Abstract 5739: Caring through the controversy: Primary care provider practice patterns and attitudes towards PSA based prostate cancer screening in a high risk area

Abstract

Abstract Prostate cancer remains the leading cancer diagnosis among men in the United States and the second leading cause of cancer-related mortality. Furthermore, the incidence and mortality of prostate cancer in the Bronx, NY is in the highest quintile in New York State. Prostate cancer screening is accomplished mainly through measurement of serum prostate specific antigen (PSA). However, most prostate cancers detected by screening are not aggressive, and can be monitored under active surveillance, with no interventions required. Unfortunately, many men diagnosed with prostate cancer experience anxiety and pressure to seek treatment, resulting in overtreatment of clinically insignificant disease. Guidelines for prostate cancer screening with PSA measurement have changed several times in the past 10 years, with the leading recommending groups frequently disagreeing on recommendations. National data suggests that this has resulted in inconsistent prostate cancer screening practices and current screening rates at our institution are low (23%). Current recommendations are to screen healthy men aged 55-69 with an emphasis on shared decision making with the patient. The authors administered an anonymous, voluntary paper survey to medical providers in the Departments of Family and Internal Medicine at BronxCare. In total, 91 anonymous surveys were collected. 50% of respondents had ordered a PSA in the past 2 years, most frequently because of patient age (34%), urological symptoms (26%) or because the patient had asked (27%). They most frequently decided against PSA testing in certain patients because of patient age (25%) or health status (23%). 46% of medical practitioners stated that they at least occasionally screen their healthy patients for prostate cancer and they screen patients at all age ranges from 35-80+ years, even though 73% say that they intend to follow current USPSTF guidelines. Notably, in response to questions about comfort with PSA testing, feelings about the scientific validity and importance of PSA testing, medical provider responses were nearly evenly distributed across the Likert Scale, while most (68%) were comfortable with shared decision making with there patients. Importantly, the majority (79%) felt that they wanted more information on prostate cancer screening. Regardless of demographics or training level, primary care providers at BronxCare approach PSA testing in many ways. The majority intend to follow USPSTF guidelines while most are not actually in practice. Given the high need for prostate cancer screening among our patients, and the desire of PCPs for additional information on PSA testing, a Quality Improvement project is underway. The intervention will include an educational module developed in conjunction with the Departments of Internal Medicine, Urology and the BronxCare Cancer Center and changes to the electronic medical record to spur prostate cancer screening discussions and guide PCPs and patients through the shared decision making process are being developed. Citation Format: Asona Lui, Jose Tiburcio, Douglas Reich. Caring through the controversy: Primary care provider practice patterns and attitudes towards PSA based prostate cancer screening in a high risk area [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5739.