Primary care physicians do not always discuss the risks and benefits of prostate cancer screening with patients
Research Activities, December 2009, No. 352
There is insufficient evidence to recommend for or against routine prostate cancer screening. Thus, guidelines recommend that doctors discuss the risks and benefits of prostate cancer screening, so that men can decide for themselves about prostate-specific antigen (PSA) testing. However, one in five primary care physicians (PCPs) do not have this discussion with their patients, according to a new study.
Primary care physicians filled out a survey that included open-ended questions about their use of prostate cancer screening practices and patient discussions. Among the 63 physicians surveyed, 20.6 percent ordered a PSA test without any discussion with the patient and 71.4 percent ordered the test after a prescreening discussion. Three physicians did not order a PSA test or discuss it with the patient. Ordering a PSA test was highest among PCPs who did not discuss screening with their patients, followed by PCPs who engaged in discussions and recommended the PSA test for their patients. PSA test orders were lowest among PCPs who discussed testing with their patients and let them decide.
Patient risk factors also played a role in how likely physicians were to screen men. For example, 69 percent of nondiscussion physicians and 50 percent of discussion physicians said they were more likely to screen black men (who have a higher risk for the disease). Also, 91 percent of nondiscussion physicians and 46 percent of discussion physicians indicated they were more likely to screen patients with family histories of prostate cancer.
Among the nearly three-fourths of PCPs who used prescreening discussions, the role of decisionmaker varied. Some PCPs let patients decide, while others recommended testing. Physicians who tried to persuade men to get tested believed in the efficacy of screening and PSA testing. Physicians who did not try to persuade men to be tested questioned the lack of scientific evidence and efficacy of the PSA test and some were concerned about treatment side effects (e.g., incontinence and impotence from surgery or radiation). None of the surveyed physicians reported recommending against the test.
The study was supported in part by the Agency for Healthcare Research and Quality (HS10612). See "Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: A cross-sectional survey," by Suzanne K. Linder, M.D., Sarah T. Hawley, Ph.D., Crystale P. Cooper, Ph.D., and others, in the March 18, 2009, online issue of BMC Family Practice 10(19) at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666644/.