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PSA screening should include patient discussion

Kathleen Blanchard's picture

PSA screening remains controversial, yet the majority of men over age 50 have been tested for prostate cancer using the PSA test that measures prostate specific antigen. According to a new survey, PSA screening should include more involved discussion between patient and clinicians about the risks and benefits of conducting the test.
PSA screening has not been shown to reduce prostate cancer deaths, and could lead to treatment complications if the test is positive. The study authors, writing in the Archives of Internal Medicine say, "Given the uncertain benefit for screening and known treatment risks, prostate cancer screening decisions should be guided by patient preferences. Indeed, most professional organizations recommend that the first step in screening should be a discussion between health care providers and patients about the risks and benefits of early detection and treatment so that patients can make informed decisions about whether to be screened."

The survey, conducted by the VA Health Care System and University of New Mexico School of Medicine, Albuquerque, and led by Richard M. Hoffman, M.D., M.P.H. included 3,010 randomly selected men – 375 of whom had undergone or discussed prostate cancer testing with their clinician within the previous two years.

The survey revealed recommendation for PSA testing in 73.4 percent of the patients – without further discussion of risks and benefits of the prostate cancer screening test.

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"Although respondents generally endorsed shared decision-making process and felt informed, only 69.9 percent actually discussed screening before making a testing decision, few subjects [32 percent] reported having discussed the cons of screening, 45.2 percent said they were not asked for their preference about PSA testing and performance on knowledge testing was poor”, according to the authors. “Therefore, these discussions—when held - did not meet criteria for shared decision making. Our findings suggest that patients need a greater level of involvement in screening discussions and to be better informed about prostate cancer screening issues." Less than half of the men (47.8 percent) were able to answer any of three questions presented in the survey about PSA risks and benefits.

In a second study, researchers looked at a model that predicts the risks and potential harm of PSA screening tests. Men who are screened were found to be four times more likely to be diagnosed with prostate cancer compared to those not tested. However, there is no substantial difference found in prostate cancer deaths, meaning a majority of men could be undergoing prostate cancer treatment for insignificant disease.

The authors say, "In conclusion, before undergoing PSA screening, men should be aware of the possible benefits and harms and of their chances of these benefits and harms occurring." Treatment for prostate cancer can lead to complications that include impotence, urinary incontinence, and death. Most men obtain PSA tests upon recommendation from their clinician. The study authors recommend more patient discussion of the risks and benefits of PSA screening.

Source: Archives of Internal Medicine