Study: New prostate Ca screening guidelines face a tough sell

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

In the survey of 125 primary care physicians, researchers from Johns Hopkins University, Baltimore found that while physicians agreed with older recommendations to curtail routine screening in men over age 75 years 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% of physicians was, "My patients expect me to continue getting yearly PSA tests," followed by 66% 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."

"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 first author Craig E. Pollack, MD, MHS. "Everyone agrees that PSA screening 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."

The survey was conducted in November 2011, shortly after the USPSTF released its draft recommendations on prostate cancer screening, but before the recent release of the final recommendations. Results were published online in Cancer (April 19, 2012).

Dr. 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.

In another report derived from results of the survey, published in April in the Archives of Internal Medicine (2012; 172:668-70), Dr. Pollack and co-authors say nearly half of the providers agreed with the USPSTF’s recommendations to eliminate routine screening for healthy men. Still, less than 2% said they would no longer order routine PSA screening in response to the draft recommendations; 21.9% said they would be much less likely to do so; 38.6% said they would be somewhat less likely to do so; and 37.7% said they would not change their screening practices.

In related news, Pennsylvania State Representative Karen Boback (R-Columbia/Luzerne/Wyoming) announced that her House Resolution 523, which encourages continued PSA screenings for all men who are at risk of prostate cancer, passed unanimously in early May through the House Health Committee.

Boback introduced the resolution in reaction to the USPSTF’s fall 2011 draft recommendations.

"At the time when the task force issued its recommendation last fall, an updated study found that with screening, deaths from prostate cancer dropped 44%," Boback said. "The conventional wisdom is, no matter what type of cancer we’re dealing with, early detection is always best. I’ve fought to protect women’s health and I’ll do the same for men across the Commonwealth."

The resolution awaits consideration by the full House.

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