Prostate Cancer Screening Practices Research Articles

US Primary Care Physicians' Prostate Cancer Screening Practices: A Vignette-Based Analysis of Screening Men at High Risk.

Background:Limited information exists on primary care physicians’ (PCPs) use of the prostate-specific antigen (PSA) test by patient risk category. We describe PCP responses to hypothetical patient scenario (PS) involving PSA testing among high-risk asymptomatic men.Methods:Data were from the 2007 to 2008 National Survey of Primary Care Physicians’ Practices Regarding Prostate Cancer Screening. PS#1: healthy 55-year-old white male with no family history of prostate cancer; PS#2: healthy 45-year-old African American male with no family history of prostate cancer; and PS#3: healthy 50-year-old male with a family history of prostate cancer. Data were analyzed in SAS/SUDAAN.Results:Most PCPs indicated that they generally discuss the possible benefits/risks of PSA testing with the patient and then recommend the test (PS#1-PS#3 range, 53.4%-68.7%; P < .001); only about 1% reported discussing and then recommending against the test. For PS#3, compared to PS#1 and #2, PCPs were more likely to discuss and recommend the test or attempt to persuade the patient who initially declines the test. For PS#3, all clinicians generally would order/discuss the PSA test and not rely on the patient to ask.Conclusion:Clinicians treat family history as an important reason to recommend, persuade, and initiate PSA testing.

The Impact of Recent Screening Recommendations on Prostate Cancer Screening in a Large Health Care System

The United States Preventive Services Task Force recently recommended against routine prostate cancer screening, stating that the risks of screening outweigh the benefits. We determined the impact of this recommendation on prostate cancer screening in a large health system. We obtained data on all screening prostate specific antigen tests performed at University Hospitals Case Medical Center and affiliated hospitals in northeastern Ohio from January 2008 to December 2012. We examined the total number of prostate specific antigen tests ordered with time and adjusted for patient volume by fitting a regression line. The overall trend was examined and stratified by location (urban, suburban or rural), patient age and provider type (primary care or urology). A total of 43,498 screening prostate specific antigen tests were performed from January 2008 to December 2012. Most tests were ordered by specialists in internal medicine (64.9%), followed by family medicine (23.7%), urology (6.1%) and hematology/oncology (1.3%). Prostate specific antigen screening increased with time until March 2009, when initial screening trials were published. Prostate specific antigen testing then decreased significantly and continued to decrease after the task force recommendations. Similar patterns were noted in almost all subgroups. The greatest decrease in screening wasobserved by urologists and in patients in the intermediate age group (50 to 59 years). United States Preventive Services Task Force recommendations appeared to have decreased prostate cancer screening. The greatest impact was seen for urologists and patients in the intermediate age group. Further study is needed to determine the long-term effects of these recommendations on the screening, diagnosis, treatment and prognosis of this prevalent malignancy.

African american primary care physicians' prostate cancer screening practices.

Prostate cancer is the most common cancer and the second leading cause of cancer death among men in the United States. African American (AA) men have greater prostate cancer burden than other men. Little is known about AA primary care physicians' (PCPs) practices regarding prostate cancer screening. We analyzed data from the 2007-2008 National Survey of Primary Care Physicians' Practices Regarding Prostate Cancer Screening. The current study included 604 AA PCPs. Outcomes assessed were (a) offering screening using the prostate-specific antigen (PSA) test, (b) use of screening discussions to involve patients in the decision to screen, and (c) having a discussion policy to try to talk the patient into getting the screening tests. Most AA PCPs were male (52%), younger than 50 years (61%), and had 21% to 100% AA patients in their practices (74%). The majority (94%) of AA PCPs offered prostate cancer screening using PSA, discussed the tests with their male patients to involve them in the decision to screen (83%), and had a policy to try to talk the patient into getting the screening tests (77%). Multivariate analysis showed that offering screening, use of discussions, and a usual policy to encourage taking the screening tests varied mainly by practice-related factors, including practice type, practice location, and percentage of AA patients in the practice. Data from this study indicate that most AA PCPs reported high proscreening behaviors for all 3 outcomes. Additionally, practice- and screening-related factors may be important when examining AA PCP screening behaviors.

