Does your PCP encourage PSA testing at your annual check-up?

The roles and behaviors of primary care physicians (PCPs) in the US in encouraging men to or discouraging men from having a PSA test to assess possible risk for prostate cancer are still not well understood.

Hall et al. have recently analyzed data from the 2007-2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening. This survey, which involved 1,256 PCPs, is the most recent and the most comprehensive survey specifically designed to address issues concerning prostate cancer testing. According to Hall et al. it provides information representing the behaviors and beliefs of nearly 95,000 PCPs.

The research team evaluated the relationship between PCP behavior regarding discussions about prostate cancer testing for individual patients and things such as PCP demographic and practice-related factors.

The core results reported by Hall et al. are as follows:

  • 80 percent of PCPs reported that they routinely discuss prostate cancer testing with their male patients.
  • 64.1 percent of PCPs who discussed testing with any patients reported that they attempted to talk their patients into getting the PSA test.
  • Encouragement of PSA testing was more likely among
    • Non-Hispanic black PCPs (odds ratio [OR] = 2.80)
    • PCPs serving 100 or more patients per week (OR = 2.16)
    • PCPs spending a greater number of hours per week in direct patient care (31 to 40 hours, OR = 1.90; ≥ 41 or more hours, OR = 2.09) compared to their referents.
  • PCPs in multi-specialty group practices were more likely to remain neutral or discourage PSA testing compared to PCPs in solo practice.

Given the significantly higher incidence and mortality rates of prostate cancer among African Americans than Caucasians and Hispanics, it make perfect sense than non-Hispanic, African American primary care providers would be very likely to make a strong recommendation for testing to their male patients.

In the case of the physicans who are seeing more patients or spending more time on patient care issues, the increased likelihood of PSA testing may simply reflect the “simplicity” of adding a PSA test to the other tests being carried out on a standard blood sample. In other words, the doctor may just be requesting the test after little more than a cursory discussion with the patients. (“Now that you are 50, I’m also going to get a PSA test done to check for prostate cancer.”)

We also know from prior studies that PCPs’ individual mindsets about PSA testing are often influenced by their personal or familial experiences with prostate cancer or other prostate disorders.

6 Responses

  1. Without my knowledge, when he did a physical, my PCP checked the PSA box on the lab request. My PSA came back at 19.8. I was only 44 years old at the time. There was no discussion until he had the results. Then I had to ask what a PSA test was.

    I wonder if with the current trend, that would have clearly been against me getting screened, he would have need to be sat down and given a timeout? From me he gets Christmas cards …

  2. Yes, he did provide, without discussion, PSA blood test along with other annual screening tests. My 2.4 ng/ml at first test at age 52 was of no concern, apparently, to him. It was reported as “normal.” The 5.1 ng/ml value 3 years later was then followed by a 4.9 and a postcard that said “Better! :)” Really. Better with a smiley face. Two years later I was metastatic. So the test is just the first thing. I wish he had had a conversation with me after the test, rather than the postcard with the teenage emoticon and then complete forgetfulness.

  3. Which kinda makes my point. Not only was he uninformed (because a PSA of 5.1 is a clear signal of risk); because he was uninformed, he also failed to educate you.

    I wish he’d had a conversation with you after the first test result of 2.4. Even that was elevated for someone of your age at that time.

  4. Let’s be fair. Why do we expect GPs to be informed? Many if not most of their organizations do not recommend testing with PSA. They mostly follow the recommendations of the USPSTF.

    The debate about mass screening has confused the issue for individuals. Doctors and men read every day about the harms of PSA. Dr. Ablin who identified the protein but never dreamed of commercializing it is negative about it.

    When Otis Brawley talks negatively about screening with PSA, buried somewhere he says he is not against individuals deciding to be tested…but then adds that he has never been tested and never will.

    Why do we expect to find many GPs using the test? Maybe only because of malpractice fear … and those are few …

  5. Ralph … Your comment would not appear to gel with the findings of the above-referenced study, in which 80% of PCP claimed to discuss testing with their male patients and well over half of that 80% attempted to talk their patients into (not out of) having PSA tests.

  6. I had a similar situation to John. The doctor did PSA and %free PSA test at 43 years without any discussion. Results were 2.4 and 12.86%. This did not concern her even though the %free PSA value was marked “Low” on the report.

    I think she did not understand how to read %free PSA results and thought low was good. A PSA of 2.4 is high for a 43-year-old but she clearly did not know that. No DRE was performed and she even recommended that I take DHEA to address my low energy levels, something which is contraindicated in people with risk of prostate cancer as it increases androgen levels. Two years later PSA was 4.5 and I had T3 cancer.

    Not too much point doing tests if the doctor doesn’t understand what the results mean.

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