Risk-Based Prostate Cancer Screening: Perceptions and Informational Needs of Screening-Eligible Men

Prostate Cancer (PCa) is the most common cancer among men in the U.S., however, Black men are more likely to get and die from prostate cancer as compared to White men. Although PCa screening using Prostate-Specific Antigen (PSA) has the potential to improve outcomes, over-screening can contribute to significant harm including over-diagnosis, over-treatment, and false positives. The moderate benefits of widespread PCa screening as well as the potential harms has led to inconsistent PSA screening guidelines. This leaves the decision to screen up to each individual, ideally with men discussing the individual harms and benefits of screening with their providers before deciding whether to be screened (i.e., informed decision-making). However, evidence suggests that these nuanced decisions rarely happen. The decision to screen is especially burdensome for Black men as they are generally at higher risk for incident PCa as well as adverse outcomes. Nonetheless, even among Black men there is a lack of consistent screening recommendations. This has led to a sub-optimal situation where there is significant over-screening among older, wealthy, educated men and lower rates of screening among African American men. In ongoing research much needed strategies for PSA-based, risk-stratified or tailored screening that determines “who”, “when”, and “how often” men should be screened for PCa based on their individual risk are being developed. However, effective implementation of risk-based screening recommendations will require a thorough understanding of how men perceive screening harms and benefits. Specifically, risk-stratified screening recommendations will likely require some men to either escalate or de-escalate screening; yet little is known about how to effectively implement tailored screening decisions. These decisions will likely be even more burdensome for Black men as messaging about screening may make them more likely to favor PSA testing without the opportunity to engage in informed decision-making. Men with limited health literacy and medical mistrust may also experience additional barriers in making well-informed PCa screening decisions and navigating the healthcare system. Therefore, in this proposal we will use focus groups to characterize the perceptions, informational needs, beliefs, and knowledge of Black men regarding (1) the benefits and harms of PSA screening and (2) tailored, risk-based recommendations to escalate or de-escalate screening, while accounting for heterogeneity in health literacy and medical mistrust (Aim 1). We will then develop recommendations to enhance risk-based PSA screening decisions (Aim 2). In the future the findings of our study, coupled with risk-based screening strategies, can be used to develop a decision support tool that will aid men in making well-informed screening decisions and help improve outcomes. Project Number: 1R03CA308660-01 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: Saira Khan | Institution: WASHINGTON UNIVERSITY, SAINT LOUIS, MO | Award Amount: $160,093 | Activity Code: R03 | Study Section: Special Emphasis Panel[ZRG1 SEIR-B (80)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11291600