Targeted prostate cancer ablation

Prostate cancer screening practices are providing new opportunities for earlier diagnosis, and for identifying smaller tumours with low probability of regional involvement and high likelihood of curability. Simultaneous innovations in tissue ablation technologies offer the potential for effective targeted treatments to discrete areas within the prostate, with negligible side-effects. This review provides an overview of recent data on developing options for prostate cancer ablation, the mechanisms of action of these modalities and results to date of these treatments. Advances in diagnostic imaging and image-guided biopsy techniques hold the promise of more accurate localization of cancers within the prostate and a shift in the field of prostate cancer treatment towards an interest in less invasive, localized treatment options. Several energy ablative technologies, currently being tested in clinical trials, are likely to play a greater role in the treatment of patients with smaller, earlier stage tumours. Although none of the advances in cancer detection, targeted imaging or focal treatment have yet proven to be game-changing, together, they have contributed to a movement towards less invasive, focal treatment for prostate cancer and a growing awareness of the potential clinical benefits of this form of therapy.

Prostate cancer screening practices in the Republic of Ireland: The determinants of uptake

The objectives of this paper are to analyse the determinants of prostate cancer screening uptake in the Republic of Ireland and to compare the role of non-need factors in uptake of screening among those in and outside the age range recommended as cost-effective for screening according to the European Randomised Study of Screening for Prostate Cancer (ERSPC). The investigation combined a logistic regression analysis of uptake, with an estimation of income-related concentration indices and decomposition of the indices using data collected as part of the Survey of Lifestyle and Nutrition (SLAN) 2007. Comparisons were made across groups differentiated by age in terms of the expected value of the prostate cancer screening. Uptake of prostate screening in men 40 years and over in the preceding 12 months was approximately 24%. Uptake was higher among those in age groups that are perceived to receive most benefit from a Prostate Specific Antigen (PSA) test based on the findings of the ERSPC trial. Screening is highest in those with highest socioeconomic status and educational attainment, and who also hold private insurance cover. The largest socioeconomic inequality is observed for men over 70 years of age (0.2298). The smallest inequality was observed for those aged 55-69 (0.1573). Decomposition of the concentration indices shows that possession of private insurance is the largest determinant of inequality among those aged 55-69 (36%) and remains a significant determinant for those aged 40-54 (26%) and those aged 70 and over (17%). There are high levels of prostate cancer screening uptake and significant income-related inequality in uptake in the Republic of Ireland. Given that the merits of prostate cancer screening overall and across different age groups are the subject of debate, the high levels of screening and income-related inequalities in uptake warrant closer attention and identification of potential policy responses.

Awareness of General Public Towards Cancer Prostate and Screening Practice in Arabic Communities: a Comparative Multi-Center Study

The current study aimed at exploring the knowledge and beliefs of men aged forty years and over towards prostate cancer screening and early detection in three Arab countries. The field work was conducted in three countries; Saudi Arabia, Egypt and Jordan, during the period February through December 2011. Our target population were men aged 40 years and over. It was a population-based cross sectional study comprising 400 subjects at each site. In addition to socio-demographic data, history of the present and past medical illness, practice history of prostatic cancer examination, family history of cancer prostate; participants were inquired about their knowledge and attitude towards prostate cancer and screening behavior using two different likert scales. The percentage of participants who practiced regular prostate check up ranged from 8-30%. They had poor knowledge and fair attitude towards prostate cancer screening behavior, where the mean total knowledge score was 10.25±2.5, 10.76±3.39 and 11.24±3.39 whereas the mean total attitude score was 18.3±4.08, 20.68±6.4 and 17.96±5.3 for Saudi Arabia, Egypt and Jordan respectively. The respondents identified the physicians as the main sources of this information (62.4%), though they were not the main motives for regular checkup. Knowledge was the only significant predictor for participants' attitude in the multiple regression models. Participants' attitudes depends mainly on level of knowledge and quantity of information provided to the patients and their families. Such attitudes should rely on a solid background of proper information and motivation from physicians to enhance and empower behaviors towards prostate cancer screening practices.

