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Study: Men are getting one-sided view of PSA screening from their doctors

Just as Prostate Cancer Awareness Month winds down, along comes a study that reports that men may be getting a one-sided view of prostate cancer screening from their physicians.

Specifically, the study, published in today’s issue of the Archives of Internal Medicine, found that doctors rarely discuss with their patients the counterarguments — or “cons” — of the prostate-specific antigen (PSA) blood test.

This means that many doctors are not following the guidelines of major health organizations, such as the American Cancer Society and the US Preventive Services Task Force, which urge doctors to engage their patients in shared and informed decision-making before PSA testing is done.

What are men apparently not hearing from their doctors? Statements like this one, which appears in an editorial that accompanied the study:

[E]vidence that early detection improves outcomes is scant, the often latent forms of the disease may pose little clinical threat to patients, false-positive results are common, and the harms and downstream consequences may outweigh the benefits.

The study’s details
The study involved a telephone survey of 375 men aged 40 years and older who had either undergone or discussed the test with their physician within the previous two years. Almost three-quarters of the men (70 percent) remembered talking about the test before making a decision about it, but only about one-third (32 percent) reported having discussed the cons of the test with their doctor.

And about half of the men (45 percent) said they were never asked their preference about having the test.

In addition, only 7 percent of the men surveyed could answer more than one of the following three knowledge questions about prostate cancer correctly (and only about half answered any of the three questions correctly). (Go ahead. Take this three-question quiz. I’ll provide the correct answers at the end of this post.)

• Of every 100 men, about how many do you think will die of prostate cancer?
a. 0
b. 1-5
c. 6-10
d. 11-20
e. ≥ 20

• Of 100 men, about how many will be diagnosed as having prostate cancer at some time in their lives?
a. 1-14
b. 15-25
c. > 25

• For every 100 times a PSA test result suggests the need for further testing, about how many times does it turn out to be cancer?
a. 1-20
b. 21-40
c. 41-60
d. > 60

Granted, patients’ recollections of medical advice can be inaccurate, to say the least, immediately after a visit with their doctor, let alone two years later. That’s one of the limitations of this study. But, interestingly, most of the incorrect answers to those three knowledge questions involved overestimating the risk of dying from or being diagnosed with prostate cancer — as well as overestimating the accuracy of the PSA test.

Yet the majority of the men surveyed said they believed they were well informed about prostate cancer.

“The larger cultural context helps explain the inertia of the health care system in implementing [shared decision making regarding the PSA test],” notes the editorial. “Uncertainties about benefit and concerns about harms that justify [shared decision-making] are not widely shared by physicians or patients, who hold strong beliefs in the benefits of cancer screening generally and exaggerated confidence in PSA screening in particular.”

Maybe what we need is an annual designated “awareness” month in which all cancer screening is discussed frankly and without exaggeration — a discussion based on current evidence rather than on outdated beliefs and wishful thinking.

Here are the correct answers to the three questions: b. 1-5, b. 15-25, b. 21-40. How did you do?

Comments (3)

  1. Submitted by Dimitri Drekonja on 09/29/2009 - 09:05 am.

    Nice article on an often overlooked issue that tends to drive a lot of medical testing and costs. I’d just point out that question 2 seems to have a typo- answer b is 15-25, and answer c is > or = to 20; usually there shouldn’t be an overlap of answers, presumably c should be > 25

  2. Submitted by Susan Perry on 09/29/2009 - 12:19 pm.

    Dimitri: Thanks for catching my typo. I’ve corrected it.

  3. Submitted by Bernice Vetsch on 09/29/2009 - 02:47 pm.

    If 15-24 men out of a hundred are likely to have cancer, doesn’t that justify the test?

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