Prevalence and Determinants of PSA Screening Among Men Aged 70 and Older in a Tripoli Outpatient Clinic: A Pilot Cross-Sectional Study

Abstract

Prostate-specific antigen (PSA) screening remains a widespread practice among older men, despite current guidelines advising against routine screening in individuals aged 70 years and older (9). In Libya, particularly in urban centers such as Tripoli, data on PSA screening prevalence and patterns are scarce. Although guidelines recommend caution, international studies from Spain, the USA, and Brazil have documented persistent PSA testing among elderly men (1–5). This study aimed to explore the prevalence and determinants of PSA screening in a Libyan context, providing local evidence to inform clinical practice. A cross-sectional, pilot study was conducted at the urology outpatient clinic of Tripoli Central Hospital. Thirty men aged ≥70 years were recruited using purposive sampling. Data were collected via structured questionnaires, medical record reviews, and semi-structured interviews. Descriptive statistics and chi-square tests were used to analyze associations between sociodemographic variables and PSA screening behavior. The study was exploratory and aimed to generate hypotheses for larger, representative studies. Of the 30 participants, 50% reported undergoing PSA screening at least once, primarily due to physician recommendation (47%). Further diagnostic procedures were followed in 30% of screened cases. Only 40% of participants reported being informed about the risks and benefits of PSA screening, and 30% felt fully involved in decision-making. No statistically significant associations were observed between screening and sociodemographic variables, although higher educational attainment showed a positive, non-significant trend (p = 0.08). Notably, 80% of participants expressed a desire for more information regarding PSA testing. Despite international guidelines discouraging routine PSA screening in men ≥70, half of the participants had undergone testing, largely influenced by physicians. Limited shared decision-making and gaps in patient education were evident. These findings underscore the need for locally tailored educational interventions and structured physician–patient discussions to align screening practices with evidence-based recommendations and support informed decision-making in Libya.