Abstract
BackgroundIncreased use of prostate specific antigen (PSA) has been associated with increased prostate cancer incidence. Ireland is estimated to have one of the highest prostate cancer incidences in Europe and has no national guidelines for prostate cancer screening. GPs have a pivotal role in influencing PSA testing, therefore, our aim was to describe GP testing practices and to identify factors influencing these.MethodsA postal survey, including questions on clinical practice and experience, knowledge and demographics was distributed to all GPs (n = 3,683). The main outcomes were (i) PSA testing asymptomatic men and (ii) "inappropriate" PSA testing, defined as testing asymptomatic men aged < 50 or > 75 years. Factors associated with these outcomes were identified using logistic regression.Results1,625 GPs responded (response rate corrected for eligibility = 53%). Most respondents (79%) would PSA test asymptomatic men. Of these, 34% and 51% would test asymptomatic men < 50 and > 75 years, respectively. In multivariate analyses, GPs were more likely to test asymptomatic men if they were ≥ 50 years, in practice ≥ 10 years, female or less knowledgeable about PSA efficacy. Male GPs who would have a PSA test themselves were > 8-times more likely to PSA test asymptomatic men than GPs who would not have a test. GPs who had an asymptomatic patient diagnosed with prostate cancer following PSA testing, were > 3-times more likely to test asymptomatic men. Practice-related factors positively associated with testing included: running 'well man' clinics, performing occupational health checks and performing other tests routinely with PSA. Factors positively associated with 'inappropriate' testing included; being male and willing to have a PSA test, having worked/trained in the UK and supporting annual PSA testing. 91% of respondents supported the development of national PSA testing guidelines.ConclusionOur findings suggest that widespread PSA testing of asymptomatic men in primary care is primarily due to a combination of clinical experience, poor knowledge and the support of doctors for PSA testing, as evidenced by the willingness of male doctors to have a PSA test. There is an urgent need for education and support for GPs concerning prostate cancer screening, starting with the implementation of national guidelines.
Highlights
Increased use of prostate specific antigen (PSA) has been associated with increased prostate cancer incidence
A recent Cochrane review confirmed that evidence on the efficacy of PSA testing as a prostate cancer screening tool is still lacking [5] and mortality data from two large randomised control trials is a number of years away [6,7]
Executive and the National Screening Committee guidelines recommend against screening asymptomatic men [22]. These trends mean that Ireland is predicted to have had the highest rate of prostate cancer incidence in Europe in 2006 [23]. It was against this background that we investigated factors associated with active PSA testing of asymptomatic men among GPs
Summary
Increased use of prostate specific antigen (PSA) has been associated with increased prostate cancer incidence. Prostate specific antigen (PSA) testing of asymptomatic men, de facto screening, is increasingly common in many developed countries [1,2]. This escalating use of PSA testing has driven the increases in prostate cancer incidence that began to be seen in the 1990s, and continues to be observed [3,4]. The majority of PSA tests originate in primary care [9,10] While other factors such as urologists practice [11], local guidelines [11], patient demand [12], a man's social network [13] and the media [11,12,13] influence the frequency of PSA testing, GPs have a pivotal role in determining levels and patterns of testing in the population. Improving understanding of the triggers for PSA testing of asymptomatic men is, of considerable importance, especially if there is to be any possibility of evidence-based practice in this area
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