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Will doctors follow new PSA test advice? Signs aren't great

May 24, 2012|By Rosie Mestel, Los Angeles Times / For the Booster Shots blog
  • Blood drawn for a PSA test. Will doctors drop this routine screen now that the U.S. Preventive Services Task Force has recommended against it?
Blood drawn for a PSA test. Will doctors drop this routine screen now that… (Adam Gault / Digital Vision…)

Is the routine PSA test to screen for prostate cancer going to fade away now that the U.S. Preventive Services Task Force has recommended against it for men of all ages?

The signs are maybe not, according to a survey of primary care physicians done by Dr. Craig E. Pollack and colleagues at Johns Hopkins University School of Medicine. The survey was done in November, after the task force’s draft recommendations had been released but before the final ones were published earlier this week in the Annals of Internal Medicine.

In the survey, 125 primary care physicians and nurse practitioners affiliated with Johns Hopkins responded to a questionnaire about their approach to PSA screening. All of them provided primary care to men.

Here are results from the paper, published in April in the Archives of Internal Medicine.

Of the care providers:

93% had heard of the recommendations.

49% agreed or strongly agreed with them.

36% disagreed or strongly disagreed with them.

17% said that in the prior year they’d generally ordered a PSA screen without talking it over with a patient, and 36% said they recommended the screening to patients after a discussion of risks and benefits.

When asked how the recommendations would change their approach to routine PSA test screening:

About 2% said they wouldn’t offer routine PSA screens anymore.

22% said they’d be much less likely to, while 39% said they'd be “somewhat” less likely.

38% said the recommendations wouldn’t affect their screening practices.

What about those who said they agreed with the recommendations? Fewer than half said they would no longer offer, or be much less likely to offer, a routine PSA screen.

Here are the main things the respondents pointed to as barriers: Patients want the test (75%), it took too long to explain the changes (67%) and fear of being sued for malpractice (54%).    

“The results suggest that ... the USPSTF recommendations may encounter significant barriers to adoption,” the authors wrote. One measure that might help (along with allaying doctors’ malpractice fears and convincing the public) would be “to allow adequate time for screening discussions,” they added. One wonders how likely that is to happen given how many things doctors are meant to talk with us about these days, and how rushed the appointments often are.

Meanwhile, here’s an October survey by U.S. News and World Report of its "top doctors" that found “virtually all responding urologists and more than 60% of internal-medicine specialists rejected the recent proposal by a high-level government advisory committee to end routine PSA testing, which is meant to catch prostate cancer early.”

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