Prostate cancer survivors' beliefs about screening and treatment decision-making experiences in an era of controversy

Abstract

Objective Controversy about the costs and benefits of screening and treatment of prostate cancer (PCa) has recently intensified. However, the impact of the debate on PCa patients has not been systematically studied. Methods We assessed knowledge of, and attitudes toward, the U.S. Preventive Services Task Force’s (USPSTF) May 2012 recommendation against PSA-based screening among men diagnosed with clinically localized PCa, and tested whether exposure to the recommendation and associated controversy about overtreatment of PCa predicted treatment decisional conflict, affected treatment choice, or increased regret about PSA testing. Results Accurate knowledge of the USPSTF recommendation was uncommon (19.1%). Attitudes toward the recommendation were negative, and the vast majority (86.5%) remained highly supportive of annual PSA testing in men ≥50. Although exposure to the recommendation and controversy about treatment was associated with lower enthusiasm for screening and treatment, it was not associated with treatment decisions, or greater decisional-conflict, or regret. Conclusions Findings may alleviate concern that exposure to PSA-based screening and overtreatment controversies has adversely affected recent cohorts of PCa patients. However, patients remain highly supportive of PSA-based screening. As survivor anecdotes often influence people’s medical decisions, it is important to appreciate the scale of opposition to the new recommendation.

Prostate cancer characteristics and outcome in renal transplant recipients: results from a contemporary single center study

“…International guidelines suggest PCa screening by prostate‐specific antigen (PSA) and digital rectal examination (DRE) in all RTR male over 50 years of age with life expectancy of at least 10 years . Given that screening is nowadays controversial in the general population, it should also be questioned for RTR . Furthermore, PCa incidence is expected to increase in RTR: through the improved medical cares of RTR in the last decades, inducing a longer life expectancy and graft survival, and through the bias of screening, urologists will inevitably have to manage more RTR with PCa.…”

What's new in screening in 2015?

“…[77–80] Two survey studies showed that there was awareness on the screening controversy yet the majority of men still believed that screening saved lives and should be used despite the USPSTF recommendation. [81, 82] Jemal et al examined the recent changes in stage specific incidence and PSA testing rates. The authors used SEER data on invasive PC incidence data from 2005 to 2012 and had the availability of 2013 incidence data from one registry (Georgia).…”

Association Between Online Information-Seeking and Adherence to Guidelines for Breast and Prostate Cancer Screening

“…To qualify as informed decision making, people must be aware of their cancer risk and discuss the benefits and possible harms of screening with their health care provider ( 4 ). Despite the emphasis on the value of informed decision making in guidelines issued by the US Preventive Services Task Force (USPSTF) and other organizations, studies show that few people with average risk for cancer are aware of the ongoing debate about the potential harms associated with some types of cancer screening and may overestimate benefits and underestimate potential risks ( 5 – 7 ). Some studies show that interventions at clinics, with decision aids such as questionnaires and counseling, can increase patient understanding of potential harms of screening and may facilitate discussion between patients and their health care providers ( 7 – 11 ).…”

“…Despite the emphasis on the value of informed decision making in guidelines issued by the US Preventive Services Task Force (USPSTF) and other organizations, studies show that few people with average risk for cancer are aware of the ongoing debate about the potential harms associated with some types of cancer screening and may overestimate benefits and underestimate potential risks ( 5 – 7 ). Some studies show that interventions at clinics, with decision aids such as questionnaires and counseling, can increase patient understanding of potential harms of screening and may facilitate discussion between patients and their health care providers ( 7 – 11 ). However, little is known about how people at average risk acquire screening-related information and if and how they use this information in discussions with their providers to arrive at a screening decision.…”