Data published in JAMA Network Open suggest that there may be a lack of knowledge among primary care providers (PCPs) on the value of prostate specific antigen (PSA) testing, particularly for high-risk groups such as those of African ancestry.1
“Black individuals have experienced a consistent and dramatic disparity in prostate cancer death in the US over the past 50 years, despite advances in the diagnosis and treatment of prostate cancer,” the authors explained. “Our first integrated finding suggests that both patients and physicians come to informed decisions around PSA-based screening with substantial knowledge deficits regarding benefits and harms of prostate cancer early detection.”
For the study, the investigators interviewed 29 Black men with a median age of 59 years (range, 32 to 72). In addition, 31 primary care providers (PCPs) and 32 urologists took part in a survey on their beliefs and perceptions on PSA screening. Notably, 90.3% of PCPs and 75% of urologists identified as White, whereas only 3.2% of PCPs and 3.1% of urologists identified as Black.
The interviews with Black men revealed a belief that PCPs functioned as the gatekeepers of PSA testing. However, participants also believed that many PCPs lacked knowledge specific to Black men’s risk for prostate cancer and held attitudes about testing that do not support its use. For example, participants noted that information about Black men’s specific health risks often focused on conditions such as cardiovascular disease and diabetes, rather than prostate cancer.
Some patients even reported resistance from their PCPs when they asked about PSA testing.
Yaw A. Nyame, MD, MS, MBA
“In our study, we found that this request was often met with resistance, that the primary care providers didn’t believe in PSA testing,” said Yaw A. Nyame, MD, MS, MBA, in a news release on the findings.2 “In bigger picture, we need to revisit how we view prostate cancer screening in these communities.”
Survey findings supported participants’ perceptions that PCPs do not value PSA testing for prostate cancer.
Compared with urologists, PCPs were more likely to rely on United States Preventive Services Task Force (USPSTF) guidelines in their screening practices compared with urologists. In total, 96.8% of PCPs said that they relied on USPSTF guidelines for screening, compared with 31.2% of urologists.
PCPs were also less likely than urologists to rely on American Urological Association (AUA) or American Cancer Society (ACS) guidelines to support their screening practices. Overall, 51.6% of PCPs vs 90.6% of urologists reported relying on AUA or ACS guidelines. Notably, only 13% of PCPs reported being familiar with the content of either the AUA or ACS guidelines. These findings are especially important considering that USPSTF guidelines currently do not include recommendations specific to Black patients, while AUA and ACS guidelines do include considerations for high-risk groups.
The authors noted, “Incorporating evidence-driven guidance for PSA screening among Black individuals into the guidelines that PCPs rely on could therefore substantially improve prostate cancer early detection among this highly at-risk population.”
In assessing attitudes toward screening, a high percentage of both PCPs (80.6%) and urologists (84.4%) reported a belief that early detection of prostate cancer is important for reducing all-cancer mortality. However, despite these similar rates, PCPs were significantly less likely than urologists (41.9% vs 81.3%) to report that early detection was important for reducing prostate cancer-specific mortality.
The data also found differences in attitudes toward PSA testing specifically. Overall, 48.4% of PCPs reported that the PSA test was an overall valuable test, compared with 96.9% of urologists. Further, only 6.5% of PCPs reported a belief that PSA testing can substantially reduce prostate cancer death in screened patients, compared with 75% of urologists.
Consistent with these attitudes, PCPs were also less likely than urologists to discuss PSA testing with their at-risk patients. Specifically, 61.3% of PCPs vs 87.5% of urologists reported often or always discussing PSA testing with Black patients. Additionally, 45.2% of PCPs vs 90.6% of urologists reported often or always discussing PSA testing with those who have a family history of prostate cancer.
Lead author Jenney R. Lee, MA, concluded in the news release,2 “We know this is a hot button issue in many medical communities. But this is a discussion that needs to be had.”
REFERENCES
1. Lee JR, Morehead D, Young B, et al. Patient and physician perceptions of prostate-specific antigen testing among Black individuals. JAMA Netw Open. 2025;8(9):e2530946. doi:10.1001/jamanetworkopen.2025.30946
2. New hurdle seen to prostate screening: Primary-care docs. News release. University of Washington School of Medicine and UW Medicine. September 12, 2025. Accessed September 15, 2025. https://www.newswise.com/articles/new-hurdle-seen-to-prostate-screening-primary-care-docs