Patient and Physician Perceptions of Prostate-Specific Antigen Testing Among Black Individuals.

Importance: Black individuals have a twofold higher rate of prostate cancer death in the US compared with the average population with prostate cancer. Few guidelines support race-conscious screening practices among at-risk Black individuals. Objective: To examine structural factors that facilitate or impede access to prostate cancer screening among Black individuals in the US. Design, Setting, and Participants: This qualitative, mixed-methods study was conducted between September 1, 2021, and December 31, 2023, in clinical and community settings across Washington, Wyoming, Alaska, Montana, Idaho, and Oregon. It included semistructured interviews with Black adults (aged ≥18 years) at risk for prostate cancer with or without a history of prostate-specific antigen (PSA) testing and a survey of primary care practitioners (PCPs) and urologists. Main Outcomes and Measures: Patient and physician experiences, knowledge, attitudes, and practices of PSA testing and prostate cancer screening were evaluated. Consensus coding and thematic analysis were used to analyze interviews; surveys were analyzed using descriptive statistics. Results: A total of 29 Black men (median [range] age, 59 [32-72] years) participated in the interviews, and 31 PCPs (including 30 phyicians and 1 physician assistant) and 32 urologists (45 of 63 aged 30-59 years [71.4%]; 40 male [63.5%]) participated in the survey. Interview participants perceived that PCPs function as gatekeepers in accessing PSA testing but may lack knowledge specific to Black men's risk for prostate cancer and hold attitudes about PSA testing that do not support its use. Interview participants also reported a lack of trusted relationships with PCPs to support shared decision-making. While both urologists and PCPs were highly aware of US Preventive Services Task Force guidelines, PCPs were much less likely than urologists to believe in the value of PSA testing or the role of early detection to prevent prostate cancer-related mortality (2 [6.5%] vs 24 [75.0%], respectively). Conclusions and Relevance: In this qualitative study examining structural factors associated with access to prostate cancer screening among Black individuals, findings from the survey supported participants' perceptions that PCPs do not value PSA testing for prostate cancer early detection or appreciate its role in reducing the risk of prostate cancer-related mortality. Primary care practitioner reliance on USPSTF guidelines, which currently do not provide guideline recommendations for screening high-risk groups, including Black individuals, suggests that incorporating evidence-driven guidance for PSA screening among Black individuals into these guidelines may substantially improve prostate cancer early detection among this high-risk population.