Physicians Hesitant About Stopping PSA Tests

Recent recommendations from the US Preventive Services Task Force (USPSTF; Rockville, MD, USA) advising elimination of routine prostate-specific antigen (PSA) screening for prostate cancer in healthy men are likely to encounter serious resistance from primary care physicians, according to a new survey.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) conducted a survey among 125 primary care doctors conducted during November 2011, following the USPSTF draft recommendations to end routine screening of all men, but before May 2012, when the draft recommendations were officially approved. Participants were asked about their current screening practices, factors that influenced their decision to discontinue screening, and barriers to discontinuing screening.

The researchers found that 59.3% of the participants took both age and life expectancy into account, whereas 12.2% did not consider either in their decisions to discontinue PSA screening. Providers varied in the age at which they typically stopped screening patients, and the majority reported difficulty in assessing life expectancy. Taking patient age and life expectancy into account was not associated with provider characteristics or practice styles. The most frequently cited barriers to discontinuing PSA screening were patient expectation (74.4%) and time constraints (66.4%).The survey results were published early online on April 19, 2012, in the journal Cancer.

“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,” said lead author Craig Pollack, MD, MHS, an assistant professor in the division of general internal medicine at the JHU School of Medicine. “Men often expect PSA screening to be part of their annual physical. To change their minds, we need to address their perceptions about screening, allow time for screening discussions, and reduce concerns regarding malpractice litigation.”

The USPSTF claim that the potential harms caused by PSA screening of healthy men as a means of identifying prostate cancer outweigh its potential to save lives, and that routine annual screening should be eliminated in the healthy, since elevated PSA readings are not necessarily evidence of prostate cancer, and can lead to unnecessary prostate biopsy. In addition, even when biopsies reveal signs of prostate cancer cells, evidence shows that a large proportion will never cause harm, even if left untreated. In addition, the disease in older men often progresses slowly so that those who have it frequently die of other causes.

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