PSA screening: determinants of primary-care physician practice patterns

Abstract

BACKGROUND:The effect of practice guidelines and the European Randomised Screening for Prostate Cancer (ERSPC) and Prostate, Lung, Colorectal and Ovarian (PLCO) trials on PSA screening practices of primary-care physicians (PCPs) is unknown. METHODS:We conducted a national cross-sectional on-line survey of a random sample of 3010 PCPs from July to August 2010. Participants were queried about their knowledge of prostate cancer, PSA screening guidelines, the ERSPC and PLCO trials, and about their PSA screening practices. Factors associated with PSA screening were identified using multivariable linear regression.RESULTS: A total of 152 (5%) participants opened and 89 completed the on-line survey, yielding a response rate of 58% for those that viewed the invitation. Eighty percent of respondents correctly identified prostate cancer risk factors. In all, 51% and 64% reported that they discuss and order PSA screening for men aged 50-75 years, respectively. Fifty-four percent were most influenced by the US Preventative Services Task Force (USPSTF) guidelines. Also, 21% and 28% of respondents stated that their PSA screening practices were influenced by the ERSPC and PLCO trials, respectively. Medical specialty was the only variable associated with propensity to screen, with family medicine physicians more likely to use PSA screening than internists (b ¼ 0.21, P ¼ 0.02). CONCLUSIONS:Half of the physicians surveyed did not routinely discuss PSA screening with eligible patients. The impact of the ERSPC and PLCO trials on PSA screening practices was low among US PCPs. USPSTF recommendations for PSA screening continue to be the strongest influence on PCPs' propensity to use PSA screening.

Association of sociodemographic factors and prostate-specific antigen (PSA) testing

“…This being said, in 2009 the American Urological Association updated its PSA Best Practice Policy, lowering the recommended age of testing from 50 years to 40 years [7]. Therefore, it is unclear whether this trend is being driven by patient self-advocacy, as has been shown in other studies [8,9,22,23] or by organizations such as the American Urological Association which supported testing in younger men at the time.…”

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

“…While urologists are expected to act consistently with the German S3 guideline and findings of the recent literature in order to ensure their expertise [1,2,3,4,5,6], this cannot be deduced for GPs and ISs by implication. On the other hand, international studies show that PSA-based early PCa detection is widely used by GPs and ISs [7,8,9,10,14,15,16,17,18,19,20]. Furthermore, there is no scientific evidence on which consequences are drawn by GPs and ISs based upon given PSA levels in combination with clinical findings.…”

“…Furthermore, there is no scientific evidence on which consequences are drawn by GPs and ISs based upon given PSA levels in combination with clinical findings. Available study data on this topic illustrate the heterogeneous role of GPs in population-based PSA screening for PCa in various countries [7,8,9,10,14,15,16,17,18,19,20]. A recently published study by van der Meer et al [21], exploring the impact of ERSPC results on the implementation of population-based PCa screening by GPs in daily routine, clearly showed the consequences in the region of Rotterdam: (a) after publication of the ERSPC data, fewer PSA tests were performed by GPs in men ≥60 years of age; (b) PSA levels of 4-10 ng/ml were controlled significantly less frequently; (c) significantly fewer patients with a PSA level >4 ng/ml were referred to a board-certified urologist.…”

“…Optimally, urologists' diagnostic approaches should be consistent with German interdisciplinary guidelines and the recently published results of the ERSPC and the PLCO trial. On the other hand, it has to be assumed that most men will initially contact their general practitioner (GP) or internal specialist (IS) for early detection of PCa [7,8,9,10]. Evidence is lacking about the proportion of population-based PCa screening initiated by GPs and ISs.…”

Trends in United States Prostate Cancer Incidence Rates by Age and Stage, 1995–2012

“…Numerous studies have evaluated the temporal associations of publishing screening guidelines and clinical trial results on screening practices and attitudes (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). However, most studies focused on the impact of the 2008 USPSTF guidelines.…”