Prostate cancer screening practices of African-American and non-African-American US primary care physicians: a cross-sectional survey

Purpose:We explored whether African-American (AA) primary care physicians (PCPs) have different prostate cancer screening practices compared to non-AA PCPs, after adjustment for potential confounding factors such as the proportion of AA patients in PCP practices.Methods:We used SAS/SUDAAN to compare weighted responses from AA PCPs (n = 604) with those from non-AA PCPs (n = 647) in the 2007–2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening. We used multivariate logistic regression to calculate the weighted odds ratios (OR) and 95% confidence intervals (CI).Results:We found that AA PCPs had higher odds of working in practices with above-the-median (≥ 21%) proportions of AA male patients (OR, 9.02; 95% CI: 5.85–13.91). A higher proportion of AA PCPs (53.5%; 95% CI: 49.5–57.4) reported an above-the-median proportion (≥ 91%) of PSA testing during health maintenance exams as compared to non-AA PCPs (39.4%; 95% CI: 35.5–43.4; P < 0.0002). After adjusting for the proportion of AA patients and other factors, we found that AA PCPs had higher odds of using PSA tests to screen men (OR, 1.74; 95% CI: 1.11–2.73).Conclusion:This study quantifies the magnitude of the differences reported in previous focus group studies. Our results may be helpful in hypothesis generation and in planning future research studies.

Factors Influencing Prostate Cancer Healthcare Practices in Barbados, West Indies

Although some investigations have assessed the barriers to prostate cancer screening among African-American men, limited data are available regarding such practices in similar African-origin populations. Key informant interviews were employed to obtain a range of perspectives pertaining to the healthcare practices of African-Barbadian men and to identify factors that obstruct prostate cancer screening in Barbados, West Indies. Gender-related perceptions were identified as a major obstruction to prostate cancer screening. Additionally, concerns about privacy, taking time away from work and mistrust of the medical community were reported as themes impeding the healthcare-seeking behaviors of African-Barbadian men. System-level barriers included limitations in access to care and ineffective dissemination of health information. Findings from this study suggest that targeted efforts aimed at modifying socio-cultural perceptions may assist in improving prostate cancer screening and general healthcare-seeking practices of African-Barbadian men and others who share similar beliefs.

PCN160 Prostate Cancer Screening Practices in the Republic of Ireland- The Determinants of Uptake

PCN160 Prostate Cancer Screening Practices in the Republic of Ireland- The Determinants of Uptake

Prostate cancer screening, detection and treatment practices, among Sub-Saharan African urologists

Introduction Prostate cancer is reported to be the leading cancer in men in Sub-Saharan Africa (SSA) and the number of prostate cancer deaths is expected to double in the next 20 years. Despite the importance of this public health issue in SSA, there remains relatively limited information about practices related to prostate cancer treatment in this population.

The decision-making process in prostate cancer screening in primary care with a prostate-specific antigen: A systematic review

Abstract Routine use of prostate-specific antigen (PSA) tests for early detection of prostate cancer remains highly controversial, particularly for older patients. It is thus paramount to examine the factors that influence the decision-making process in prostate cancer screening in primary care (PC). A systematic review was conducted, searching eight databases for articles published – in English, German, French or Dutch – or in press between January 2000 and February 2011 on studies on the self-reported practices and attitudes of primary care physicians (PCPs) with regard to the use of PSA tests as well as older patients' points of view regarding PSA testing. Study selections, data extraction and assessment of the quality of the studies were conducted independently by two reviewers. A taxonomy of factors influencing the decision-making process was developed to support data extraction. The analysis involved 20 studies conducted in North America and Europe. Screening with PSA represents a routine practice in PC, even for the most elderly patients. The primary drivers of the decision-making process, as acknowledged by both PCPs and patients, are interactions between patients and PCPs and patient characteristics (e.g. high risk, older age). Other factors are related to the PCP (characteristics, working environment, perceived responsibility, knowledge, perception of PSA test) and the patient (awareness). Even if guidelines are precautious about screening for prostate cancer, using a PSA test in PC is routine practice in a variety of countries. This review has identified factors influencing prostate cancer screening for older adults. The results suggest that multi-component system changes at the physician and patient levels are needed in order to optimize prostate cancer screening practices in PC, particularly for older men who will not benefit from it.

