Fewer than 1 in 3 men received adequate counseling about prostate-specific antigen (PSA) screening for prostate cancer (PCa), including its risks, benefits, and uncertainties, according to the latest data published online ahead of print in Urology. This reflected a slight downtrend from 2012, the year the US Preventive Services Task Force (USPSTF) recommended against routine PSA screening for PCa.
“That only about a third of patients reported having a discussion of advantages and disadvantages is an alarming statistic,” stated lead author George A Turini III, MD, ScM, of Brown University and the Southcoast Physician Group in Providence, Rhode Island, according to a news release.
Of 111,241 men who responded to the 2014 Behavioral Risk Factor Surveillance Survey, 29.5% reported discussing both its potential risks and benefits with a health care provider (HCP) prior to undergoing PSA screening. The remainder reported that only advantages of the test were discussed (35.7%), only disadvantages (0.8%), or neither (33.9%). More men had reported a balanced dialogue of pros and cons in 2012, before the USPSTF statement. Of 105,812 men who responded to the survey that year, 30.1% had discussed both, 38.5% only advantages, 0.8% only disadvantages, and 30.5% neither. In 2012, 63.0% of men underwent PSA screening and in 2014, 62.4%.
Dr Turini and his colleagues said they believe their findings “may be indicative of a shift in practice patterns away from detailed prescreening discussions among HCPs who have implemented the USPSTF recommendation into their care giving. Long-term evaluation of this trend is necessary.”
An advantage of PSA screening is earlier cancer detection. A disadvantage is the adverse effects associated with treatment for a slow-growing cancer.
Black men, who are at higher risk of PCa and its adverse outcomes, were more likely to receive quality counseling about the test. Groups least likely to receive complete information about PSA testing included men of Hispanic origin and those lacking in higher education, income, and insurance coverage. The American Urological Association and the American Cancer Society recommend shared decision-making for certain age and risk groups of men who are considering PSA screening.
Urologists can play an important role in this endeavor. According to Dr Turini and colleagues, “urologists may be well served to focus attention on reaching out to out to the community of general medicine or family medicine practitioners. Those physicians seem to be the ones who often have the first opportunity to discuss PSA testing and screening with patients.”
With regard to the study’s limitations, the researchers conceded that they did not know whether discussions were taking place before a first or a repeat PSA test, which could alter findings.
In an accompanying editorial, Laura Bukavina, MD, MPH, Robert Abouassaly, MD, MSc, and Simon P. Kim, MD, MPH, noted that lower rates of PSA screening need to be weighed against a recent rise in distant metastasis among older men in the US. “At this time of uncertainty regarding prostate cancer screening, it now more important for patients and providers to engage in thoughtful discussions about the risks and benefits of a PSA test and incorporate SDM into the clinical encounter.”
1. Turini III GA, Gjelsvik A, Renzulli II JF. The State of Pre-Screening Discussions About PSA Testing Following Implementation of the 2012 USPSTF Task Force Statement. Urol. PII: S0090-4295(17)30246-7. doi: 10.1016/j.urology.2016.12.069 [Epub ahead of print]
2. Editorial comment. Bukavina L, Abouassaly R, Kim SP. Urol. PII: S0090-4295(17)30246-7.
3. Prostate screening often occurs without discussion of benefits, risks. [news release] Brown University; March 28, 2017.