Clinical Research

Shared decision making and prostate-specific antigen based prostate cancer screening following the 2018 update of USPSTF screening guideline



Previous study reported shared decision making was underused in PSA-based prostate cancer screening. In mid-2018, the US Preventive Service Task Force recommended shared decision making (SDM) before PSA-based prostate cancer screening among men aged 55–69 year while remained against PSA testing in men aged 70 or older. The objective of this study is to examine recent changes in SDM and prostate cancer screening following recent USPSTF recommendations.


A retrospective cross-sectional study among men aged 50 years or older were conducted using 2015 and 2018 National Health Interview Survey data (n = 10,926). Outcomes included self-reported PSA testing for prostate cancer screening last year, and if yes, whether respondent ever had a discussion with the healthcare provider about its advantages and disadvantages. Analyses were stratified by respondent’s age (50–54 vs. 55–69 vs. 70+).


Routine PSA screening rates remained stable from 34.3% in 2015 to 35.4% in first half of 2018, and 36.0% in second half of 2018 (p trend = 0.57). A similar pattern was found in men ≥70 years (p trend = 0.98). Receipt of SDM increased in men aged ≥50 years from 30.5% in 2015 to 33.6% in first half of 2018, and 36.7% in second half of 2018 (p trend = 0.002). The increase was most prominent in men aged 55 to 69 years (31.6, 36.9, and 40.2% in 2015, first half of 2018 and second half of 2018 respectively; p trend = 0.001).


Between 2015 and 2018, there was no significant increase in the PSA-based prostate cancer screening. However, a significant increasing trend in SDM was observed, especially in men aged 55–69 years.

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Fig. 1: Recent patterns in prostate-specific antigen based prostate cancer screening and shared decision making by age group in the United States, 2015 and 2018 National Health Interview Survey.


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CJ and XH had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the paper: All authors. Critical revision of the paper for important intellectual content: All authors. Statistical analysis: CJ and XH. Administrative, technical, or material support: CJ and XH. Supervision: SAF, AJ, and XH.

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Correspondence to Changchuan Jiang.

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Jiang, C., Fedewa, S.A., Wen, Y. et al. Shared decision making and prostate-specific antigen based prostate cancer screening following the 2018 update of USPSTF screening guideline. Prostate Cancer Prostatic Dis (2020).

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