Millions of men worldwide grapple with the crucial decision of whether to undergo screening for prostate cancer, a leading cause of cancer-related death among men. National medical guidelines emphasize the importance of a personalized conversation between patients and their healthcare providers discussing the benefits and potential harms of prostate cancer screening before deciding to proceed with testing. However, new research from the Medical University of South Carolina (MUSC) reveals that these conversations occur far less frequently than recommended—an oversight that could impact early detection and treatment outcomes significantly.
The study, published in the Southern Medical Journal and led by family medicine physician and MUSC Hollings Cancer Center researcher Dr. Nicholas Shungu, involved a retrospective review of medical records from 600 men aged 45 to 69 receiving primary care in MUSC family medicine clinics. The investigation specifically looked for documentation of shared decision-making discussions about prostate cancer screening and subsequent prostate-specific antigen (PSA) testing. Alarmingly, only 6% of these encounters contained documentation of a shared decision-making conversation, underscoring a substantial gap between clinical practice and national guidelines.
Prostate cancer screening is markedly different from other widely accepted cancer screenings, such as mammograms for breast cancer or colonoscopies for colorectal cancer. The principal tool for prostate cancer detection, the PSA blood test, measures the level of prostate-specific antigen—a protein produced by the prostate gland that can rise in response to cancer but also due to benign conditions such as benign prostatic hyperplasia and inflammation. These nuances render PSA tests less definitive, raising the risk of overdiagnosis and overtreatment. Men with elevated PSA levels often undergo invasive biopsies that sometimes reveal indolent cancers that might never progress clinically, posing significant implications for patient quality of life and healthcare resources.
Dr. Shungu emphasizes the evolving landscape of prostate cancer detection, noting that advances such as multiparametric prostate magnetic resonance imaging (MRI) provide enhanced accuracy. These imaging techniques help discriminate which patients require biopsies and which do not, reducing unnecessary procedures. Additionally, active surveillance strategies have become more refined, enabling careful monitoring of low-risk prostate cancers and thereby avoiding immediate treatment while safeguarding patients. Together, these advancements have shifted the existing paradigm from blanket screening recommendations towards individualized, informed decision-making between clinicians and patients.
The MUSC study’s results highlight that shared decision-making discussions play a powerful role in directing patient outcomes. Men who had documented conversations about prostate cancer screening were twice as likely—approximately 72%—to receive PSA testing, compared to only 36% among those without documented discussions. This effect was even more pronounced in Black men, who are disproportionately affected by prostate cancer: 85% of Black men with documented discussions proceeded to screening versus 36% of those without such conversations. These findings underscore that communication significantly influences screening behavior and patient engagement.
This disparity in prostate cancer burden among Black men—who experience higher incidence and mortality rates relative to other groups—draws focus to the critical need for equitable healthcare dialogue. Prostate cancer is the most common non-skin malignancy in men in South Carolina, and the state reports some of the nation’s highest death rates from the disease. By facilitating open, culturally sensitive discussions within primary care settings, clinicians may improve screening uptake and early detection rates in underserved populations at elevated risk.
Despite the undeniable importance of these conversations, several barriers reduce their occurrence during routine primary care visits. Time constraints, competing health priorities, and the complexity of balancing risks and benefits complicate clinicians’ ability to engage in thorough dialogues. There is also the possibility that some conversations occur but remain undocumented in electronic health records, posing challenges for researchers and quality improvement efforts seeking to capture the breadth of shared decision-making practices accurately.
Dr. Shungu advocates for making prostate cancer screening discussions an essential and deliberate part of clinical encounters. Clinicians must prioritize these dialogues to empower patients with knowledge of the nuanced benefits and limitations of PSA testing and the evolving treatment landscape. Patients, in turn, should feel encouraged to proactively raise prostate health concerns during medical visits, thereby championing their own prevention and wellness needs in partnership with healthcare providers.
The MUSC team’s findings resonate with broader initiatives underway in South Carolina aimed at combating prostate cancer disparities. Programs such as the South Carolina African American Men’s Education Network (SC AMEN) and the South Carolina Prostate Cancer Research, Education and Networking Strategies (SC PRENS) engage community members and healthcare partners to increase awareness, access, and screening among men at high risk. This study reinforces shared decision-making as a vital strategy complementing these outreach efforts.
In sum, this research sheds light on a critical but underutilized step in prostate cancer care—meaningful, documented communication between patients and clinicians about screening choices. As medical science refines diagnostic accuracy and treatment personalization, fostering informed discussions becomes paramount to delivering optimal, patient-centered cancer care. Transforming guidelines into everyday practice requires elevating these conversations within primary care and community settings alike.
Subject of Research: People
Article Title: Prostate Cancer Screening Shared Decision Making and Prostate-Specific Antigen Testing in Black and Non-Black Men in Primary Care in South Carolina
News Publication Date: 2-Jun-2026
Web References: http://dx.doi.org/10.14423/SMJ.0000000000001980
References: Southern Medical Journal article (DOI: 10.14423/SMJ.0000000000001980)
Image Credits: Medical University of South Carolina
Keywords: Prostate cancer, prostate-specific antigen, PSA testing, shared decision-making, cancer screening, racial disparities, primary care, prostate MRI, active surveillance, South Carolina
