The most recent guidelines from the U.S. Preventive Services Task Force (USPSTF) recommend against routine testing for prostate-specific antigen (PSA), but the level to which this advice is followed may vary by physician type, according to a study published in JAMA Internal Medicine.
The research, based on analysis of a nationally representative survey data on 64 men who went to urologists for preventive care visits and 1,100 who saw primary care physicians (PCPs), revealed that urologists don't necessarily agree that less testing for early stage prostate cancer is a good idea, as urologists' orders for PSA tests dropped just 4 percentage points, to about 35 percent overall, the year after the new guidelines took effect.
Meanwhile, screening among PCPs tumbled 21 percentage points from 2010 to 2011, from 37 percent to 16 percent testing rates among male patients aged 50 to 74.
Although most experts agree that men with limited life expectancy do not benefit from PSA testing, doctors' decision whether to recommend the test to others is a matter of opinion, noted senior study author Quoc-Dien Trinh, M.D., a urologist at Brigham and Women's Hospital in Boston.
"I do feel strongly that some men are more at risk of prostate cancer and I'm concerned about what will happen to these men given the current USPSTF recommendations and trends in PSA testing," Trinh told Reuters.
The American Cancer Society and the American Urological Association recommend shared decision-making between men and their doctors to weigh the benefits and harms of screening, the news service added.
A recent proposal from the Centers for Medicare & Medicaid Services that would tie PSA testing for non-recommended patients to physician quality scores drew considerable controversy, FiercePracticeManagement reported previously. The debate is ongoing and people feel very strongly about it, one way or another, according to David Penson, M.D., chair of public policy and practice support for the American Urological Association, about the CMS proposal. "To make it a quality measure would say, 'You're a poor quality doctor if your patients get this test.'"
To learn more:
- read the article
- see the study abstract