National Survey: Health Care Providers Unlikely To Tell Men About Prostate Cancer Screening Risks

Main Category: Prostate / Prostate Cancer
Also Included In: Men's health;  Urology / Nephrology
Article Date: 29 Sep 2009 - 1:00 PDT

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Health care providers are twice as likely to discuss the benefits rather than the risks associated with PSA (Prostate Specific Antigen) testing, despite national guidelines recommending full disclosure before screening, according to the results of national survey of men age 40 and older published in the September 28 issue of the Archives of Internal Medicine. The study also found that most men overestimate their knowledge of prostate cancer and the PSA test and rely on their physicians to make the decision about screening.

"These findings underscore a growing concern about the overuse of PSA testing and the need for a shared decision making process (between patient and physician) to fully inform patients of all consequences before screening takes place," says Richard M. Hoffman, MD, the study's lead author and a professor of medicine and member of the Cancer Epidemiology and Prevention program at the University of New Mexico Cancer Center. He adds that the American Urological Association, the American Cancer Society, and the United States Preventive Services Task Force all recommend full disclosure surrounding PSA tests' risks and benefits.

PSA testing (which detects the levels of this prostate-produced protein in the blood) has long been controversial because there is no convincing evidence that this screening reduces deaths from prostate cancer. PSA is a nonspecific test, and a number of factors can lead to elevated levels. And, false positives often lead to needless invasive procedures that can have a negative impact on a patient's health. Two large-scale screening studies published in Europe and the US last spring found little or no support for its routine use.

In their study, Hoffman and his team examined the survey responses of 375 men who recently faced prostate cancer screening decisions and found that they reported that most health care providers (HCP) were likely to address the pros of the screening (68 percent) but were unlikely to address the cons (31 percent). The study also showed that the men who were surveyed overestimated their knowledge of prostate cancer and PSA screening; 58 percent reported being well informed about both areas, but nearly half -- 43 percent -- failed to correctly answer any of three basic questions pertaining to prostate cancer incidence or PSA testing. (Most incorrect responses were in the direction of overestimating risks for diagnosis and mortality and overestimating the accuracy of the PSA test.)

Although respondents generally endorsed a shared decision-making process -- whereby doctors and patients work together to make medical decisions and patients' preferences are asked and considered -- 45 percent of respondents were not asked their preference about PSA testing.

In addition, the study subjects frequently cited health care providers as an extremely important source of information about prostate cancer and reported that health care providers usually recommended screenings.

Data used for this study were derived from the National Survey of Medical Decisions (the Decisions Study), which systematically assessed medical decision-making in a nationally representative sample of adults age 40 years and older. The Decisions Study is the first to systematically assess multiple common medical decisions (such as PSA testing, taking medications for high cholesterol, and pursuing elective surgeries for low back pain) using consistent survey methodology and a nationally representative sample.

The study was supported by the not-for-profit Foundation for Informed Medical Decision Making (FIMDM) in Boston.

Given that the evidence supporting prostate cancer screening is inconclusive, Hoffman emphasizes that men need to recognize that they should have an important role in deciding whether to undergo screening. Making the right decision -- the one that best reflects a man's values and concerns --requires an understanding of the risks and benefits of screening and treatments. The FIMDM research team is working to develop strategies to provide men with appropriate information tools to support screening decisions.

In addition to Hoffman, study authors included Mick P. Couper, PhD; Brian J. Zikmund-Fisher, PhD; Carrie A. Levin, PhD; Mary McNaughton-Collins, MD, MPH; Deborah L. Helitzer, ScD; John VanHoewyk, PhD; and Michael J. Barry, MD.

About the Foundation for Informed Medical Decision Making

The Foundation for Informed Medical Decision Making's mission is to assure that people understand their choices and have the information they need to make sound decisions affecting their health and well being. The Foundation organizes and frames medical evidence in an unbiased manner to help people evaluate their options, particularly in instances where differences in individual preferences and perspectives are likely to affect personal choice.

About the University of New Mexico Cancer Center

The UNM Cancer Center is the official Cancer Center of the State of New Mexico, and one of only 64 National Cancer Institute designated cancer centers in the nation. It is home to 85 board-certified oncology physicians representing every cancer specialty and more than 120 research scientists hailing from such prestigious institutions as M.D. Anderson, Johns Hopkins and the Mayo Clinic.

Source: Foundation for Informed Medical Decision Making

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