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Despite new USPSTF recommendation, men remain favorably inclined to PSA testing
Most men still plan to undergo PSA testing despite recent evidence that suggested the harms outweigh the benefits, according to study results.
In October 2011, the US Preventive Services Task Force released a draft recommendation discouraging the use of PSA tests in healthy, symptom-free men, citing insufficient evidence to assess the balance of benefits and harm of prostate cancer screening in men aged younger than 75 years.
“Since cancer screening has been promoted as a way to save lives, this recommendation may seem counterintuitive to many people,” researcher Linda B. Squiers, PhD, of RTI International, said in a press release.
To establish knowledge of and attitudes toward the USPSTF’s newly released draft recommendation, the researchers conducted a survey of men aged 40 to 74 years without a history of prostate cancer (n=1,089). The investigators used the Web-enabled Knowledge-Panels (GfK Custom Research LLC), a probability-based panel intended to be representative of the US population.
The researchers performed Chi-square tests and logistic regression analyses to identify factors associated with disagreement with and intention to follow the recommendation. Data were analyzed in March 2012, two months before the USPSTF issued its final recommendation.
According to study results, 62% of surveyed men agreed with the USPSTF recommendation.
Age and concerns about prostate cancer diagnosis were significantly correlated to disagreement with the recommendation. Only 13% of respondents planned to follow the USPSTF recommendation and not receive a PSA test in the future, whereas 54% expressed intentions to not follow the recommendation; 33% of respondents were undecided.
Men in their 50s were significantly more likely than men in their 40s to disagree with the recommendation not to get screened. Black men, those with higher incomes, and those who had received a PSA test in the previous 2 years were more likely to not adhere to the new recommendation.
“Findings provide a snapshot of men’s attitudes toward the new recommendation and can serve as a baseline for studies that monitor changes in men’s attitudes and intentions toward PSA testing over time,” Squiers and colleagues wrote. “We need to do a better job of presenting both the benefits and harms of screening to all patients and explaining the science behind the recommendation in plain language so everyone can understand it.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Despite ongoing controversies and accumulating evidence supporting the benefits of PSA testing, the USPSTF made its final recommendation in May 2012 against PSA screening in all men, regardless of age or family history. As a urologist who actively treats men with prostate cancer, I like to point out that the USPSTF did not include a single urologist or group of physicians who regularly cares for patients with prostate cancer. In fact, the panel included a group of “experts,” including pediatricians and family practice physicians, who are usually not involved in the care of patients with the disease.
The study by Squires and colleagues sought to evaluate whether potential patients (ie, consumers) were aware and/or influenced by the USPSTF stance on PSA screening. More than 75% of respondents to the survey reported not paying attention to or being unaware of the recommendations. I believe this supports the fact that most patients are generally uninformed about screening practices for prostate cancer and generally leave it up to the responsibility of experts (eg, primary care physicians and urologists) to tell them about what tests to have performed. However, the study also documented that when respondents were told about the recommendations, almost two-thirds of them agreed with the recommendation and thought it was based upon the latest research.
It is important to note that I believe the studies upon which the USPSTF recommendations were based were grossly flawed and were not of substantial quality to make any recommendations about the potential benefits and harms of PSA testing.
As a practicing urologist who specializes in the care of men with prostate cancer, I can only hope that we will continue to offer men the benefits of PSA screening.
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This study touches on the ongoing controversy regarding the early detection and treatment of prostate cancer. The core of the debate centers on the value of mass screening for the disease. There is no question that widespread use of PSA based screening has resulted in a shift from presentation at an advanced stage to more localized disease. The challenge is that we are finding a lot of cancers that may be described as “toothless lions.”
It is not surprising that the consumers are favorably disposed to PSA testing, as reported by Squiers and colleagues. Human nature is such that there is a belief that early detection of most diseases is beneficial. In my role as chairman of the National Prostate Conditions Education Council, I have seen this behavior many times. More than a decade ago, some organizations condemned screening. The reflex reaction was a feeling that this did not apply to me and I had better get checked.
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As a non-urologist voyeur of this confusing topic, I would like to see a study that determines whether repeat PSA levels done 6 or 12 months apart in patients with an initial elevated level might be useful in sorting out the toothless tigers that need no invasive procedures or quality-of-life–reducing therapies. I am aware of highly intelligent folk who have chosen this scenario with subsequent normalizing PSA values. The prognosis in many such patients needs to be ascertained in expanded studies in the future.