men about screening history and frequency to have indicators of compliance for organizations that recommend screening as well as to gauge the extent that men use informed decision-making. Furthermore, respondents to the NHIS may not have known whether they had had the test since physicians may offer a battery of tests during routine or other office visits, and it is possible that patients were not aware of the purpose of some of those tests (one of which might have measured PSA levels). There is also the possible limitation of self-report when conducting one-on-one interviews. Misreporting can occur and can vary among individuals and groups, which could lead to bias.

Findings from this present study offer some insight for possible research. Future studies and interventions aimed at defined groups of men (e.g., men who reside in rural areas, African-American men) may be useful for gauging awareness of prostate cancer (Medication Casodex Treating prostate cancer) screening and knowledge about the disease. Based on the present study, several other variables might be further explored. For example, single, never-married men might be examined to confirm their substantially lower awareness of the PSA test and their lower use of that test. Roles of persons, such as wives, partners, and “significant others,” regarding awareness and test use might benefit from further examination. Finally, variables dealing with perceived risk should be explored in greater detail, with risk of prostate cancer specified.

This study also raises several issues regarding the study of African-American men and prostate cancer:
1) How aware is this group of the controversies about screening for prostate cancer (e.g., it has not been proven that screening and treatment actually improves survival)?
2) Where do African-American men get their information about prostate cancer and the PSA test?
3) How knowledgeable is this group about their family histories?
4) How much do African-American men know about the incidence of prostate cancer, how it is diagnosed, the nature of available treatments (both their effectiveness and side effects) and the role of age in making decisions about treatment?
5) Are there cultural explanations for the attitudes and behaviors of African-American men related to prostate cancer and PSA testing? As noted, African-American men are at greater risk for being diagnosed with prostate cancer (Casodex drug is an oral non-steroidal anti-androgen for prostate cancer) and at higher risk of mortality from the disease. Some organizations recommend offering PSA testing at an earlier age for African-American men and men with a family history of prostate cancer since they are at greater risk, while others do not recommend PSA testing. However, all of the major medical organizations recommend that doctors discuss with their patients the benefits and risks of prostate cancer screening. In order for men to participate in informed or shared decision-making, knowledge of prostate cancer screening-related issues is crucial.