Prostate cancer screening in hospitalized patients: Results from the Nationwide Inpatient Sample

Background: Prostate cancer (PCa) is the most common non-skin cancer in American men. The aim of the study was to determine the nationwide prevalence, trends, and predictors of inpatient PCa screening encounters in patients with average risk of PCa using the National Inpatient Sample (NIS) database. Methods: The NIS database from 2006 to 2014 was used to evaluate PCa screening among hospitalized patients in the United States (US). All hospitalized male patients between the ages of 45 and 69 at average risk for PCa were included. The outcome was whether a patient had an encounter for prostate cancer as noted on their discharge record. Variables analyzed included demographic factors, hospital characteristics, and other concomitant diagnoses for prostate or male urinary problems. Results: The prevalence of inpatient PCa screening was 2.57 per 100,000 hospital discharges. In a multivariate setting, the following were significant factors associated with greater odds of inpatient PCa screening: Medicare (AOR: 3.07; P = 0.0016), Self-Pay or Uninsured patients (AOR: 1.74; P = 0.0371), rural (AOR: 11.9; P = < 0.0001) or urban nonteaching hospitals (AOR: 5.26; P = < 0.0001), receiving care in the Midwest (AOR: 4.90; P = < 0.0001), a diagnosis for urinary tract infections (P = 0.0367), genitourinary symptoms (P < 0.0001), hyperplasia of prostate (P = 0.0006), or other male genital disorder (P < 0.0001). Conclusion: According to current cancer screening guidelines, PSA screening should include shared decision making between physicians and patients. In light of unequal access to quality healthcare, there exist disparities in uninsured and rural patients for cancer screening. Screening tools such as prostate-specific antigen (PSA) are minimally invasive modalities in the inpatient setting that can help screen individuals at increased risk for the development of prostate cancer, allowing for early detection, prevention, improved rates of cure and ultimately, decreased rates of mortality.