Introduction:

Prostate cancer is the second most common cancer among men worldwide. In 2015, one third of men in the US older than 50-years-old had been screened for PCa with prostate-specific antigen (PSA) testing. 

Screening rates for various malignancies, such as breast cancer, have been shown to be affected by sexual orientation. However, studies assessing the impact of sexual orientation on screening men for prostate cancer are lacking. Therefore, we sought to assess the role of sexual orientation on PSA testing among men in the US. 

Methods:

Data for men ≥ 40 years-old with no history of prostate cancer (n=22,825) were collected from the National Health Interview Survey (NHIS). The NHIS is a nationally representative, cross-sectional health survey of civilian, non-institutionalized people, which asks about specific demographic and health information including behaviors and conditions.

Descriptive statistics were calculated using the Mann-Whitney and Chi-Square tests for continuous and categorical variables, respectively. Temporal trends were compared using the Cochran-Armitage trend test. Multivariable logistic regression was used to determine the association between sexual orientation and  screening PSA test adjusting for age, race, marital status, income, region, insurance type, time since last seeing a physician, whether or not they had looked up health information on the internet in the last 12 months, self-reported health level, comorbidity, education level, smoking status, language of interview, whether they needed but could not afford medical care within the prior 12 months, and alcohol use status.

Results:

A total 481 (2.1%) and 93 (0.4%) men identified as gay and bisexual, respectively. Gay and bisexual men who reported ever undergoing a PSA screening test were younger than straight men (median ages 58 and 62.5 vs 64 years, respectively, p<0.0001). The proportion of gay, straight, and bisexual men that had ever received a PSA test was 53% , 45%, and 44%, respectively. There were no significant changes in PSA testing in the prior year across survey years for gay (35% in 2013 to 35% in 2018, p = 0.09), bisexual men (23% in 2013 to 41% in 2018, p = 0.98). However, there was an increase in testing for straight men (26% in 2013 to 31% in 2018, p < 0.001). On multivariable analysis, gay men were more likely to have ever undergone a screening PSA test (OR 1.56; 95% CI 1.20 – 2.02). 

Conclusion:

We found significant disparities in prostate cancer screening according to sexual orientation in the US between 2013-18. Gay men were more likely to have ever undergone a screening PSA test compared to straight men. Moreover, gay men were screened at a younger age comapred to straight men. These data reinforce the importance of accounting for sexual orientation when determining healthcare delivery. Studies are needed to deter understand the role of sexual orientation in prostate cancer screening and management. 

Funding: N/A