Can Women Facilitate Men's Prostate Cancer Screening Informed Decision-Making? The M-PACT Trial

Evidence-based Prostate Cancer Screening Interventions for Black Men: A Systematic Review

Prostate cancer is the second leading cause of death for men in the U.S. and Black men are twice as likely to die from the disease. However, prostate cancer, if diagnosed at an earlier stage, is curable. The purpose of this review is to identify prostate cancer screening clinical trials that evaluate screening decision-making processes of Black men.

METHODS

The databases PubMed, Ovid MEDLINE, CINAHL Plus, and PsychInfo were utilized to examine peer-reviewed publications between 2017 and 2023. Data extracted included implementation plans, outcome measures, intervention details, and results of the study. The Critical Appraisal Skills Programme was used to assess the quality of the evidence presented.

RESULTS

Of the 206 full-text articles assessed, three were included in this review. Educational interventions about prostate cancer knowledge with shared and informed decision-making (IDM) features, as well as counseling, treatment options, and healthcare navigation information, may increase prostate cancer screening participation among Black men. Additionally, health partner educational interventions may not improve IDM related to screening participation. The quality of the evidence presented in each article was valid and potentially impactful to the community.

DISCUSSION

Black men face various social determinants of health barriers related to racism, discrimination, cost of health services, time away from work, and lack of trust in the healthcare system when making health-related decisions, including prostate cancer screening participation. A multifactorial intervention approach is required to address these inequities faced by Black men especially as prostate cancer is curable when diagnosed at an earlier stage.

Prostate Cancer Foundation Screening Guidelines for Black Men in the United States

BACKGROUND

In the United States, Black men are at highest risk for being diagnosed with and dying from prostate cancer. Given this disparity, we examined relevant data to establish clinical prostate-specific antigen (PSA) screening guidelines for Black men in the United States.

METHODS

A comprehensive literature search identified 1848 unique publications for screening. Of those screened, 287 studies were selected for full-text review, and 264 were considered relevant and form the basis for these guidelines. The numbers were reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Three randomized controlled trials provided Level 1 evidence that regular PSA screening of men 50 to 74 years of age of average risk reduced metastasis and prostate cancer death at 16 to 22 years of follow-up. The best available evidence specifically for Black men comes from observational and modeling studies that consider age to obtain a baseline PSA, frequency of testing, and age when screening should end. Cohort studies suggest that discussions about baseline PSA testing between Black men and their clinicians should begin in the early 40s, and data from modeling studies indicate prostate cancer develops 3 to 9 years earlier in Black men compared with non-Black men. Lowering the age for baseline PSA testing to 40 to 45 years of age from 50 to 55 years of age, followed by regular screening until 70 years of age (informed by PSA values and health factors), could reduce prostate cancer mortality in Black men (approximately 30% relative risk reduction) without substantially increasing overdiagnosis.

CONCLUSIONS

These guidelines recommend that Black men should obtain information about PSA screening for prostate cancer. Among Black men who elect screening, baseline PSA testing should occur between ages 40 and 45. Depending on PSA value and health status, annual screening should be strongly considered. (Supported by the Prostate Cancer Foundation.).

Community Health Worker Interventions for Men: A Scoping Review Using the RE-AIM Framework

INTRODUCTION

Community health workers (CHWs) are health promotion specialists who are trusted members of the community served and have a close understanding of the community's needs and values. CHWs are a cost-effective and scalable workforce to promote health among men through tailored approaches. The purpose of the present review was to use the RE-AIM Framework to assess design, implementation, and outcomes of CHW-implemented health promotion efforts tailored for men to provide recommendations for future efforts.

METHODS

The protocol was pre-registered with PROSPERO. The primary inclusion criteria were that the interventions were (a) implemented at least partially by CHWs, (b) conducted only among men, and (c) designed to improve a health-related outcome. PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Global Index Medicus were searched using a librarian-generated search strategy. In all, 1,437 articles were uploaded to Rayyan and two reviewers blindly reviewed each article for inclusion. A total of 24 articles met the inclusion criteria.

