New Hollings study reveals barriers, presents solutions to improve prostate cancer screening among Black men

Ending health disparities isn’t just something Nicholas Shungu, MD, preaches – it’s something he practices every day as an MUSC Health family medicine physician. It’s one reason he led a new study revealing barriers, and presenting solutions, to improving prostate cancer screening decision-making among Black men.

“Historically, Black men haven’t been included in studies that guide screening recommendations,” Shungu said. “I’ve always had a desire to change that.”

That desire became even stronger during medical school when Shungu’s father was diagnosed with and treated for prostate cancer near their New Jersey home. That experience was a driving factor in a study led by Shungu that was published in the Journal of the American Board of Family Medicine.

In the study, titled Barriers and Facilitators to Informed Decision-Making About Prostate Cancer Screening Among Black Men, researchers found that the majority of the 21 Black men who participated didn’t feel as though they had adequate information to make an informed decision about prostate cancer screenings.

“We know that Black men have a higher incidence rate and mortality rate of prostate cancer than white men,” Shungu said. “Despite that, we are still falling short in providing adequate education about screenings and reaching the populations that are at a higher risk.”

Participants in the study took part in a focus group to discuss their experiences as patients, their knowledge of prostate cancer screening and their attitudes toward screening recommendations. A majority of the men, 61.9%, had a friend or family member diagnosed with prostate cancer and had also talked with a doctor about prostate cancer screening before. However, only 47.6% of participants had been screened for prostate cancer using a PSA blood test.

“I think there are two big takeaways. One, we as clinicians must do a better job about educating and talking with patients, especially Black men, about prostate cancer and screening options available to them,” Shungu said. “Second, we really need to help patients feel more comfortable making a decision about prostate cancer screening.”

Researchers identified several barriers in the study that affected the likelihood of making an informed decision about prostate cancer screening. In addition to not feeling educated enough to make an informed decision about screening, participants also told researchers that they hadn’t had proper discussions with their doctors about the perceived benefits and risks of getting tested. There also was concern about pride and the fear that being screened could impact a man’s sexual function.

“Screening doesn’t affect sexual function,” Shungu said. “If diagnosed with prostate cancer, there is the possibility of erectile dysfunction and urinary incontinence stemming from treatment, but that is down the road and not something caused by screening itself.”

Katherine Sterba, PhD, an MUSC Hollings Cancer Center researcher and co-author of the study, said she was also surprised about the confusion and misconceptions participants had about the types of screening tests available and the difference between prostate cancer screening and a colonoscopy. Sterba said many of the men thought that the only way to screen for prostate cancer was through a digital rectal exam and were unfamiliar with the PSA blood test option.

“This study is a great example of research questions coming directly out of clinical practice,” Sterba said. “It’s so important to listen to patients, understand their experiences and use research findings to guide clinical practice about how best to talk with and advise patients.”

By providing better resources and education about prostate cancer screening and encouraging dialogue about it in the community, researchers believe more Black men would make informed decisions about screenings.

Shungu said efforts already underway at Hollings, such as the SC Amen Program, will play an important role in education and awareness within the Black community. Shungu believes that those efforts, along with candid discussions with their doctors about prostate cancer screening, could save lives moving forward.

“These are difficult conversations to have. We as doctors have to do better. We need to be more comfortable having real conversations with these men,” he said. “I hope that this study and my work in medicine can help to reduce health disparities and save lives. That’s my ultimate goal.”