One in four family doctors doesn’t ask male patients before screening them for prostate cancer, according to a new survey.
So-called prostate specific antigen (PSA) testing has been controversial in recent years because of uncertainty about whether it actually saves lives and concern about side effects from potentially unnecessary and invasive follow-up tests and treatments.
The U.S. Preventive Services Task Force, a government-backed panel, recommended against PSA tests for normal-risk men in 2012, saying there is no evidence that screening has more benefits than harms.
Screening is still acceptable, according to the USPSTF, if the man being tested understands the possible outcomes – good and bad – and makes the personal decision to get tested.
But that may not always happen, researchers found.
“There’s some amount of confusion for providers about what the right course of action is,” said Dr. Craig Pollack, who has studied doctors’ attitudes toward prostate cancer screening at Johns Hopkins Medicine in Baltimore, Maryland.
In addition, “one of the big drivers of PSA screening is patient expectations – that doctors think their patients expect to get screening,” said Pollack, who was not involved in the new research.
For the current study, Robert Volk from The University of Texas MD Anderson Cancer Center in Houston and his colleagues surveyed 246 family doctors in 2007 and 2008 about whether and how they screened their male patients for prostate cancer.
Of those doctors, 24 percent said they ordered PSA tests without first discussing screening with patients.
Another 48 percent talked about the possible benefits and harms with their patients and let men decide for themselves whether to get screened.
Most of the remaining doctors also discussed screening’s pluses and minuses but specifically recommended it, Volk’s team reported Monday in the Annals of Family Medicine.
It’s concerning that some men may not know all the implications of being screened but get PSA tests anyway, researchers said.
“One of the main concerns with PSA screening is it can set people down a pathway of getting the biopsy, potentially getting a cancer diagnosis and treatment that may not have (been) needed,” Pollack told Reuters Health.
Volk agreed, calling prostate cancer screening the beginning of a “slippery slope.” That’s because some men will be diagnosed with slow-growing cancer and will need to decide whether to get treatment – and risk side effects such as impotence and incontinence – or wait to see if the cancer grows and poses any danger.
“Men really need to be aware of these issues (when they are) making a decision about screening, because of all the decisions that come after that,” he told Reuters Health.
About one in six men will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society. However far fewer – about one in 36 – will die of the disease, in part because prostate cancer is often slow-growing and affects mostly older men.
“A fairly large proportion of men will die with their prostate cancer instead of from their prostate cancer,” Pollack explained.
Volk said men “need to be given quality information” about the benefits and risks of PSA tests, including what could happen after a positive test.
Men, he added, “should feel empowered to ask their doctors about screening and have a very frank discussion about what’s important to them.”
SOURCE: Annals of Family Medicine, online January 14, 2013