Rural-urban disparities in prostate-specific antigen testing and shared decision-making in the US.

PURPOSE: Examine rural-urban disparities in prostate-specific antigen (PSA) testing and participation in shared decision-making (SDM) following the 2018 USPSTF guidelines. METHODS: We analyzed data from the 2019, 2021, and 2023 cycles of the National Health Interview Survey including men ≥55 years, excluding those with a history of prostate cancer or missing data. We tested three outcomes: (1) ever received a PSA test; (2) past 12-month PSA testing; and (3) participation in SDM (assessed in 2019 only). The main exposure was rural-urban classification of respondents' residence. RESULTS: There were 15,393 eligible respondents. After adjusting for sampling weights and the complex sampling design, 18% of men resided in rural areas. Sixty-one percent received PSA testing, 39% received past 12-month testing, and in 2019, 48% had participated in SDM. On multivariable regression, there was no significant association between rural-urban classification and ever receiving PSA testing (aOR: 0.96; 95% CI 0.85,1.09; p=0.552), past 12-month testing (aOR: 0.96; 95% CI 0.85, 1.07; p=0.454), and participation in SDM (aOR: 0.95; 95% CI 0.78,1.15; p=0.586). CONCLUSIONS: Following publication of the 2018 USPSTF guideline, we found no significant rural-urban disparities in PSA testing nor receipt of SDM. These findings might reflect declining preventive care utilization during the COVID-19 pandemic or similarly lower testing and SDM for PSA testing across both populations.