Study: Discussion of prostate screenings scarce
Published: Sunday, July 14, 2013, 5:45 p.m.
NEW YORK — Most men have not discussed the potential advantages and disadvantages of prostate cancer screening with their doctor, according to a new study.
Guidelines from groups including the American Urological Association and American College of Physicians call for shared decision-making when it comes to prostate specific antigen (PSA) testing, taking into account each man's values regarding screening.
“There's a lot of scientific uncertainty about its benefits and harms for any one person,” said Dr. Paul Han of the Maine Medical Center in Portland, who led the study.
The concern with screening is that PSA tests catch some cancers that never would have affected a man's life because they are so small and slow-growing — yet treatment can cause side effects such as incontinence and impotence.
And there's still controversy about whether regular screening saves a significant number of lives.
The U.S. Preventive Services Task Force (USPSTF), a government-backed panel, recommends against prostate cancer screening.
Han and his colleagues analyzed questionnaires completed by about 3,400 men in their 50s, 60s and early 70s as part of a 2010 national health survey.
They found 64 percent of those men had not discussed the pluses and minuses of PSA tests with their doctors, or the scientific uncertainty of their effect. Of the rest, about half had talked only about the advantages of screening.
About 44 percent of study participants hadn't been screened for prostate cancer in the past five years. The majority of those — 88 percent — reported no discussions regarding that choice, according to findings published in the Annals of Family Medicine.
Prior studies have focused on men who were screened without a discussion of the potential benefits and harms — sometimes without their knowledge.
Beyond weighing the risks and benefits of screening for any individual man, the PSA test itself may not be that accurate or reliable an indicator of cancer.
But if the evidence on PSA tests is “truly uncertain,” Han said, failing to talk about the decision to not get screened could be concerning as well.
The PSA test is the “poster child for uncertainty,” said Dr. Michael Wilkes of the University of California, Davis.
“The test is horrible, yet there are still reasonable men who still might opt to have the test because they feel that knowing the information, even though it's not perfect, is better than not knowing it,” he said.
“In this situation, reasonable people can look at the data and because of their own values and their own preferences decide, ‘I want the test' or, ‘I don't want the test.' ” In two studies published in the same journal, Wilkes and his colleagues looked at whether educating doctors about prostate cancer screening and prompting patients to ask about it boosted rates of shared decision-making.
Their studies included about 120 doctors.
“What we found was, educating the doctor is necessary but not sufficient,” Wilkes said.
He recommends men do their homework on prostate cancer screening — by looking at the Centers for Disease Control and Prevention and USPSTF websites, for example — before going in to see their doctor.
Better training and resources for doctors might also help, Han said.
“Studies are converging to the same conclusion, that (shared decision-making) really doesn't happen very often in PSA screening,” he said.
“It's one of these things like world peace. Everyone agrees with it as an ideal, but how to actually achieve it, we don't know.”
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- US Airways’ pornographic tweet won’t cost anyone a job
- Obama, House Republicans trade accusations in thwarting immigration reform
- Denver wife killed 12 minutes into 911 call, sparking inquiry
- AC/DC not disbanding, lead singer Brian Johnson says
- Android systems running 4.1.1 softward carry Heartbleed bug
- Suspect in Jewish community sites shootings appears in court in wheelchair
- New York Police Department commissioner disarms post-9/11 intel program
- Vermont Senate OKs GMO labels as industry insists genetically modified crops are safe
- Census director defends changes, denies questions altered to inflate Obamacare success
- Tea Party flap averted fraud probe by IRS, Justice, emails show
- Pulitzers awarded for coverage of NSA spy programs, Boston Marathon bombing