番茄社区

About one-third of U.S. men surveyed said their doctor never talked with them about the pros and cons of prostate-specific antigen (PSA) screening before they were tested, researchers reported.

Among more than 200,000 men in the analytic sample, 37% were told about only advantages of PSA screening compared to 30% of men who were advised about both advantages and disadvantages, according to George Turini III, MD, of Brown University in Providence, R.I., and colleagues.

Also, the proportion of uninformed men increased slightly but significantly from 30% in 2012 to nearly 34% in 2014 (P<0.01), they wrote in .

The study "demonstrates a potentially concerning trend in the quality of pre-PSA screening discussions that men are having with healthcare practitioners before blood work is drawn," they stated. "While some literature has proposed that shorter office visit times related to high patient volumes and increased practice demands may provide sufficient explanation as to why clinicians are not routinely talking to all men about both advantages and disadvantages of PSA testing, we believe the true explanation is likely much more complex."

The authors said a from the United States Preventive Services Task Force (USPSTF) may be part of the explanation. The statement recommends against PSA screening for the general population, citing the potential harms associated with complications of screening and overdiagnosis.

"The USPSTF report very clearly dissuades clinicians from recommending routine PSA screening in healthy males, and we believe our findings may be indicative of a shift in practice patterns away from detailed prescreening discussions among healthcare practitioners who have implemented the USPSTF recommendation into their care giving," they wrote.

In an editorial comment, Simon Kim, MD, MPH, of Case Western Reserve University School of Medicine in Cleveland, and colleagues agreed with that assessment.

"To a large degree, this clinical debate is attributable to the marked disagreement ranging from the USPSTF issuing a Grade D recommendation against prostate cancer screening for all men at average risk for prostate cancer contrasted to the , , and the endorsing shared decision making about reviewing the merits of screening and eliciting patient preferences into the decision for early detection of prostate cancer," Kim's group wrote.

"At this time of uncertainty regarding prostate cancer screening, it now more important for patients and providers to engage in thoughtful discussions about the risks and benefits of a PSA test and incorporate shared decision making into the clinical encounter," they advised.

Turini's group analyzed data from 217,053 men who participated in the 2012 and 2014 (BRFSS) surveys. These telephone surveys were administered by state health departments using a standardized questionnaire. Approximately 80% of the men surveyed were white, 9% were black, and 8% Hispanic.

In 2012, before the task force made its recommendation, 30.5% of the men surveyed reported discussing neither advantages nor disadvantages of screening with their healthcare provider; 30.1% said they discussed both, 38.5% discussed only advantages, and 0.8% discussed only disadvantages. In 2014, after the recommendation, 33.9% reported discussing neither pros nor cons while 29.5% discussed both, 35.7% only talked about advantages, and 0.8% only talked about disadvantages.

In 2012, black men were twice as likely to have discussed both advantages and disadvantages with their healthcare provider compared with white men (relative risk ratio 2.07, 95% CI 1.84-2.34, P<0.01). That figure didn't change much in 2014 (relative RR 1.95, 95% CI 1.76-2.18, P<0.01), the study found.

"We feel this finding is encouraging on multiple levels," the investigators said. "First, it suggests that general healthcare providers, represented in the BRFSS, appreciate published literature identifying not only a higher prevalence of prostate cancer among certain populations (in this case, African-American men) but also a higher risk of mortality, and consequently provide more educational information about advantages and disadvantages of PSA testing to those men."

A study limitation was that it didn't distinguish between first time PSA checks and annual screening tests. "If healthcare practitioners more frequently discuss advantages and disadvantages with a patient prior to his first PSA test than before subsequent routine screening, our finding that men were less likely to receive comprehensive counseling in 2014 relative to 2012 may be more accurately explained by a higher percentage of repeat screening tests than a true shift away from appropriate pre-screening advice," the authors acknowledged.

Nevertheless, "the trend we've identified towards a large number of patients undergoing PSA testing without any counseling about both advantages or disadvantages should not only be viewed as a serious problem but acted upon swiftly so as to minimize the chances of cultivating a growing cohort of patients ill-prepared to handle the repercussions of prostate cancer screening," they stated.

Comment