Men largely make decisions about prostate cancer screening based on conversations with their clinicians, but these discussions often do not include information about the risks of testing in addition to the benefits, according to a report in the September 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. A second report in the same issue uses statistical modeling to estimate the benefits and risks of prostate-specific antigen (PSA) screening in men of various ages and risk levels.
The majority of American men older than 50 have been screened with the PSA blood test, according to background information in one of the articles. However, the practice is controversial because there is no convincing evidence that screening prevents deaths from the disease, and treating early-stage cancers detected by screenings may lead to important complications. "Given the uncertain benefit for screening and known treatment risks, prostate cancer screening decisions should be guided by patient preferences," the authors write. "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."
Richard M. Hoffman, M.D., M.P.H., of New Mexico VA Health Care System and University of New Mexico School of Medicine, Albuquerque, and colleagues conducted a telephone survey of 3,010 randomly selected English-speaking adults age 40 and older in 2006 and 2007. The sample included 375 men who had either undergone or discussed PSA testing with their clinicians in the previous two years. These men were asked what they knew about prostate cancer, what their discussions with clinicians were like and what factors and sources of information influenced their screening decisions.
Overall, 69.9 percent of the men had discussed screening with their clinician before making a decision, including 14.4 percent who chose not to undergo testing. Most often, clinicians raised the idea of screening (64.6 percent), and 73.4 percent recommended it. Recommendation from a clinician was the only characteristic of the discussion associated with testing.
"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," with only 47.8 percent of men correctly answering any of three questions about prostate cancer risk and screening accuracy, the authors write. "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."