Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical Research

The impact of sociodemographic factors and PSA screening among low-income Black and White men: data from the Southern Community Cohort Study

Prostate Cancer and Prostatic Diseases volume 20, pages 424–429 (2017)Cite this article

Subjects

Abstract

Background:

Variation in PSA screening is a potential source of disparity in prostate cancer survival, particularly among underserved populations. We sought to examine the impact of race and socioeconomic status (SES) on receipt of PSA testing among low-income men.

Methods:

Black (n=22 167) and White (n=9588) men aged ⩾40 years completed a baseline questionnaire from 2002 to 2009 as part of the Southern Community Cohort Study. Men reported whether they had ever received PSA testing and had testing within the prior 12 months. To evaluate the associations between SES, race and receipt of PSA testing, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from the multivariable logistic models where age, household income, insurance status, marital status, body mass index and educational level were adjusted.

Results:

Black men were younger, had a lower income, less attained education and were more likely to be unmarried and uninsured (all P<0.001). Percentages of men having ever received PSA testing rose from <40% under the age of 45 years to ~90% above the age of 65 years, with Whites >50 more likely than Blacks to have received testing. Lower SES was significantly associated with less receipt of PSA testing in both groups. After adjustment for SES, White men had significantly lower odds of PSA testing (OR 0.81; 95% CI: 0.76–0.87).

Conclusions:

Greater PSA testing among White than Black men over the age of 50 years in this low-income population appears to be mainly a consequence of SES. Strategies for PSA screening may benefit from tailoring to the social circumstances of the men being screened.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Moyer VA . What we don't know can hurt our patients: physician innumeracy and overuse of screening tests. Ann Intern Med 2012; 156: 392–393.

    Article  Google Scholar 

  2. Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360: 1320–1328.

    Article  Google Scholar 

  3. Andriole GL, Crawford ED, Grubb RL III, Buys SS, Chia D, Church TR et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 2009; 360: 1310–1319.

    Article  CAS  Google Scholar 

  4. Sammon JD, Abdollah F, Choueiri TK, Kantoff PW, Nguyen PL, Menon M et al. Prostate-specific antigen screening after 2012 US Preventive Services Task Force Recommendations. JAMA 2015; 314: 2077–2079.

    Article  Google Scholar 

  5. Barocas DA, Mallin K, Graves AJ, Penson DF, Palis B, Winchester DP et al. Effect of the USPSTF Grade D Recommendation against screening for prostate cancer on incident prostate cancer diagnoses in the United States. J Urol 2015; 194: 1587–1593.

    Article  Google Scholar 

  6. Jemal A, Fedewa SA, Ma J, Siegel R, Lin CC, Brawley O et al. Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations. JAMA 2015; 314: 2054–2061.

    Article  CAS  Google Scholar 

  7. Brawley OW . Prostate cancer epidemiology in the United States. World J Urol 2012; 30: 195–200.

    Article  Google Scholar 

  8. Pettaway CA, Troncoso P, Ramirez EI, Johnston DA, Steelhammer L, Babaian RJ . Prostate specific antigen and pathological features of prostate cancer in black and white patients: a comparative study based on radical prostatectomy specimens. J Urol 1998; 160: 437–442.

    Article  CAS  Google Scholar 

  9. Powell IJ . Epidemiology and pathophysiology of prostate cancer in African-American men. J Urol 2007; 177: 444–449.

    Article  Google Scholar 

  10. Gaines AR, Turner EL, Moorman PG, Freedland SJ, Keto CJ, McPhail ME et al. The association between race and prostate cancer risk on initial biopsy in an equal access, multiethnic cohort. Cancer Causes Control 2014; 25: 1029–1035.

    Article  Google Scholar 

  11. Siegel RL, Miller KD, Jemal A . Cancer statistics 2017. CA Cancer J Clin 2017; 67: 7–30.

    Article  Google Scholar 

  12. Carpenter WR, Howard DL, Taylor YJ, Ross LE, Wobker SE, Godley PA . Racial differences in PSA screening interval and stage at diagnosis. Cancer Causes Control 2010; 21: 1071–1080.

