Sexual Orientation and Healthcare Access Factors Associated With Prostate-specific Antigen Screening in the United States

Objective To evaluate prostate-specific antigen (PSA) screening patterns among gay and bisexual men and identify factors associated with screening uptake in this population. Methods We conducted a cross-sectional analysis using 2023 Behavioral Risk Factor Surveillance System (BRFSS) data from 8 states and 1 territory that administered key survey modules. Cisgender men aged ≥ 40 years identifying as gay, bisexual, or straight with no prostate cancer history were included. Gay and bisexual men were matched with straight men using propensity scores based on demographics. Predictors of PSA screening within 2 years were assessed with multivariable regression. Results Of 19,925 respondents, 593 identified as gay or bisexual; 49.8% reported recent PSA screening compared with 46.2% of straight men. Sexual orientation was not associated with screening differences (P = .084). Clinician-led discussion was the strongest predictor (adjusted odds ratio [aOR] 5.45; P '.001), while uninsured status (aOR 0.39; P = .007) and no check-ups within 2 years (aOR 0.11; P '.001) were linked to lower rates of screening. Among gay and bisexual men, age 55-69, discussion of testing, college education, and recent check-ups were associated with increased screening rates. Conclusion Prostate cancer screening rates did not differ significantly by sexual orientation, suggesting that clinician communication, insurance coverage, and primary care continuity are stronger predictors of PSA testing. Enhancing provider communication through LGBTQ+-affirming training and strengthening primary care continuity may improve early detection of prostate cancer across diverse populations.