Do urologists practice what they preach…about PSA screening?




BOSTON — Physicians who routinely treat prostate cancer are “very likely” to undergo PSA screening themselves or recommend it to immediate family members, concludes a survey-based study presented here at the American Urological Association (AUA) 2017 Annual Meeting.

In total, 784 (90%) of the 869 physician respondents endorsed past or future screening for themselves or for relatives.

The survey respondents were mostly urologists (83%) and mostly came from North America (68%), as well as Central and South America, Europe, Australia, and New Zealand.

Less overwhelmingly, only 61% of the 807 male respondents had personally undergone PSA screening. However, 94% of the “screen eligible” men said they had taken a PSA test, clarified lead study author Christopher Wallis, MD, from the University of Toronto, Ontario, Canada.

Awkwardly, Dr Wallis did not know the age the AUA recommends most men start screening, when asked by a reporter. He guessed 50 years of age. “Fifty-five,” quietly said Stacy Loeb, MD, from New York University, New York City, who moderated the press conference.

Dr Wallis pointed out to Medscape Medical News that the survey is international and that, although the AUA recommends screening from age 55 to 69, the NCCN recommends screening from age 45 to 75, and the EAU recommends screening from 50 until life expectancy is less than 10 to 15 years.

Dr Loeb was loud and clear about the new results: “We can see that the doctors who manage prostate cancer really do practice what they preach, and choose PSA screening for themselves,” she said in a meeting press statement.

In the survey, 82% of the 807 male physicians also said they planned to have a PSA test in the future.

The women were less enthusiastic: Only 69% of the 62 female physicians had recommended PSA testing to immediate family members.

But the study has a methodological limitation: it contains exclusively self-reported behavior. “We don’t know if the men who said they got PSA testing actually got PSA testing,” Dr Wallis admitted.

Furthermore, “these results may be unreliable,” Dr Wallis told reporters.

“We don’t know if the men who said they got PSA testing actually got PSA testing,” Dr. Christopher Wallis added.

 He explained that physicians have been shown in a previous study to recommend different treatments than they would choose for themselves ( Arch Intern Med. 2011;171:630-634). The study was widely reported at the time, including by Medscape Medical News.

There is also a “discrepancy” between what physicians may recommend to one individual patient and what they recommend in general for a population of patients, according to other research, Dr Wallis said, citing other research.

 He said his team employed the “physician surrogate method” to “try and get around these issues.” Their methodology called for posing both direct and hypothetical questions to allow for a fuller range of responses. This method has, for example, been used to interview physicians about lung cancer preferences, he explained.

In the new survey, the male respondents were directly asked: “Have you been screened, and will you be screened?” If a man was not of screening age, the question was, “Do you plan to get screened?”

Women respondents were asked what they recommended their first-degree relatives (husbands, fathers, brothers, etc) do about PSA testing.

The study has limitations in addition to self-reporting. First, the authors do not know the response rate. “The organizations that distributed the survey wouldn’t tell us,” said Dr Wallis.

Second, the respondents were predominantly urologists. The responses may have differed with more oncologists, he suggested.

The purpose of the survey was to examine what motivates the recommendation for PSA testing from specialists.

“You could say that, in theory…a specialist may recommend screening to identify a cancer because that drives patients to them,” which is a financial motivation, but the results suggest these professionals are motivated instead by their trust in the PSA test, added Dr Wallis.

Finally, the survey also asked physicians whether they were diagnosed with prostate cancer and, if so, what treatment they chose.

Thirty men responded affirmatively: they had prostate cancer and had been treated. Similarly, 16 women responded affirmatively, speaking on behalf of relatives they had advised.

Specialists tended to get treated by their fellow specialists: “Urologists choose surgery, radiation oncologists choose radiation,” said Dr Wallis.

That is, 64% of the responding urologists received a radical prostatectomy and 83% of radiation oncologists underwent radiation therapy. There was a significant correlation between specialty and treatment (P = .001).

These treatment preferences are concordant with other research, emphasized Dr Wallis. That concordance, he said, might bode well for the accuracy of the PSA portion of the survey.

“Perhaps people are responding in a way that is reliable for our other question,” he said hopefully.

American Urological Association (AUA) 2017 Annual Meeting: Abstract PD07-07. Presented May 12, 2017.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

For more from Medscape Oncology, follow us on Twitter: @MedscapeOnc

One Reply to “Do urologists practice what they preach…about PSA screening?”

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: