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Many doctors screen for prostate cancer without permission

USPSTF recommended against PSA testing for normal-risk men in 2010

Topics: Prostate Cancer, Tumor Site Strategy, Oncology, Service Lines, Physician Issues

January 16, 2013

study in the Annals of Family Medicine finds that nearly one in four family physicians does not ask their male patients before ordering controversial prostate specific antigen (PSA) tests.

For the study, Robert Volk from the University of Texas MD Anderson Cancer Center and colleagues surveyed 246 family physicians from 2007 to 2008 to determine whether they had screened their male patients for prostate cancer.

According to the survey:

  • 24% of family physicians said they ordered PSA tests without discussing the tests with patients;
  • 48% discussed the benefits and harms associated with PSA tests with patients and allowed them to decide whether to receive it; and
  • Most of the remaining physicians discussed the benefits and harms associated with PSA tests with patients and recommended that they receive it.

The U.S. Preventive Services Task Force (USPSTF) in 2012 recommended against PSA screening for healthy men after they found a lack of evidence supporting the need for routine tests. Moreover, concerns that the tests led to unnecessary—even harmful—procedures has stirred controversy, Reuters reports.

"One of the main concerns with PSA screening is it can set people down a pathway of getting the biopsy, potentially getting a cancer diagnosis and treatment that may not have [been] needed," says Johns Hopkins professor Craig Pollack. Moreover, a main reason why physician perform the test is because of "patient expectations—that doctors think their patients expect to get screening," Pollack says.

  • The Oncology Roundtable's Next Generation Tumor-Site Strategy study offers a step-by-step guide for designing tumor-site centers of excellence and insights on developing best-in-class breast, lung, prostate, and colorectal cancer programs.

USPSTF says that screening is still acceptable so long as patients understand the potential outcomes and makes a personal decision to receive the test. "Men really need to be aware of these issues [when they are] making a decision about screening, because of all the decisions that come after that," Volk says (Pittman, Reuters, 1/14).

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