Prostate cancer screening and informed decision-making: provider and patient perspectives

The objective was to determine the extent of informed decision making for prostate cancer screening in a defined population. A state-wide population based survey of men aged 50 and above (Behavioral Risk Factor Surveillance System, 2004, Washington state) and a simple random sample of primary care physicians, were conducted in the same geographic area. We examined prostate cancer screening rates among the men (defined as either PSA or digital rectal examination within the past year) and prostate cancer screening practices among the physicians. Screening rates were 56% at ages 50-64, 68% at ages 65-79 and 64% among men age 80 and older. Adjusted analyses indicated that age, income, marital status, possessing health insurance and a personal health care provider, and talking with a provider about prostate cancer screening tests were all positively associated with screening status. In the physician survey, most physicians recommend screening to their average-risk male patients. Three-fourths (74%) of physicians discussed benefits and risks of PSA testing with their patients; but few used educational tools. Only 35% discussed the side effects of prostate cancer treatment with their patients. The rates of screening reported by men were relatively high, given that current recommendations promote informed decision making rather than universal screening. The majority of physicians recommend prostate cancer screening to their patients, with few decision-making tools used. All relevant information may not be provided in the discussion. These results point to the need for increasing informed decision making about prostate cancer screening.

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

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.

Prostate Cancer Awareness, Knowledge, and Screening Practices among Older Men in Oyo State, Nigeria

Prostate cancer is the leading cause of cancer among Nigerian men. This study assessed the knowledge, awareness, and screening practices among older men regarding prostate cancer in Oyo State, Nigeria. A cross-sectional study used a multi-stage sampling technique to select 561 adult males. A semi-structured questionnaire was used. Respondents' median age is 60.0 years. Prostate cancer awareness was high [449 (80.0%)]. The overall mean knowledge of prostate cancer causation, treatment, and prevention was 5.8 (± 3.0) out of a maximum of 16. Only 109 (19.4%) perceived themselves at risk of developing prostate cancer, but only 4.5% have ever been screened. Though knowledge and risk perception of prostate cancer were low, a majority of respondents (81.5%) were willing to be screened for the disease. Community-based prostate cancer educational interventions and provision of screening centers are needed for this group.

Tailored Community Cancer Education Programs: Pawsox and Prostates

To assess the prostate cancer screening practices in Rhode Island, we designed a questionnaire which was sent to 150 primary care physicians. A population-based survey was distributed to 194 men over 40 asking about screening history and risk factors. Eighty-five percent of primary care physicians reported performing annual prostate-specific antigen tests (PSAs) and digital rectal exams, 63% recognized family history as a risk factor, and 14% identified African Americans as a high-risk population. The survey found that 48% of men recognized family history as a risk factor and 6% understood that African Americans were at high risk. Each year, 200 men, primarily SED, are invited to a PawSox baseball game where physicians provide information on prostate cancer risk, treatment options, and outcomes. Free PSAs are provided. The questionnaire and survey demonstrate a need for more public education regarding prostate cancer in high-risk populations. Tailored community-based interventions, such as the Pawsox & Prostate program, can be effective professional and public education strategies to increase screening in high-risk populations.

Abstract B29: African American men never or rarely screened for prostate cancer

Abstract Introduction: Prostate cancer is the leading cancer and the second leading cause of cancer deaths among men in the United States. African American (AA) men are at greater risk than Caucasian American (CA) and other men in both incidence and mortality related to prostate cancer. Incidence among AA men is about 60 percent greater and mortality about 240 percent greater than in CA men. AA men also have a greater likelihood of presenting at higher stage and grade with poorer health and other outcomes. Little is known about factors related to AA men who never or are rarely screened for prostate cancer using the DRE and PSA tests. The purpose of this study was to explore prostate cancer screening practices of AA men and to examine demographic characteristics that are associated with AA men who never or are rarely screened. Methods: AA men age 40 or older were asked questions about their knowledge, awareness, and attitudes regarding prostate cancer and prostate cancer screening using DRE and PSA. The study used a convenience sample of 448 AA men 40 years and older residing in the Southeastern U.S. Data were self-reported survey responses and analyzed using SAS. Results: The majority of study participants were married (52%), had some college or technical training (78%), and employed (59%). Over 90% of the AA men had prior knowledge of DRE and 77% were aware of the PSA test. The percentage of AA men who had not had prostate cancer screening in over 5 years or not at all (never or rarely screened) was 33% for DRE and 34% for PSA. Demographic factors related to never or rarely screened for DRE were: being single, younger age, no health insurance, and higher levels of education. Factors related to never or rarely screened for PSA were: younger age, no health insurance, and higher levels of education. Conclusions: Since AA men have greater burden of prostate cancer among men, it is surprising that despite knowledge and awareness of screening and increased levels of education, approximately one-third of the men in this sample had neither a DRE or PSA ever or in 5 or more years. Additional studies are needed to further explore the relationship between prostate cancer knowledge and awareness, education attainment, and prostate cancer screening in AA men. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B29.

