Recently, the US Preventive Services Task Force (USPSTF) advised eliminating routine prostate-specific antigen (PSA) screening for prostate cancer in healthy men. According to results of a survey by Johns Hopkins researchers, the new recommendations are likely to meet serious resistance from primary care physicians. Study results were published online in the journal Cancer.
In a November 2011 survey of 125 primary care doctors, the researchers found that doctors agreed with older recommendations to curb routine screening in men over age 75 and among those not expected to live 10 or more years. However, a large number of those surveyed said they faced significant barriers to discontinuing PSA testing in men who had been receiving it regularly.
Perceived barriers of those physicians surveyed included:
- “My patients expect me to continue getting yearly PSA tests” (74%)
- “It takes more time to explain why I’m not screening than to just continue screening” (66%)
- “By not ordering a PSA, it puts me at risk for malpractice” (>50%)
Leader of the study and assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, Craig E. Pollack, MD, MHS, says, “It can be very difficult for doctors to break down the belief that all cancer screening tests are invariably good for all people all the time. 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.”
According to the USPSTF, routine annual screening should be eliminated in healthy men because evidence suggests the potential harms caused by PSA screening as a means of identifying prostate cancer offset its potential to save lives. Because elevated PSA results are not necessarily evidence of prostate cancer, unnecessary prostate biopsies are performed. In addition, evidence shows that a large proportion of prostate cancer cells will never cause harm, even if left untreated.
Treatments for prostate cancer have the potential to cause serious problems like erectile dysfunction, complete impotence, urinary incontinence, or bowel damage. Furthermore, men who choose to “watch and wait” after elevated PSA readings often experience anxiety knowing they have an untreated cancer that could progress.
“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.”
Source: Johns Hopkins Medicine.