Primary Care Practitioners: An Analysis of their Perceptions of Voiding Dysfunction and Prostate Cancer

Abstract

Purpose We analyzed practice and referral patterns of primary care practitioners regarding the diagnosis of prostate cancer, and the evaluation and treatment of voiding dysfunction. Materials and Methods An anonymous multiple-choice questionnaire was mailed to all primary care practitioners in Brooklyn, New York who were registered with the Medical Society of the State of New York. Results More than 25 percent of primary care practitioners begin performing digital rectal examination after patient age 55 years. Compared to prostate specific antigen (PSA) 59 percent of practitioners believe that digital rectal examination is more sensitive or that the tests are equal, or they do not know. In regard to PSA 11 percent of respondents begin testing after patient age 60 years, 11 percent evaluate PSA only if digital rectal examination is abnormal and greater than 3 percent never evaluate PSA. Approximately 45 percent of primary care practitioners indicated that PSA of greater than 4.0 ng./ml. signifies prostate cancer regardless of patient age, prostate size or prostatitis and 50 percent think that digital rectal examination elevates PSA in a clinically significant way. Although 93.2 percent of respondents refer a patient to a urologist after palpating a prostatic nodule, only 51.1 percent refer for an area of induration. Of the 47.2 percent of respondents who attempt pharmacotherapy for voiding dysfunction with finasteride, terazosin or both 15 percent do not know the agent mechanisms of action. Of those prescribing finasteride 68.6 percent are not aware of its effects on serum PSA. Overall 66.5 percent of primary care practitioners are not familiar with the American Urological Association Symptom Index while only 15 percent of those attempting pharmacotherapy use the index as a diagnostic tool. Conclusions Primary care practitioners might require further education in regard to the use of PSA, digital rectal examination and pharmacotherapy in voiding dysfunction. Consideration should be given to the establishment of guidelines for urological referral.