Most Doctors Talk About Prostate Cancer Screening with Patients

The PSA test detects a protein (prostate specific antigen) produced by prostate cells. This protein is produced only in the prostate gland. Since this is a normal protein in the prostate gland, a high PSA test value may be associated with several prostate conditions including an enlarged prostate, an infection, prostate cancer, or another problem. Usually it means that further tests are needed.

The PSA test and the digital rectal exam are useful in determining if cancer might be present, but prostate cancer can be diagnosed only with a prostate gland biopsy. The PSA test, although not perfect, allows prostate cancer to be found early, when a cure is possible.

Not all medical experts agree that screening for prostate cancer will save lives. The U.S. Preventive Services Task Force (USPSTF) recommends against PSA-based screening for men that do not have symptoms. Understanding that men and their doctors may continue to screen for prostate cancer, the main public health approach is to support informed decision making about screening. Public health agencies and professional organizations are trying to provide men with information about the benefits and risks of prostate cancer screening so each man can make his own decision.

According to national guidelines, doctors should talk about the benefits and harms of prostate cancer screening with patients before ordering the test. CDC conducted a study that examined—

• The percentage of U.S. primary care physicians (doctors) who talk about prostate cancer screening and whether they recommend it to their patients.
• Characteristics of doctors who were more or less likely to talk about prostate cancer screening with their patients, and who were more or less likely to encourage patients to get a PSA test.

A sample of 1,256 doctors, representing nearly 95,000 doctors in the United States, were surveyed in the 2007–2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening. The survey was specifically designed to address doctors' behaviors concerning prostate cancer screening. We evaluated what characteristics of doctors were associated with talking about prostate cancer screening with their patients, and found that both individual and practice-related factors were associated with doctors' use of prostate cancer screening discussions.

Important Findings

How many doctors talk about and encourage PSA testing?

• Four out of five doctors said they routinely talk about prostate cancer screening with all of their male patients.
• Nearly two-thirds of doctors who talked about screening with any patients said they encouraged their patients to get a PSA test.

Which doctors were more likely to encourage PSA testing?

• African-American doctors were nearly three times more likely to encourage PSA testing.
• Doctors who serve 100 or more patients per week were twice as likely to encourage PSA testing.
• Doctors who spend more than 30 hours per week in direct patient care were twice as likely to encourage PSA testing.

Which doctors were less likely to encourage PSA testing?

• Doctors in multi-specialty group practice were more likely to remain neutral or discourage PSA testing than doctors in solo practice.

Hall IJ, Taylor YJ, Ross LE, Richardson LC, Richards TB, Rim SH. Discussions about prostate cancer screening between U.S. primary care physicians and their patients. Journal of General Internal Medicine 2011;26(10):1098–1104.