Doctors don’t adequately discuss prostate tests with patients

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Half of men who received a PSA test for prostate cancer were not asked if they wanted it, despite national guidelines recommending that physicians thoroughly discuss the issue with their patients, according to a new telephone survey. More than two-thirds of the men’s doctors, moreover, did not discuss potential adverse effects of the tests, according to the report today in the Archives of Internal Medicine.

Since its introduction in the late 1980s, the prostate-specific antigen, or PSA, test has grown increasingly controversial. Two large clinical trials recently completed, one in the United States and one in Europe, showed that the test does not reduce mortality from cancer, but it does increase the number of invasive procedures looking for tumors and the likelihood of adverse events from diagnosis and treatment, including incontinence and impotence. No national medical group advocates routine testing of older men with the PSA test. Instead, they recommend that physicians discuss the test with patients and that a shared decision be made. Apparently, however, many physicians have decided that, despite the evidence, the test is a good thing.

Cancer epidemiologist Dr. Richard M. Hoffman of the University of New Mexico Cancer Center and his colleagues used data from the National Survey of Medical Decisions, a telephone interview with more than 3,000 American adults over age 40, about several medical issues, including prostate cancer. From that group, the researchers chose 375 who had undergone PSA testing in the previous two years or who had considered it.

They found that 68% of the men recalled their physician giving them positive information about the test, but only 31% recalled receiving negative information. Only 55% of them were asked their preference about the test -- the rest simply accepted it. Only 14.4% rejected the test. A full 58% of the men considered themselves well-informed about the test, but 43% failed to correctly answer even one of three questions about PSA testing:

Of every 100 men, how many do you think will die of prostate cancer? (Correct answer, 3.)

Of 100 men, about how many will be diagnosed with prostate cancer at some time during their lives? (17)

For every 100 times a PSA result suggests the need for further testing, about how many times does it turn out to be cancer? (25)

Most men overestimated the risks of diagnosis and death from prostate cancer and the accuracy of the PSA test.

‘These findings uderscore a growing concern about the overuse of PSA testing and the need for a shared decision-making process between patients and physicians to fully inform patients of all consequences before screening takes place,’ Hoffman said.

-- Thomas H. Maugh II