    Article  Google Scholar 

  13. Amini A, Jones BL, Yeh N, Guntupalli SR, Kavanagh BD, Karam SD et al. Disparities in disease presentation in the four screenable cancers according to health insurance status. Public Health 2016; 138: 50–56.

    Article  CAS  Google Scholar 

  14. Signorello LB, Hargreaves MK, Steinwandel MD, Zheng W, Cai Q, Schlundt DG et al. Southern community cohort study: establishing a cohort to investigate health disparities. J Natl Med Assoc 2005; 97: 972–979.

    PubMed  PubMed Central  Google Scholar 

  15. Fowke JH, Schlundt D, Signorello LB, Ukoli FA, Blot WJ . Prostate cancer screening between low-income African-American and Caucasian men. Urol Oncol 2005; 23: 333–340.

    Article  Google Scholar 

  16. Sammon JD, Dalela D, Abdollah F, Choueiri TK, Han PK, Hansen M et al. Determinants of prostate specific antigen screening among Black Men in the United States in the contemporary era. J Urol 2015; 195: 913–918.

    Article  Google Scholar 

  17. LaNoue M, Harvey A, Mautner D, Ku B, Scott K . Confirmatory factor analysis and invariance testing between Blacks and Whites of the Multidimensional Health Locus of Control scale. Health Psychol Open 2015; 2: 2055102915615045.

    Article  Google Scholar 

  18. Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL et al. Early detection of prostate cancer: AUA Guideline. J Urol 2013; 190: 419–426.

    Article  Google Scholar 

  19. Kawachi MH, Bahnson RR, Barry M, Busby JE, Carroll PR, Carter HB et al. NCCN clinical practice guidelines in oncology: prostate cancer early detection. J Natl Compr Canc Netw 2010; 8: 240–262.

    Article  CAS  Google Scholar 

  20. Wolf AM, Wender RC, Etzioni RB, Thompson IM, D'Amico AV, Volk RJ et al. American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin 2010 60: 70–98.

    Google Scholar 

  21. Qaseem A, Barry MJ, Denberg TD, Owens DK, Shekelle P . Screening for prostate cancer: a guidance statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2013; 158: 761–769.

    Article  Google Scholar 

  22. Drazer MW, Prasad SM, Huo D, Schonberg MA, Dale W, Szmulewitz RZ et al. National trends in prostate cancer screening among older American men with limited 9-year life expectancies: evidence of an increased need for shared decision making. Cancer 2014; 120: 1491–1498.

    Article  Google Scholar 

  23. Barocas DA, Mallin K, Graves AJ, Penson DF, Palis B, Winchester DP et al. Effect of the USPSTF Grade D Recommendation against Screening for prostate cancer on incident prostate cancer diagnoses in the United States. J Urol 2015; 194: 1587–1593.

    Article  Google Scholar 

  24. Kim SP, Karnes RJ, Gross CP, Meropol NJ, Van Houten H, Abouassaly R et al. Contemporary National Trends of Prostate Cancer Screening Among Privately Insured Men in the United States. Urology 2016; 97: 111–117.

    Article  Google Scholar 

  25. Halbert CH, Gattoni-Celli S, Savage S, Prasad SM, Kittles R, Briggs V et al. Ever and annual use of prostate cancer screening in African American men. Am J Mens Health 2017; 11: 99–107.

    Article  Google Scholar 

  26. Ross LE, Powe BD, Taylor YJ, Howard DL . Physician–patient discussions with african american men about prostate cancer screening. Am J Mens Health 2008; 2: 156–164.

    Article  Google Scholar 

  27. Auffenberg GB, Meeks JJ . Application of the 2013 American Urological Association early detection of prostate cancer guideline: who will we miss? World J Urol 2014; 32: 959–964.

    Article  Google Scholar 

  28. Carpenter WR, Howard DL, Taylor YJ, Ross LE, Wobker SE, Godley PA . Racial differences in PSA screening interval and stage at diagnosis. Cancer Causes Control 2010; 21: 1071–1080.

