Presented by: Borivoj Golijanin
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University

Introduction

There is stronger evidence for colorectal cancer (CRC) screening and vaguer recommendations for prostate cancer screening with prostate-specific-antigen (PSA) testing. Evidence suggests that involvement in prior preventative health behaviors, like CRC screening, improves the likelihood of shared-decision-making (SDM) and compliance with medical recommendations. It is unclear how participation in CRC screening influences the likelihood of  PSA testing.

Materials

This study identifies age-eligible men in the Behavioral Risk Factor Surveillance Survey who underwent PSA testing between 2019 and 2020 and assesses their participation in health behaviors, exercise, CRC screening, and PSA testing, and SDM with their healthcare provider. Participation in these preventative health behaviors is used to establish the likelihood odds of SDM and PSA testing.

Results

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In age eligible men (n=54,396), screening rates were 62% for PSA and 88% for CRC.  Rates of SDM were 39.1% in those with PSA screening, and 16.2% in those without. Odds of PSA screening were higher when SDM was present (AOR=2.68, CI= 2.67 – 2.68). There was a positive association between SDM and history of colonoscopy (AOR=1.16, CI=1.15 – 1.16), sigmoidoscopy (AOR=1.26, CI=1.25-1.26), stool DNA (AOR=1.23, CI=1.22 - 1.23), and stool blood testing (AOR=1.05, CI=1.05 - 1.05). VR colonoscopy is associated with lower odds of SDM (AOR=0.98, CI=0.98 - 0.99) and PSA testing (AOR=0.95, CI=0.95 - 0.95). There were higher odds of having a PSA test when there was history of receiving colonoscopy (AOR=1.94, CI=1.94 - 1.95), sigmoidoscopy (AOR=1.23, CI= 1.23 – 1.23), stool DNA testing (AOR=1.11, CI=1.11 – 1.11), and stool blood testing (AOR=1.11, CI=1.11 – 11). Health behaviors, like regular exercise are associated with increased odds of SDM (AOR=1.14, CI=1.13 – 1.14) and PSA testing (AOR=1.28, CI=1.28 – 1.29). History of flu vaccination in the last twelve months was associated with higher odds of SDM (AOR=1.29, CI=1.29 – 1.3) and PSA testing (AOR=1.36, CI=1.35 – 1.36). Increased SDM was associated with history of pneumonia vaccination (AOR=1.19, CI=1.19 – 1.2). The history of current or prior smoking was negatively associated with SDM (AOR=0.86, CI=0.85 – 0.86) and PSA testing (AOR=0.93, CI=0.92 – 0.93).

Conclusion

Participation in health behaviors is associated with more SDM which appears to be a proxy marker for quality preventative healthcare, both in terms of following PSA screening guidelines, as well as its’ association with other appropriate cancer screenings.  SDM may be a trackable metric that can strengthen the patient-doctor relationship and lead to wider preference-sensitive care and improved preventative care.

Funding

None.

Lead Authors

vikas bhatt,
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University

Co-Authors

alexander homer,
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University

gyan pareek,
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University

Elias Hyams,
Minimally Invasive Urology Institute of the Miriam Hospital and Warren Alpert Medical School of Brown University