Prostate Cancer Screening: Who Recommends PSA Testing?
Recent research led by Brigham and Women’s Hospital suggests that the likelihood of a patient getting prostate-specific antigen (PSA) testing for the early detection of prostate cancer depends on the type of physician he sees.
In October 2011, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation against the use of PSA testing for prostate cancer screening for all men. In its assessment, the task force concluded that, overall, the harms of PSA testing outweigh its benefits. The study authors, however, hypothesized that adoption of the USPSTF recommendation would vary according to a physician’s specialty.
The researchers examined PSA testing use among primary care physicians (PCPs) and urologists in the year immediately before the recommendation was issued and the year immediately afterward. To focus on preventive care visits, men previously diagnosed with prostate cancer, an elevated PSA level, or other prostate conditions were excluded from the study.
The study found that PSA testing for men aged 50-74 years decreased significantly from 36.5 percent in 2010 to 16.4 percent in 2012 among PCPs. However, during those same years, such testing among urologists only decreased from 38.7 percent to 34.5 percent.
Dr. Quoc-Dien Trinh, a Brigham and Women’s Hospital urologist and lead author of the study, isn’t surprised by the results. He notes that the American Urological Association continues to recommend that men aged 55 to 69 years make joint decisions with their physician about PSA testing. This recommendation is supported by the BWH Division of Urology and the Lank Center for Genitourinary Oncology at Dana-Farber/Brigham and Women’s Cancer Center, which believe that research shows that PSA screening saves lives, and the benefits outweigh the risks.
“Our findings reflect the differing opinions among physicians about PSA screening and how those differences impact patient care,” says Dr. Trinh. “This highlights the need for physicians to reach a broader consensus on the risks and benefits of prostate cancer screening and the importance of patients discussing their care options with their physicians.”
In this video, Anthony D'Amico, MD, Professor and Chief of Genitourinary Radiation Oncology at BWH, explains how the recommendation by the US Preventative Service Task Force (USPSTF) to label the PSA test for prostate screening with a "do not use" rating is a mistake.