THE "NEW" PROSTATE CANCER INFOLINK

There have been several news reports about a survey conducted by Hoffman et al. and reported this week in the Archives of Internal Medicine. The survey suggests that the degree of communication about PSA testing between men and the doctors is generally poor.

According to these news reports (in, for example, Forbes and the Booster Shots blog of the Los Angeles Times), the take away message is that, “Doctors don’t adequately discuss prostate tests with patients.”

However, it is worth noting the following points that are clearly made in the article:

• “We conducted a telephone survey of a randomly selected national sample of 3010 English-speaking US adults 40 years and older.”
• “Included in the survey were 375 men who had either undergone or discussed (with health care providers [HCPs]) PSA testing in the previous 2 years.”

In other words, only 375/3,010 (12.5 percent) of the men contacted had either undergone or discussed a PSA test with their doctor during the time period referred to.

The survey report goes on to state the following results:

• 262/375 subjects (69.9 percent) discussed PSA testing before making a testing decision, including 54/375 (14.4 percent) who were not tested.
• Health care providers were the people most often raising the the idea of screening, and recommended PSA testing in over 70 percent of the cases.
• Health care providers emphasized the pros of testing in 71.4 percent of discussions but addressed the cons in only  32.0 percent of the situations.
• 58.0 percent of the subjects said that they “felt well-informed” about PSA testing, but nearly half of them (47.8 percent were unable to correctly answer any of the three questions they were asked about PSA testing).
• 54.8 percent of subjects reported being asked for their screening preferences.

What The “New” Prostate Cancer InfoLink finds interesting here is three things:

• The fact that in 85 percent of cases there was no discussion about PSA testing by either the patient or the doctor — which shows what a lousy job we are doing about prostate cancer risk awareness, despite all the money being spent on this.
• The fact that even in the small number of men (218/375) who thought they understood the issues, only about half could even give a correct answer to one of the three questions they were asked.
• The fact that it was usually the doctor, not the patient, who brought up the issue of PSA testing (and recommended it most of the time).

Make no mistake, we are doing a really lousy job of communicating the risks and benefits of PSA testing to the average American male and his primary care physician, and it’s not as though the topic doesn’t come up all the time!

According to HealthDay, Dr. Otis W. Brawley, chief medical officer at the American Cancer Society, in commenting on this report, said that, “Men should not be told that prostate cancer screening is more beneficial than we have evidence to show.” We absolutely agree with that sentiment, but we would also point out that that sentiment doesn’t mean that PSA testing is inappropriate. Interestingly, Dr. Brawley went on to state that the American Cancer Society “is reviewing its recommendations for PSA screening, and is expected to change them next year.”

Filed under: Diagnosis, Risk Tagged: | Diagnosis, PSA, risk, testing