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 riskfor 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.

“If we can get the word out more that this is important for us as Black men to get screened and have the test, man, I think more guys will opt to have that done,” one patient said.

On the clinician side, Lee and her colleagues asked about knowledge of and reliance on prostate cancer screening guidelines from the US Preventive Services Task Force (USPSTF), the AUA, and the ACS.

The cancer group recommends discussing PSA screening in men aged between 50 and 55 years, and for men at high risk for cancer, including Black men, at the age of 45 years. In the current study, 62.5% of primary care clinicians said they were unsure whether they agreed with these recommendations, while only 30% of the urologists said the same.

Although the AUA and ACS guidelines include recommendations for testing high-risk groups, including Black men, only 13% of primary care clinicians said they were familiar with the content of either of these guidelines.

The most recent USPSTF guidelines recommend discussion of PSA screening for men aged 55-69 years but do not address high-risk groups, including Black men.

Notably, approximately two thirds of primary care clinicians, but just one urologist, said the USPSTF recommendations strongly or very strongly influenced their use of PSA testing.

Only 6.5% of clinicians working in primary care said they thought PSA testing significantly reduces the chance of dying from prostate cancer compared with 75% of urologists.

Stephen Freedland, MD, a professor of urology at Cedars-Sinai Medical Center in Los Angeles, said he was surprised that not many primary care clinicians seemed to realize a PSA test can reduce the likelihood of dying from prostate cancer.

“This contradicts the guidelines and well-conducted randomized trials that clearly outline the benefits of PSA testing, namely less deaths from prostate cancer,” Freedland said.

Recent guidelines from the Prostate Cancer Foundation advised a lower age for baseline PSA testing for Black men than currently recommended. Dropping the baseline PSA screening age to 40-45 years could potentially reduce prostate cancer deaths in this high-risk population, according to the foundation.

How to Change Attitudes

Primary care clinicians need better education not only on the benefits of PSA testing but also on the impact of race on prostate cancer risk and mortality, Freedland said.

“We can continue to educate Black men to advocate for their own health, though it was clear in the current study that many already were well educated about the excess risk they face,” he said. “PCPs were often dismissive and not understanding the clear benefits of PSA testing.”

Lee and her team are concluding a 3-year project to identify priorities in early detection of prostate cancer to develop an agenda for research that can inform clinical practice with funding from the Patient-Centered Outcomes Research Institute. They partnered with Black patients, who did and did not have a history of prostate cancer, and clinicians and researchers.

The study was supported by awards and grants from the Andy Hill Cancer Research Endowment Fund, the National Cancer Institute, the US Department of Defense, and the Washington State Urology Society.

Freedland reported having no financial conflicts. One study author reported receiving personal fees from Ortho Clinical Diagnostics outside the submitted work. No other disclosures were reported.