Prostate-specific antigen testing for prostate cancer screening: A national survey of Canadian primary care physicians’ opinions and practices

Abstract

Introduction: In 2014, the Canadian Task Force on Preventive Health Care (CTFPHC) recommended against routine prostate cancer screening with the prostate-specific antigen (PSA) blood test.1 We surveyed Canadian primary care physicians (PCPs) to understand their opinions and attitudes towards prostate cancer screening in 2016.Methods: Twenty PCPs piloted the survey to assess its accessibility. We distributed a flyer to 19 633 PCPs as an insert in a large mailed package inviting them to attend a national meeting, and later promoted the survey at the meeting. Multinomial logistic regression models examined factors associated with agreement of key guideline statements and the overall benefit of PSA screening.Results: A total of 1254 PCPs responded (rate of 6.4%); 54.7% of physicians aware of the CTFPHC recommendations report screening less often as a result. Overall, 55.6% of PCPs feel that the risks of PSA screening outweigh the benefits. On multivariable analysis, physicians who did not read the guidelines, did not have an academic appointment, or were in practice for over 20 years were significantly more likely to disagree with the statement that men 55‒69 years old should not be screened for prostate cancer with PSA.Conclusions: Our national survey found that the prostate cancer screening practices of Canadian PCPs varies widely across physician demographic groups, with almost equal numbers for or against. This has significant ethical, medical, and legal implications. The poor response rate to highly incentivized survey request may suggest a reluctance or general apathy towards this subject because of the Task Force recommendations. Future efforts should provide physicians with objective guidance around PSA screening, incorporating input from all stakeholders, including PCPs, urologists, and patients.

Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019

“…Modeling studies demonstrated that newly diagnosed metastatic prostate cancer cases increased by 44%-60% in the 5 years after the 2012 USPSTF recommendation ( 30 ). Similar inversions in incidence and mortality of prostate cancer were also documented by previous studies, along with steady declines of willingness in physicians and general population toward PSA screening test after the changes in the USPSTF's recommendations in Canada and Australia ( 27 , 60 ). In 2018, the USPSTF recommended discussion of the potential benefits and harms of screening with their clinician for men aged 55–69 years ( 31 ).…”

Global, regional, and national burden of kidney, bladder, and prostate cancers and their attributable risk factors, 1990–2019

“…The observed change in global incidence of genitourinary cancers likely reflects the evolution of early detection methods, such as prostate-specific antigen (PSA) screening for prostate cancer and cross-sectional imaging for kidney cancer [ 13 , 14 ]. The widespread use of routine PSA testing led to a rapid increase in the incidence of prostate cancer in the early 1990s in the USA; however, prostate cancer incidence has been declining in recent years with the reduction in routine PSA testing [ 15 – 17 ]. Likewise, advances in imaging technology have led to an increase in the detection rate of kidney cancer in developed countries [ 13 ].…”

Global, Regional, and National Burden of Kidney, Bladder, and Prostate Cancers and Their Attributable Risk Factors, 1990-2019

“…The changed global incidence of genitourinary cancers indicated the evolution of early detection of disease, such as prostate-specific antigen screening for prostate cancer and cross-sectional imaging for kidney cancer [10,11]. For example, the widespread use of routine prostate-specific antigen testing led to a rapid increase in the incidence of prostate cancer in the early 1990's among USA; however, prostate cancer incidence has been declining in recent years with the reduction in routine prostate-specific antigen testing [12][13][14]. Likewise, advances in imaging technology have led to an increase in the detection rate of kidney cancer in developed countries [10].…”