RESULTS

Most interventions (a) targeted men under 50 years, (b) were conducted among a subset of underserved men, (c) improved health outcomes, (d) community-based and informed, (e) atheoretical, and (f) had satisfactory retention rates. The roles and responsibilities of CHWs were varied. Attention was given to training of CHWs, but limited attention was given to how/if the CHWs were supervised.

DISCUSSION

CHW-implemented interventions can improve health outcomes among men. Opportunities exist to build on past interventions, such as addressing mental health and incorporating prosocial aspects of masculinity. The results have implications for designing similar interventions.

Enhancing public awareness and practice of prostate cancer screening among African men: A scoping review

BACKGROUND

Prostate cancer (PCa)-related incidence is on the increase, with black South African men presenting disproportionately with aggressive disease. Recent studies show a greater net benefit of prostate-specific antigen (PSA) screening of black men compared with the general population. This scoping review provides an overview of available research on strategies that have enhanced PCa screening awareness and practice in the African setting.

METHODS

Relevant databases were searched to identify 2010-2021 studies. Following scoping review guidelines, data were extracted, summarised and quantitatively analysed.

RESULTS

Of the 21 articles included, 19 were from the United States. Nine were published within the last five years and 14 were pre-test/post-test. Most articles evaluated the effect of health-promoting strategies on awareness and practice of PCa screening among black men. Community-oriented strategies enhanced awareness and practice of PCa screening. Healthcare providers and community members, including PCa survivors, participated in the strategies' planning, development and implementation. Topics that improve PCa knowledge and clear cultural misconceptions were addressed, targeting public spaces unique to these men. Prostate cancer health education methods were diverse, comprehensive, user friendly and culturally sensitive.

CONCLUSION

More research on strategies to enhance PCa screening awareness and practice among African men is needed, as this is scarce. Strategies enhancing PCa screening awareness and practice among African men are community oriented and entail health education methods, topics, presenters and venues. These strategies can be adopted in the South African setting.Contribution: This study recommends strategies to enhance the awareness and practice of PCa screening among African men.

Investigation of awareness rate of prostate-specific antigen (PSA) among the general public in China and analysis of influencing factors

Objective

This study aimed to evaluate the awareness rate of prostate-specific antigen (PSA) among the general public in China and provide data about prostate cancer (PCa) for related scientific research.

Methods

A cross-sectional survey of PSA awareness was conducted in multiple regional populations using an online questionnaire. The questionnaire included basic information, knowledge about PCa, the awareness rate and application of PSA, and future expectations toward applying PSA screening in clinical practice. The study applied the methods of Pearson chi-square analysis and Logistic regression analysis.

Results

A total of 493 valid questionnaires were included. Two hundred and nineteen respondents (44.4%) were males, and 274 (55.6%) were females. Of all respondents, 212 (43.0%) were under 20 years old, 147 (29.8%) were 20-30 years old, 74 (15.0%) were 30-40 years old, and 60 (12.2%) were over 40 years old. There are 310 people (62.9%) with medical educational background and 183 (37.1%) without. One hundred eighty-seven (37.9%) of the respondents were aware of PSA, and 306 (62.1%) were unaware of PSA. Statistically significant differences were obtained between the two groups regarding different ages, educational backgrounds, occupations, departments, and habits of knowing medical knowledge (all p < 0.05). In addition, the differences between the group of aware of PSA (AP) and the group unaware of PSA (UAP) in terms of whether they had been exposed to PSA screening and whether they had exposure to PCa patients or related knowledge were also observed (all p < 0.05). Age ≥30 years, medical educational background, understanding of medical knowledge, exposure to PCa patients or related knowledge, exposure to PSA screening, and status as a graduate student and above were independent factors for the occurrence of PSA awareness events (all p < 0.05). In addition, age ≥ 30 years, medical educational background, and awareness of PSA were independent factors for future expectations toward PSA (all p < 0.05).

Conclusions

We first analyzed the public awareness of PSA. Cognition degrees of PSA and PCa awareness vary among different populations in China. Therefore, we should designate corresponding widespread scientific educational programs for different populations to increase the awareness rate of PSA.