    Article  Google Scholar 

  29. Powell IJ, Vigneau FD, Bock C, Ruterbusch J, Heilbrun LK . Reducing prostate cancer racial disparity: evidence for aggressive early prostate cancer PSA testing of African American Men. Cancer Epidemiol Biomarkers Prev 2014; 23: 1505–1511.

    Article  Google Scholar 

  30. DeFrank JT, Barclay C, Sheridan S, Brewer NT, Gilliam M, Moon AM et al. The psychological harms of screening: the evidence we have versus the evidence we need. J Gen Intern Med 2015; 30: 242–248.

    Article  Google Scholar 

  31. Klotz L . Active surveillance for low-risk prostate cancer. Curr Urol Rep 2015; 16: 24.

    Article  Google Scholar 

  32. Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol 2015; 33: 272–277.

    Article  Google Scholar 

  33. Loeb S, Sanda MG, Broyles DL, Shin SS, Bangma CH, Wei JT et al. The prostate health index selectively identifies clinically significant prostate cancer. J Urol 2015; 193: 1163–1169.

    Article  Google Scholar 

  34. Wei JT, Feng Z, Partin AW, Brown E, Thompson I, Sokoll L et al. Can urinary PCA3 supplement PSA in the early detection of prostate cancer? J Clin Oncol 2014; 32: 4066–4072.

    Article  CAS  Google Scholar 

  35. Tomlins SA, Day JR, Lonigro RJ, Hovelson DH, Siddiqui J, Kunju LP et al. Urine TMPRSS2:ERG plus PCA3 for individualized prostate cancer risk assessment. Eur Urol 2015; 70: 45–53.

    Article  Google Scholar 

  36. Sokoll LJ, Sanda MG, Feng Z, Kagan J, Mizrahi IA, Broyles DL et al. A prospective, multicenter, National Cancer Institute Early Detection Research Network study of [-2]proPSA: improving prostate cancer detection and correlating with cancer aggressiveness. Cancer Epidemiol Biomarkers Prev 2010; 19: 1193–1200.

    Article  Google Scholar 

  37. Lee DJ, Ahmed HU, Moore CM, Emberton M, Ehdaie B . Multiparametric magnetic resonance imaging in the management and diagnosis of prostate cancer: current applications and strategies. Curr Urol Rep 2014; 15: 390.

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by NIH Grants RO1CA92447, NCI/NIH 2P30CA068485-19 and NCI 5K12CA090625-14. The SCCS is supported by NIH Grants R01 CA092447 and U01 CA202979, and the Survey and Biospecimen Shared Resource, which is supported in part by the Vanderbilt‐Ingram Cancer Center (P30 CA68485).

Author contributions

KAM: Planning and conducting the study, reporting and overall guarantor; ZZ: planning and conducting the study, reporting and overall guarantor; YB: reporting; JA: reporting; AH: reporting; WJB: planning and conducting the study, reporting and overall guarantor; JHF: planning and conducting the study, reporting and overall guarantor.

Author information

Author notes

  1. K A Moses and Z Zhao: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Urologic Surgery, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA

    K A Moses & J H Fowke

  2. Department of Biostatistics, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA

    Z Zhao & Y Bi

  3. Meharry Medical College, Nashville, TN, USA

    J Acquaye & A Holmes

  4. Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA

    W J Blot & J H Fowke

Authors
  1. K A Moses
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Z Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y Bi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Acquaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A Holmes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W J Blot
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J H Fowke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K A Moses.

Ethics declarations

Competing interests

Dr Moses is a member of the NCCN Guidelines Panel on Early Detection of Prostate Cancer, and is on the Speakers’ Bureau of Astellas/Medivation. The other authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moses, K., Zhao, Z., Bi, Y. et al. The impact of sociodemographic factors and PSA screening among low-income Black and White men: data from the Southern Community Cohort Study. Prostate Cancer Prostatic Dis 20, 424–429 (2017). https://doi.org/10.1038/pcan.2017.32

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/pcan.2017.32

This article is cited by

Search

Advanced search

Quick links