Abstract
ObjectivesTo examine the attitudes, beliefs and practices of Caribbean urologists regarding prostate-specific antigen (PSA)-based screening in the Caribbean region particularly as it relates to Afro-Caribbean men.DesignAn Internet-based descriptive cross-sectional study using a standardised questionnaire designed to capture information on respondents’ attitudes, beliefs and practices towards PSA-based screening was conducted using the online survey tool Survey Monkey among known urologists in the Caribbean, based on the complete mailing list of the membership of the Caribbean Urological Association.ResultsThirty of the total population of 40 urologists (75%) from nine countries in the Caribbean completed the survey. Twelve (40%) were from Jamaica and eight (26.7%) were from Trinidad. Two-thirds (n = 20) of the urologists believed that PSA-based screening has positively impacted survival in their population and 76.7% (n = 23) supported the PSA-based screening in the Afro-Caribbean male. Seventy-eight percent believed that guidelines from other countries were not applicable to the Caribbean and 63% believed that a regional body should publish its own guidelines. Most supported yearly screening with the PSA and digital rectal examination beginning at age 40 for Afro-Caribbean men but opinion varied regarding PSA-based screening of Indo-Caribbean men. Respondents were unanimous in their belief that there should be an upper age limit for screening, 75 years old being the most commonly reported.ConclusionMost Caribbean urologists favour PSA-based screening in Afro-Caribbean men and recommend that Caribbean-specific guidelines need to be drafted.
Highlights
Prostate cancer is a serious public health problem in the Caribbean with prostate-cancer-specific mortality rates being the highest in the world [1]
Secondary prevention of prostate cancer through prostate-specific antigen (PSA)-based screening has been done on an ad hoc basis in the Caribbean by private practitioners, urologists and cancer societies since PSA was introduced into clinical practice in 1988 but despite this, almost 50% of men still present with symptomatic, locally advanced and metastatic disease in territories such as Jamaica [4]
Between 1 August and 30 November 2013 all English-speaking Caribbean urologists as well as Urologists from Haiti who are members of the Caribbean Urological Association (CURA) and on its mailing list were sent invitations via email to participate in an online survey using the survey tool Survey Monkey
Summary
Prostate cancer is a serious public health problem in the Caribbean with prostate-cancer-specific mortality rates being the highest in the world [1]. Men of African descent in new world settings such as the Caribbean and North America are disproportionately affected by prostate cancer with higher incidence and mortality rates. There has been no documented downward stage migration in incident cases of prostate cancer in the Caribbean and this is likely to be due to the poor uptake and an ad hoc nature of PSA-based prostate cancer screening. Added to this is the uncertainty and controversy surrounding the efficacy of PSA-based screening in decreasing prostate-cancer-specific mortality while minimising harms associated with screening
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