Learning amid controversy: Prostate cancer knowledge and screening practices among US medical students

Background. No studies have examined medical students' recommendation and use of prostate-specific antigen (PSA) testing and digital rectal exam (DRE) to screen for prostate cancer. We hypothesized that students' race and extent of training on these techniques would be associated with their administration of them. Methods. We analyzed multiinstitutional longitudinal data from a cohort of 2181 medical students in the class of 2003. We queried students' health behavior, their knowledge of prostate cancer racial disparities, their frequency of performing a PSA test or a DRE on a man 50 years of age or older (senior year only), the perceived relevance of such services to their future practice, and their training on PSA and DRE. We examined predictors of students' administering PSA and DRE tests to patients during the senior year and changes in the predictors over time. Results. Respectively, 27% and 34% of students reported using the PSA and DRE "usualty/always" during their senior year. Black students reported administering the PSA test more often than did students of other races, but race was not a significant predictor of PSA screening after controlling for personal healthy behavior. High perceived relevance to fijture practice and extensive training on PSA were most strongly associated with administration of PSA. Conclusions. The association between healthy personal behavior and PSA administration confounded the association between race and PSA screening. These results may help explain differences in prostate cancer screening among physicians and help medical educators tailor their curricula on prostate cancer screening.