The Impact of Patient-Provider Relationships on Prostate Cancer Screening: A Cross-Sectional Analysis of the All of Us Research Program

INTRODUCTION: Prostate-specific antigen (PSA) screening is influenced by social, structural, and interpersonal factors. We evaluated whether patient-reported domains of the patient-provider relationship were associated with PSA screening uptake. METHODS: We performed a cross-sectional analysis of men aged ≥40 years in the All of Us Research Program Controlled Tier Dataset version 8. The primary outcome was receipt of at least one eligible PSA test within a 4-year window spanning 2 years before through 2 years after survey completion. Exposures included respect, collaboration, ease of understanding, and relatability. Multivariable logistic regression was used to assess associations with PSA screening. RESULTS: Among 34,057 men, 10,848 (31.9%) underwent PSA screening. Screening rates decreased across lower response levels for respect, collaboration, and ease of understanding. After adjustment, lower perceived respect was associated with reduced odds of screening for "Most of the time" (aOR 0.89, 95% CI 0.83-0.95) and "Some of the time" (aOR 0.71, 95% CI 0.59-0.86) versus "Always." Lower collaboration was also associated with reduced screening odds across all non-reference levels (aOR range 0.83-0.94), while ease of understanding was significant only for "Some of the time" (aOR 0.80, 95% CI 0.71-0.91). Relatability was not independently associated with screening. These findings were consistent across guideline-oriented age cohorts. CONCLUSIONS: Less favorable perceptions of respect, collaboration, and ease of understanding within healthcare interactions were associated with lower PSA screening uptake. These findings suggest that patient-provider relationship domains represent modifiable factors associated with access to informed, preference-concordant, and risk-appropriate PSA screening.