New prostate cancer screening recommendations are likely to encounter disapproval from primary care physicians, according to new research by Johns Hopkins investigators.
The U.S. Preventive Services Task Force on May 21 advised eliminating the routine prostate-specific antigen – commonly known as PSA – screening for healthy men. In its new guidelines for prostate cancer screening, the federal task force urged doctors not to use PSA screening – a common blood test – to detect the disease. At best, the test only helps about 1 in 1,000 men avoid death from prostate cancer, the panel said.
In a survey of 125 primary care doctors, the Johns Hopkins study found that while doctors agreed with older recommendations to curtail routine screening in men over age 75 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 percent of physicians was, "My patients expect me to continue getting yearly PSA tests,” followed by 66 percent of them 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.”
The survey was conducted in November 2011, right after the federal panel’s draft recommendations were made to end routine screening of all men. The draft recommendations were officially approved after the survey was conducted.
Each year, more than 33,000 American men die of prostate cancer, and 20 million get the PSA test to detect the disease early.
According to the U.S. Preventive Services Task Force, evidence suggests the potential harms caused by PSA screening of healthy men as a means of identifying prostate cancer outweigh its potential to save lives and that routine annual screening should be eliminated in healthy men. Elevated PSA readings are not necessarily evidence of prostate cancer, and can lead to unnecessary prostate biopsy. In addition, even when biopsies reveal signs of prostate cancer cells, evidence shows that a large proportion will never cause harm, even if left untreated. The disease in older men often progresses slowly so that those who have it often die of other causes.
Treatments for prostate cancer include the removal of the prostate, radiation or other therapies, each of which has the potential to cause serious problems like erectile dysfunction, complete impotence, urinary incontinence or bowel damage. Men who choose to "watch and wait” after elevated PSA readings often have high anxiety levels from the knowledge that they have an untreated cancer that could start to progress.
The new study 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 a separate report derived from results of the Hopkins survey, published in April in the Archives of Internal Medicine, researchers reported that nearly half of the providers agreed with the new U.S. Preventive Services Task Force recommendations to eliminate routine screening for healthy men. Still, less than two percent said they would no longer order routine PSA screening in response to the draft recommendations; 21.9 percent said they would be much less likely to do so; 38.6 percent said they would be somewhat less likely to do so; and 37.7 percent said they would not change their screening practices.