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Why doctors won't stop PSA testing anytime soon

Kathleen Blanchard's picture
Johns Hopkins researchers say doctors not likely to stop PSA testing.

Johns Hopkins researchers say it’s going to be a hard sell to get physicians to stop screening healthy men routinely for prostate cancer with PSA testing, despite recommendations from the U.S. Preventive Services Task Force (USPSTF) that the cancer screening does more harm than good.

Patient expectations, malpractice fears cited

The researchers surveyed physicians, 74.4% of whom said patients expect PSA testing.

Another 66 percent of doctors surveyed said it takes more time to explain why they’re not performing the screening for prostate cancer than it does to do the test.

Half of physicians surveyed thought eliminating PSA testing puts them at risk for malpractice.

The surveys were conducted in November, 2011, before the guidelines were officially issued that included 125 primary care physicians.

Craig E. Pollack, M.D., M.H.S., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine who led the study, published online in the journal Cancer, said in a press release, “Everyone agrees that PSA screening isn’t as good as we want it to be.

“If we had a test that was a slam dunk, it would be different. But now we know that for many men, the benefits may be small and the harms significant.”

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A PSA test, or prostate specific antigen, has been the ‘gold standard’ for cancer screening, but has been under scrutiny because it can lead to unnecessary treatments that have side effect for men. Surgery for prostate cancer that might never progress can cause urinary incontinence and impotence.

Older men with prostate cancer are at low risk of dying from the disease because most prostate cancers develop slowly. Some physicians said even when men are older, it’s difficult to predict life expectancy and they could use a better tool to decide when to intervene for abnormal test results.

Additionally, an elevated PSA test doesn’t always mean cancer, leading to unnecessary biopsy. Other reasons prostate specific antigen levels rise include inflammation, enlarged prostate, age, infection and race, according to the National Cancer Institute.

H. Ballentine Carter, M.D., a professor of urology at Johns Hopkins and the senior investigator on the study, is working on developing a better tool to help physicians and patients decide when to do prostate cancer screening to make testing more individualized.

“Men often expect PSA screening to be part of their annual physical,” Pollack says. “To change their minds, we need to address their perceptions about screening, allow time for screening discussions and reduce concerns regarding malpractice litigation.”

Not everyone agrees PSA testing doesn’t save lives. Doctors recently spoke up at the American Urological Association (AUA) 2012 Annual Scientific Meeting in Atlanta, Georgia, saying they were ‘outraged’ by the USPSTF’s recommendations; citing there isn’t even a urologist on their panel of experts. Instead, they say it might be appropriate to ‘discourage’ PSA testing, focus on prevention and target their screening efforts.

Despite new recommendations about routine PSA testing in healthy men, many physicians are going to find it hard to stop screening for prostate cancer - 37.7 percent of physicians said they would not change their screening practice in surveys published April, 2012 in the Archives of Internal Medicine. For now, the best practice about whether or not to get a PSA test seems to be open dialogue with your doctor.

Johns Hopkins news
May 24, 2012

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