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

Introduction

 

In 2018, the United States Preventative Services Task Force (USPSTF) updated its recommendations for prostate cancer (PCa) screening, encouraging “shared decision-making" (SDM) with patients rather than discouraging screening altogether. This study aims to assess whether there was an increase in SDM following the 2018 guidelines change as well as an increase in screening for different socioeconomic groups.   

Materials

 

Responses of age-eligible men were extracted from the 2018 and 2020 Behavioral Risk Factors Surveillance Survey (BRFSS), a national survey on health behaviors.  Sociodemographic traits including socioeconomic status, race, participation in other health behaviors, and previous medical history were captured.  Hierarchical classification of records was used to identify similar clusters based on the traits. Rates of SDM  and prostate cancer screening were compared. All results were weighted. 

Results

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Four similar clusters were identified for each of the years: low-diversity low-socioeconomic status (LD-LS), low-diversity high-socioeconomic status (LD-HS), high-diversity low-socioeconomic status (HD-LS), and high-diversity high-socioeconomic status (HD-HS). In 2018, rates of SDM were similar between the groups with 25% in LD-LS, 24% in LD-HS, 22% in HD-LS, and 21% in HD-HS (Table 1). In 2020, rates of SDM were comparable to rates seen in 2018 for each of the groups with 22%,  23%, 20%, and 20%, respectively. PSA screening rates were 56% for LD-LS, 51.5% for LD-HS, 50.5% in HD-LS, and 45% in HD-HS in 2018, versus 48.5%, 49.5%, 39.5%, and 40%, respectively, in 2020.  

Conclusion

Between 2018 and 2020, there was no increase in SDM for all racial and socioeconomic groups, despite a change in guidelines recommending this practice.  PCa screening rates decreased for all groups and remained lowest in minority groups. This can be explained by a possible lack of utility of screening from prior guidelines, or insufficient time for guideline adoption.  SDM was equally low across socioeconomic levels, and the decrease in screening was comparable.  These data may demonstrate a delay in behavior adjustment after guidelines change, or rigidity in practice, particularly when practices from prior more categorical recommendations (screening is “discouraged”) may have become instilled in the medical culture.   

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