Impact of Sexual Orientation and Race/Ethnicity on the Differences in Shared Decision-Making and Prostate Cancer Screening

Disparities have been extensively documented in prostate cancer screening uptake and shared decision-making conversations among racial and sexual minorities. Yet, the impact of racial/ethnic identity and sexual orientation on prostate-specific antigen (PSA) testing uptake remains uncertain.

This analysis used the 2018-2022 Behavioral Risk Factor Surveillance Survey data. Outcomes included survey responses to questions about engagement in shared decision-making and PSA testing uptake. In total, 88,365 heterosexual men and 2562 sexual minority men aged 55 to 69 years were included in this analysis.

The data were categorized by race/ethnicity, and survey-weighted logistic regression models were utilized to examine the relationship between sexual orientation and outcomes. Models were adjusted for age, marital status, level of education, household income, insurance coverage, having a regular healthcare provider, and geographical location.

In contrast to White heterosexual men, White sexual minority men demonstrated a greater tendency to discuss the disadvantages of PSA testing with their healthcare provider (odds ratio [OR], 1.407; P<.001) and to undergo PSA testing (OR, 1.320; P<.001).

Compared with Asian heterosexual men, Asian sexual minority men exhibited a greater tendency to engage in discussions regarding PSA testing (OR, 4.470; P<.05), discuss the benefits of PSA testing (OR, 4.596; P<.05), receive recommendations for PSA testing (OR, 4.836; P<.05), and undergo PSA testing (OR, 4.401; P<.001).

Black sexual minority men had a higher likelihood of undergoing screening due to a specific issue or reason other than routine screening (OR, 1.073; P<.05) in comparison to Black heterosexual men.

The likelihood of Hispanic sexual minority males undergoing screening as part of their routine checkup was notably higher (OR, 4.2; P<.001) when compared with Hispanic heterosexual males. No differences in sexual orientation were found in PSA screening or shared decision-making among American Indians or Native Alaskans.

Variations in the utilization of PSA testing and shared decision-making based on sexual orientation differ across racial and ethnic backgrounds. Additional research is necessary to examine the determinants influencing PSA testing uptake and shared decision-making among sexual minority men belonging to various racial and ethnic groups.