PS3-14: Primary Care Providers Reported Use of Pre-Screening Discussions for Prostate Cancer Screening: A Cross-Sectional Survey

Abstract

Background and Aims: There is no scientific consensus for routine prostate cancer screening for men of average risk less than 75 years of age using the prostate-specific antigen test (PSA). However, suggested practice is for physicians to discuss the known harms and potential benefits of PSA testing and digital rectal exam (DRE) with their patients. We conducted a survey of primary care providers (PCPs) to determine their practice styles including discussion regarding prostate cancer screening; we also conducted a patient survey to learn whether their PCPs discussed PSA testing and DRE during a health maintenance exam (HME). Methods: PCPs in the Lovelace Health System were surveyed about their prostate cancer screening practices for average risk men. Based on their responses, they were divided into two groups: routine screeners (RS), those who routinely order PSA testing without discussing potential harms and benefits and informed decision makers (IDM), those who routinely discuss the PSA test and its benefits and harms. After the HME, patients were surveyed as to whether or not their PCP discussed the PSA test and its harms and benefits during their visit. Results: Among the physicians, 35.9% (23/64) were RS and 64.1% (41/64) were IDM. Of the RS patients, 82.3% (51/62) responded that their physician did discuss the PSA test compared to 71.2% (37/52) of the IDM patients (p=0.10). For RS, 58.8% (36/62) of the patients stated their provider initiated the discussion, whereas 56.8% (30/52) of the IDM initiated it. Provider recommendations to have the test were higher for the RS (80.3%) (41/51) compared to 53.1% (20/37) of the IDM p=.0032. Conclusions: By patient report, a higher percentage of RS providers discussed the PSA test with patients. As would be expected, most of the RS recommended the PSA compared to only one-third of the IDM providers. Further studies are needed to determine what other factors of physician practice styles relate to discussing or not discussing prostate cancer screening with patients, and how patient-providers interactions influence screening communication.