IMR Press / JOMH / Volume 17 / Issue 2 / DOI: 10.31083/jomh.2021.007
Open Access Original Research
Impact of social and medical factors on routine clinical practice in prostate exams of asymptomatic males
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1 Department of Surgery, University of Salamanca, Spain
2 Department of Occupational Health & Safety Management, University Hospital of Salamanca, Spain
3 Section of Urology, Department of Surgery, University of La Laguna, Tenerife, Islas Canarias, Spain
4 12-Department of Urology, University Hospital of Salamanca, Spain
5 GRUMUR (Urology multidisciplinary research group) of IBSAL Institute for Biomedical Research of Salamanca, Salamanca, Spain
6 Department of Urology, Health Complex of Ávila, Spain
7 Department of Emergency, University Hospital of Salamanca, Spain
8 Primary Health Care of Salamanca, Spain
9 Department of Urology, University Hospital of Arnau de Villanova, Valencia, Spain
10 Department of Preventive Medicine and Public Health of University of Salamanca, Spain
11 Department of Urology, University Hospital of Salamanca, Salamanca, Spain
*Correspondence: (Javier Flores-Fraile)
J. Mens. Health 2021, 17(2), 85–94;
Submitted: 25 October 2020 | Accepted: 24 November 2020 | Published: 8 April 2021
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Objectives: To examine routine clinical practice in prostate health exams in asymptomatic males, and to identify which factors influence it.

Materials and methods: Multicentre cross-sectional study in 1068 asymptomatic men aged 51-72. Groups: GA (n = 518): urban areas; GB (n = 550): rural areas. GA subgroups: GA1 (n = 364): prostate specific antigen (PSA) measured; GA2 (n = 154): PSA not measured. GB subgroups: GB1 (n = 346): PSA measured; GB2 (n = 204): PSA not measured. Variables: age, body mass index (BMI), digital rectal examination (DRE), PSA, prostate diagnosis, eating habits, physical exercise, marital status, number of children, occupational status, working hours, concomitant diseases and conditions, family history, attending physician. Descriptive statistics, Student’s t-test, chi-square test, Fisher’s exact test, ANOVA, Pearson and Spearman correlations were used.

Results: Mean age 62.3 years (standard deviation: SD 5.12). Age in GA (60.89, SD 5.53) was lower than in GB (65.10, SD 5.03); age was higher in GA1 (61.22, SD 5.49) than in GA2 (59.04, SD 5.37). There was no difference in BMI between GA and GB. DRE: No exams were performed without prior PSA. No DRE were performed in GA; 11 (3.18%) were performed in GB1. GA1: 53 had PSA > 4 ng/mL, of whom 28 had no prostate disease, 17 had benign prostatic hyperplasia (BPH) and 8 had prostate cancer (PCa). PCa prevalence in men with PSA > 4 ng/mL was 9.24% in GA and 5.19% in GB. GA1: higher PSA was correlated with lower BMI, lower age, higher occupational status, and morning shifts; lower PSA was correlated with higher alcohol consumption; older patients worked shifts and consumed more alcohol; men with higher occupational status consumed less alcohol; more men were married in GA1 (n = 343, [94.23%]) than in GA2 (n = 100, [64.93%]). In GA1, there were more non-smoking men (n = 291, [80.11%]) and men who smoked < 5 cigarettes/day (n = 23, [6.37%]), 6-10 cigarettes/day (n = 15, [4.05%]), and 11.20 cigarettes/day (n = 27, [7.33%]) than in GA2. Older men and men with higher occupational status consumed fewer cigarettes. Men who worked rotating shifts smoked more. There was no relationship between smoking and PSA level. There were more university-educated men in GA (n = 309, [59.65%]) than in GB (n = 110, [20%]). More men did not take physical exercise in GA2 (n = 49, [31.81%]) than in GA1 (n = 75, [23.90%]). GB1: PSA > 4 ng/mL in 89 patients, of whom 32 had PCa; younger men had higher PSA. PSA was higher in GB1 (mean 18.95 ng/mL, SD 12.93) than in GA1 (mean 1.61, SD 1.63). Men in GB ate more fast food than GA, with no difference between GA1 and GA2, or between GB1 and GB2. In GA there was variability in approach among the attending physicians; in GB there was no variability among attending physicians.

Conclusions: PSA tests are routinely given to 70.27% of asymptomatic men who consult a doctor in urban environments and to 62.09% of men in rural environments. In urban areas, the decision is affected by the preferences of the attending physician and by whether the patient is married. Occupational category, working hours and educational level have no impact. The decision to undergo a prostate health exam is associated with healthy habits such as physical exercise. No relationship was found between prostate disorders in asymptomatic men and high BMI, dyslipidemia or diet.

Benign prostatic hyperplasia
Medical factors
PCa factors
Prostate cancer
Fig. 1.
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