Evaluating the Use of Prostate-Specific Antigen as an Instrument for Early Detection of Prostate Cancer beyond Urologists: Results of a Representative Cross-Sectional Questionnaire Study of General Practitioners and Internal Specialists

Abstract

Objectives: The aim of this cross-sectional study was to evaluate the value of prostate-specific antigen (PSA) testing as a tool for early detection of prostate cancer (PCa) applied by general practitioners (GPs) and internal specialists (ISs) as well as to assess criteria leading to the application of PSA-based early PCa detection. Methods: Between May and December 2012, a questionnaire containing 16 items was sent to 600 GPs and ISs in the federal state Brandenburg and in Berlin (Germany). The independent influence of several criteria on the decision of GPs and ISs to apply PSA-based early PCa detection was assessed by multivariate logistic regression analysis (MLRA). Results: 392 evaluable questionnaires were collected (return rate 65%). 81% of the physicians declared that they apply PSA testing for early PCa detection; of these, 58 and 15% would screen patients until the age of 80 and 90 years, respectively. In case of a pathological PSA level, 77% would immediately refer the patient to a urologist, while 13% would re-assess elevated PSA levels after 3-12 months. Based on MLRA, the following criteria were independently associated with a positive attitude towards PSA-based early PCa detection: specialisation (application of early detection more frequent for GPs and hospital-based ISs) (OR 3.12; p < 0.001), physicians who use exclusively GP or IS education (OR 3.95; p = 0.002), and physicians who recommend yearly PSA assessment after the age of 50 (OR 6.85; p < 0.001). Conclusions: GPs and ISs frequently apply PSA-based early PCa detection. In doing so, 13% would initiate specific referral to a urologist in case of pathological PSA values too late. Improvement of this situation could possibly result from specific educational activities for non-urological physicians active in fields of urological core capabilities, which should be guided by joint boards of the national associations of urology and general medicine.

Prostate cancer screening: Beliefs and practices of the Brazilian physicians with different specialties

“…Brazilian GP tend to start screening earlier at the age of 40 (21.5%), only 32% starting at age 50 which is unlike the 73% of Canadian family physicians . Approximately 1.9% of GP begin the process before 40 years of age which is very similar to the findings pertaining the German GP (1.8%) . In our study, the percentage of those who started PCS in men without risk factors of ages 40 to 49 years (45%) was similar to the findings of Kim et al (51%) .…”

“…11 Regarding the ages to start and end the screening, the data from this study are similar to those found by others, with the majority of physicians indicating the onset at 40 to 50 years of age, and ending by ages 70 to 80 years. 18,21,22 Brazilian GP tend to start screening earlier at the age of 40 (21.5%), only 32% starting at age 50 which is unlike the 73% of Canadian family physicians. 21 Approximately 1.9% of GP begin the process before 40 years of age which is very similar to the findings pertaining the German GP (1.8%).…”

“…Different aspects of the physicians' beliefs and practices in relation to PCS have been investigated by several authors even before the publication of recommendations on the subject . Limiting the scope of these studies to surveys conducted after the publication of the major epidemiological assessments, one can find publications that have studied screening practices by urologists and primary care clinicians in the USA, Canada, and Germany …”

“…17 Limiting the scope of these studies to surveys conducted after the publication of the major epidemiological assessments, 3,4 one can find publications that have studied screening practices by urologists 18,19 and primary care clinicians in the USA, 20 Canada, 21 and Germany. 22 The aim of our study was to assess the practices of Brazilian physicians practicing in main clinical specialties related to screening for PC (ie, general practitioners, geriatricians, and urologists). To the best of the author's knowledge, this is the first study that directly compares the practices of these different specialists in relation to the main points involved in screening for PC.…”

Differences among Men on Active Surveillance for Very Low-Risk Prostate Cancer Detected Through Population-Based versus Opportunistic Prostate-Specific Antigen-Screening

“…The increasing use of Prostate-specific antigen (PSA) testing [1] has led to frequent detection of small, well-differentiated, very low-risk prostate cancer (PCa) foci that might never become harmful in a man‘s lifetime and therefore have to be considered overdiagnosed [2]. Active surveillance (AS) providing the ability to stratify treatment according to dynamic progression criteria over time has therefore been adopted into clinical practice in order to minimize unnecessary treatment.…”