Men’s opinions on PSA testing and the USPSTF guideline: does it apply to ME?

A study just published in the American Journal of Preventive Medicine suggests that “The new USPSTF recommendation against PSA testing in all men may be met with resistance” on the part of male consumers.

As our regular readers will likely be well aware, in October 2011 the U.S. Preventive Services Task Force (USPSTF) released a draft recommendation advising against the widespread use of PSA testing (“screening”) for risk of prostate cancer. The recommendation was formalized in 2012.

Squiers et al. have now published data based on a web survey of men aged between 40 and 75 years of age. The web survey was carried out by a well-known, commercial market research firm with specialized experience in health-related issues between November 22 and December 2, 2011. The goals of the study were to assess men’s awareness of the new recommendation and their responses to it.

Here is a summary of the findings:

  • The survey was completed by 1,089 men who had no actual history of prostate cancer.
  • After reviewing the recommendation,
    • 62 percent of participants agreed with it.
    • 13 percent of respondents were “intenders,” i.e., they planned to follow the USPSTF recommendation and not get PSA tests in the future.
    • 54 percent of respondents were “non-intenders,” i.e.,  they planned to not follow the USPSTF recommendation and get PSA tests in the future.
    • 33 percent of respondents were undecided.
  • Age and worry about getting prostate cancer were significantly related to disagreement with the recommendation.
  • The following characteristics were all positively associated with being a “non-intender”
    • Black race
    • Higher income
    • Having had a PSA test in the past 2 years
    • Being somewhat or very worried about getting prostate cancer

What is most interesting about this study is the fact that despite a 63 percent agreement with the recommendation, we see that many respondents then turned around and exhibited the characteristic “but in my case” syndrome, in which they agreed with the principle but indicated that in their particular case it wouldn’t be appropriate to follow the guidance that they agreed with! (This actually occurs frequently in this type of market research study.)

The “New” Prostate Cancer InfoLink is of the opinion that it is hard to know what to make of this research. At best it seems to be somewhat data-weak to us.

For a start, the men being enrolled into a study like this should have been divided into “mindset” groups from the outset, because one’s attitude to this issue is undoubtedly highly colored by one’s prior knowledge and experience. The income issue may or may not be relevant, but answering “Yes” to any one of these questions is likely to immediately place a man into the “intender” category:

  • Are you a member of a known prostate cancer risk group (e.g., African American; having at least two close male relatives diagnosed with prostate cancer)?
  • Have you intentionally participated in prostate cancer screening initiatives at least twice in the past?
  • Are you worried about your personal risk for prostate cancer?

Similarly, answering “Yes” to one or other of the following questions is likely to place a man in the “non-intender” category:

  • Have friends or members of your family ever expressed regret that they got diagnosed and treated for prostate cancer?
  • Do you believe that most men who are treated for prostate cancer never needed to get diagnosed in the first place?

The bottom line, in any case, is that (given that it is the only simple test we have available today) the PSA test is, in fact, a highly appropriate test to give to a man who has reason to believe he is at risk for prostate cancer. What is not reasonable (and has never actually happened in any case) is the idea that every man in America over the age of (say) 40 or 45 or 50 should be getting annual screening PSA tests. Somewhere in between the two extremes of “test no one ever” and “test everyone every year” there is a reasonable accommodation. Finding that reasonable accommodation is hard, however, because that’s where people’s individual opinions tend to get in  the way of good interpretation of good data (of which we don’t have very much to begin with).

4 Responses

  1. In general I think people would prefer not to hear bad news, so tests are avoided for that reason, as though ignoring the situation would make it go away. The view that it “can’t happen to me” may be psychologically satisfying to some, but does not change the facts

  2. Many men don’t even know how to spell or pronounce “prostate” before a diagnosis and even after we have to let them figure it out. So to not be against the USPSTF recommendation is logical. They sound like an informed group don’t they?

  3. I take heart in that 33% undecided group and the 54% non-intenders. Maybe the word is getting out that the USPSTF blundered badly in understanding both the research (and its critical flaws), the disease itself, and approaches, especially including active surveillance.

    My heart goes out to that 13% group who trust the USPSTF recommendation and intend not to be tested. For years, back in the 90s, I had believed a similar message that was prominent in medical advice media for patients. However, nagged by second thoughts, I changed my mind about screening. I even had to insist on my fateful PSA test that came back as 113.6 ng/ml, starting me on this journey. I am profoundly grateful I did not wait just one more year for that first-ever test at age 56. With a PSA doubling time of a little over 3 months, such a wait would likely have put me on a deadly course. No doubt some men in that trusting 13% will experience that fate, like their fathers and grandfathers who were blindsided by the disease before the PSA era.

    We need to get the message out that smart screening, coupled with active surveillance for low-risk diagnoses, makes sense!

  4. Like Butch Cassidy and the Sundance Kid quote: “Who are these guys!?”

    These are 16 PCPs and medical economists and public health officials who are government appointed. That should be your first reason to not trust in what and who they are. They are not specialists nor researchers or oncologists or virologists.

    The hepatitis C coalitions had to fight tooth and nail with these 16 health care idiots to get hepatitis C moved to a “B” status for testing. Why do we need these 16 individuals deciding your and my health care needs?

    Women are furious over their new breast cancer screening guidelines. Pink is everywhere; even the NFL! Men need to get some balls because if they don’t start speaking out about not only your testicles and your prostates and your penis you might just lose them!

    I have met 40-year-old men with aggressive prostate cancer who were thankful for the PSA test. I just met a 28-year-old woman with cervical cancer. Why do we always think it is the middle-aged and geriatric crowd that falls prey to illness?

    Why do we have the CDC? They do a bad enough job at dragging their heels. Why do we need these 16 idiots dragging along with the CDC to block or just tell you they have done some study for a month and spoke with some very scared doctors of the malpractice demons coming after them and the HIPAA police?

    Spare the nerves! That should be why men young and old should be speaking out! Better screening and testing and scanning and needed biopsies can only lead to better research and we will all look to the past at how stupid and barbaric it was to let men die and have impotence and kidney and bladder problems from a tiny little gland like the prostate.

    Oh and in case the USPSTF hasn’t done a research paper on this yet, you don’t need to worry we are all going to die when we sail off into the sunset. Guess what! They found out the Earth is not flat! So should the USPSTF’s ship of 16 fools!

    In fact we should not even have to deal with them. They should just go back to their practices and public health care jobs and their economy worries and get out of health care progress. Their ancestors were probably the ones that threw the herbalists and and homeopaths into the rivers and lakes to see if they would float or not and whether they were witches and goblins: early malpractice advocates against what was to become what we now call modern medicine.

    Ain’t some progress good. It spares innocent lives!

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