Important discussions about prostate cancer screening and treatment are not occurring between men and their health care team, according to a recent article published in the American Journal of Men’s Health (doi:10.1177/1557988315614082).
How to screen for prostate cancer has become controversial. Guidelines from the American Urological Association recommend screening for men 55 to 69 years and men younger than 55 years whose family member had prostate cancer or are African American.
However, since the US Preventive Services Task Force recommended in 2012 against prostate-specific antigen (PSA)-based screening, a simple blood test, a number of organizations have begun to caution against routine population screening. At the same time, there are some organizations that continue to recommend PSA screening.
“Nobody is willing to make strict guidelines concerning prostate cancer screening,” said Chad LaGrange, MD, an associate professor at the University of Nebraska Medical Cancer (UNMC), and coauthor of the study. “Part of the problem is the current recommendations for screening are vague. The task force study has some flaws.
“Most of the guidelines today say it’s OK to screen, but if screening is done, health providers should really discuss with the patient what screening means and what the downfalls are and what the advantages are. This is called shared decision making.”
The occurrence of this shared decision making was the topic of this study by LaGrange and researchers from UNMC and the University of Memphis. They wanted to know if it is really happening between providers and patients. Their study examined which patients are getting a good discussion about prostate cancer screening and which patients are not.
The researchers used a questionnaire that asked questions about PSA screening to determine if physicians were going over the risks and benefits of PSA screening before doing the screening or explaining how prostate cancer is treated.
Based on 1700 patient questionnaires nationwide, the study found that only 17% of the patients were told that some experts disagree about whether men should undergo PSA tests. Only 23% were informed that some types of prostate cancer are slow-growing and need no treatment.
Also, 25% were told that the PSA test is not always accurate in diagnosing prostate cancer.
Among the patients answering the study questionnaire, 31% were told that treating any type of prostate cancer can lead to serious side effects such as urinary incontinence and erectile dysfunction.
LaGrange explained that the study showed only 9% of patients had all 4 areas discussed with them, meaning that the intent to share decision making was not happening for 91% of patients.
“The only way to find the serious prostate cancer cases is to screen,” he stated. “If there’s a diagnosis, then men should get a second opinion to decide whether it needs to be treated based on the guidelines and all clinical information available.”
According to LaGrange, the debate should focus not so much on prostate cancer screening but rather on over-treating prostate cancer.
“Some cancers don’t need to be treated. We can watch patients and simply follow them,” he said.
Men should establish a long-term relationship with a primary care physician, which LaGrange explained is one of the biggest take home messages from the study.
“This speaks to the physician-patient relationship. An open discussion is more likely with a provider with whom patients have a long-term relationship,” he said.