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Psychosocial Factors Associated with an Increased Frequency of Prostate Cancer Screening in Men Ages 40 to 79 Years: The Olmsted County Study

Departments of ¹ Urology and ² Epidemiology, University of Michigan; ³ Department of Urology and Divisions of ⁴ Epidemiology and ⁵ Biostatistics, Mayo Clinic; and ⁶ Southern California Permanente Medical Group, Pasadena, California

Requests for reprints: Lauren P. Wallner, Departments of Epidemiology and Urology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109. Phone: 734-936-1848; Fax: 734-936-9536. E-mail: lwallner{at}umich.edu

Prostate cancer is the second leading cause of cancer deaths among U.S. men. Early detection is associated with drastically improved 5-year survival rates. It is unclear, however, what psychosocial factors motivate or discourage men from taking advantage of both prostate-specific antigen (PSA) testing and digital rectal examination (DRE). The goal of the current study was to identify psychosocial factors that influence screening behavior for prostate cancer in a cohort of 2,447 men. In 1990, a randomly selected cohort of Caucasian men, ages 40 to 79 years, from Olmsted County, Minnesota, were enrolled in the study. These men completed a questionnaire containing queries on family history of prostate cancer, concern about getting prostate cancer, and marital status. Medical and laboratory records were reviewed to determine the number DREs (1989-1996) and PSA tests (1989-1998). Frequent screening was defined as the upper 25th percentile for number of DREs (>4) or PSAs (>3). Men who have a family history and men who worry or have concern about prostate cancer were more likely [odds ratio (OR), 1.5; 95% confidence interval (95% CI), 1.2-2.0 and OR, 1.9; 95% CI, 1.4-2.5] to seek screening compared with those without a family history or worry. The association between family history and frequent screening was similar in men who were married or living with someone (OR, 1.7; 95% CI, 1.2-2.2); however, it was reduced among men who live alone (OR, 0.6; 95% CI, 0.2-1.8). These data suggest that psychosocial factors such as family history, worry, or concern about prostate cancer and marital status may play an important role in men's decisions about prostate cancer screening. (Cancer Epidemiol Biomarkers Prev 2008;17(12):3588–92)