Purpose: To examine the types of discussions men have with health care providers prior to getting a PSA (prostate-specific antigen) test.

Methods: Data were drawn from the National Cancer Institute's, nationally representative, 2005 Health Information National Trends Survey (n=5,394). Of the 778 men in the sample who were 50+ years old, never had prostate cancer, and had heard of a PSA test, we analyzed data from 607 (78%) who had received a PSA test and provided complete data. We assessed provider-patient communication about PSA testing by asking each respondent two questions: whether a provider had talked with him about PSA and the extent to which his provider encouraged him to ask questions/express concerns about PSA. Responses to these questions resulted in three “decision-making paths”: 1. Provider did not discuss PSA; 2. Provider discussed PSA but did not strongly encourage questions; 3. Provider discussed PSA and strongly encouraged questions.

Results: Men in our sample were largely white (88%), married (72%) and insured (96%); 44% had a college education; 32% had an annual income of at least $75K; 18% had a personal history of cancer other than prostate and 7% had family history of prostate cancer. Only 42% of respondents took the “best path” to a screening PSA test: discussion that included being strongly encouraged to ask questions. In fact, 12% had a PSA with no discussion at all; 46% had discussion without being strongly encouraged to ask questions. “Decision making path” was positively associated with income [p<0.05, chi sq (6) =13.86] and being married [p<0.01, chi sq (2) =11.56]. Education, race/ethnicity, insurance status, and both cancer history variables were not significant.

Conclusions: The majority of men who get a screening PSA test are doing so without a detailed discussion with a health care provider. National guidelines recommend providers facilitate informed decision-making by patients largely because current data do not support recommending for or against the PSA test; our nationally-representative data suggest these guidelines are not being followed. The possible longer-term consequences of having a screening PSA – and facing a cancer diagnosis, treatment choices, and side effects – without having a chance to talk about and question the plusses, minuses and alternatives, are unknown and warrant further investigation.