New prostate cancer screening guidelines face a tough sell, study suggests

By Stephanie Desmon

(Medical Xpress) -- Recent recommendations from the U.S. Preventive Services Task Force (USPSTF) advising elimination of routine prostate-specific antigen (PSA) screening for prostate cancer in healthy men are likely to encounter serious pushback from primary care physicians, according to results of a survey by Johns Hopkins investigators.

In a survey of 125 primary care doctors, the researchers found that while doctors agreed with older recommendations to curtail in men over age 75 and among those not expected to live 10 or more years, a large number said they faced significant barriers to stopping PSA testing in men who had been receiving it regularly. The most frequently cited reason by 74.4 percent of physicians was, “My patients expect me to continue getting yearly PSA tests,” followed by 66 percent of them who said, “It takes more time to explain why I’m not screening than to just continue screening.” More than half of those surveyed in the new study believed that, “By not ordering a PSA, it puts me at risk for malpractice.”

The survey was conducted in November 2011, right after draft recommendations were made to end routine screening of all men, but before last week, when the draft recommendations were officially approved.

“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,” says Craig E. Pollack, M.D., M.H.S., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, and leader of the study published online in the journal Cancer. “Everyone agrees that isn’t as good as we want it to be. If we had a test that was a slam dunk, it would be different. But now we know that for many men, the benefits may be small and the harms significant.”

Each year, more than 33,000 American men die of , and 20 million get the PSA test to detect the disease early.

According to the USPSTF, evidence suggests 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. 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. The disease in older men often progresses slowly so that those who have it frequently die of other causes.

Treatments for prostate cancer can include the removal of the prostate, radiation or other therapies, each of which has the potential to cause serious problems like erectile dysfunction, complete impotence, urinary incontinence or bowel damage. And men who choose to “watch and wait” after elevated PSA readings must live with the anxiety of knowing they have an untreated cancer that could start to progress.

In the new study, Pollack and his colleagues found that while most physicians said they took age and life expectancy into account when deciding to order PSA screening, many also said they had a hard time estimating life expectancy in their patients and could use a better tool. H. Ballentine Carter, M.D., a professor of urology at Johns Hopkins and the senior investigator on the study, is planning to investigate the potential of individualized prostate cancer screening recommendations. Specifically, he and colleagues plan to create a decision-making tool that incorporates age, life expectancy, family history and prior PSA results in order to help doctors and their patients make better choices for prostate cancer screening.

In another report derived from results of Pollack’s and Carter’s survey, published in April in the Archives of Internal Medicine, the researchers say nearly half of the providers agreed with the new USPSTF recommendations to eliminate routine screening for healthy men. Still, less than two percent said they would no longer order routine PSA screening in response to the draft recommendations; 21.9 percent said they would be much less likely to do so; 38.6 percent said they would be somewhat less likely to do so; and 37.7 percent said they would not change their screening practices.

often expect PSA screening to be part of their annual physical,” Pollack says. “To change their minds, we need to address their perceptions about screening, allow time for screening discussions and reduce concerns regarding malpractice litigation.”

add to favorites email to friend print save as pdf

Related Stories

Recommendation against PSA test too drastic: WU expert

May 22, 2012

(Medical Xpress) -- A new recommendation issued today by the U.S. Preventive Services Task Force against routine PSA testing for healthy men age 50 and older goes too far, says a prostate cancer expert at the Siteman Cancer ...

Recommendation against PSA test goes too far: expert

Oct 12, 2011

(Medical Xpress) -- A draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older goes too far, says a prostate cancer expert at the Siteman Cancer ...

Guidelines for prostate screening widely ignored

Apr 24, 2012

New research confirms that the controversial decision by Warren Buffet – the 81-year-old CEO of Berkshire Hathaway – to undergo a blood test screening for prostate cancer despite his age is hardly ...

Recommended for you

How 'wriggling' skin cancer cells go on the move

3 hours ago

(Medical Xpress)—Scientists at King's College London have discovered a new way that melanoma skin cancer cells can invade healthy tissue and spread round the body, according to research published in Nature Co ...

Breast cancer imaging surgery world-first

4 hours ago

A world-first clinical trial to test new imaging technology that can scan tumours during breast cancer surgery has been launched at Guy's and St Thomas' NHS Foundation Trust in collaboration with King's College ...

User comments

Adjust slider to filter visible comments by rank

Display comments: newest first

pasquale55
not rated yet May 25, 2012
My PSA readings were slightly elevated. Time and antibiotics did not bring the reading down. The antibiotics, PSA testing, and waiting went on for about a year. I decided on the biopsy. I had moderately agressive cancer, located in 2 of 16 samples. At age 62, I had surgical removal. Cancer biopsy of prostate indicated moderately agressive cancer. Cancer was caught early, thanks to active use of PSA tests and monitoring PSA levels. PSA now zero. How else would this cancer have been detected without PSA test and biopsy? I was, otherwise, not symptomatic. Neighbor has battled stage 4 prostate cancer almost from the day I got surgery, about 6 years. He had had no doctor visits, no PSA testing, also no symptoms. His treatments have been pretty rugged, and his prognosis is not good. Routine PSA's would have shown something. My PSA was never higher than mid 4, his was in the hundreds.
PeterD
not rated yet May 27, 2012
The real reason doctors don't want to give up PSA test is that it makes it easy to sell biopsy and then surgery, for which they make a lot of money. Duh!