Determinants of Primary Care Physicians’ Practice of Prostate Cancer Counseling and Screening

Determinants of Primary Care Physicians’ Practice of Prostate Cancer Counseling and Screening

Determinants of primary care physicians’ practice of prostate cancer counseling and screening

Objective: The objective was to examine practices of primary care physicians and its determinants towards prostate cancer screening. Methods: Data was obtained from 204 primary care physicians using self-reports of prostate cancer screening practices, knowledge, attitudes towards prostate cancer screening. Results: nearly half of the respondent (54.7%) were practicing counseling and referring prostate cancer patients. The mean correct knowledge score was 54.3%, their attitude was not strong; the only statement that nearly seventy percent of physicians agreed upon was about the value of screening, however, the reliability and evidence to support DRE & PSA were in question. Knowledge and attitude were found to be the most significant predictors that determine physicians’ self practice. Conclusion: Background information and attitudes are important determinants of physicians’ practice behavior towards prostate cancer counseling and referral in our study.

Primary care physicians' reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey

BackgroundProfessional medical organizations recommend individualized patient decision making about prostate cancer screening. Little is known about primary care physicians' use of pre-screening discussions to promote informed decision making for prostate cancer screening. The aim of this study is to explore physicians' use of pre-screening discussions and reasons why physicians would or would not try to persuade patients to be screened if they initially refuse testing.MethodsPrimary care physicians completed a self-administered survey about prostate cancer screening practices for informed decision making.ResultsSixty-six physicians (75.9%) completed the survey, and 63 were used in the analysis. Thirteen physicians (20.6%) reported not using prescreening discussions, 45 (71.4%) reported the use of prescreening discussions, and 3 (4.8%) reported neither ordering the PSA test nor discussing it with patients. Sixty-nine percent of physicians who reported not having discussions indicated they were more likely to screen African American patients for prostate cancer, compared to 50% of physicians who reported the use of discussions (Chi-square(1) = 1.62, p = .20). Similarly, 91% of physicians who reported not having discussions indicated they are more likely to screen patients with a family history of prostate cancer, compared to 46% of those who reported the use of discussion (Chi-square(1) = 13.27, p < .001). Beliefs about the scientific evidence and efficacy of screening, ethical concerns regarding patient autonomy, and concerns about time constraints differed between physicians who would and would not try to persuade a patient to be tested.ConclusionAlthough guidelines recommend discussing the risks and benefits of prostate cancer screening, physicians report varying practice styles. Future research needs to consider the nature of discussions and the degree to which informed decision making is being achieved in clinical practice.

Edifice program: analysis of screening exam practices for cancer in France

The practices of screening and the parameters influencing these practices are not well known in France. The objectives of the Edifice study were to analyze a large cohort of patients and doctors in order to further characterize these parameters. The study was performed by the Institute TNS Healthcare-SOFRES, and included 2 parallel studies: 1) on 1 609 healthy persons representative of the global French population and aged 40 to 75 years (N = 1 509), with an over representation of patients aged 50 to 74 years living in the 22 pilot French departments pilots; 2) on 600 generalist practitioners. Data were collected and analyzed by the expert panel... Ninety-three, 25, 36 and 6% of the patients in the general population declared to have performed at least one a screening exam for breast, colon, prostate, and lung carcinoma respectively. Seventy, 20, 60 and 4% of GP declare to propose systematically to a 40-75-year-old patient a screening test for breast, colon, prostate, or lung cancer. For breast cancer screening the adhesion of the GP is independent of the date of implementation of a general screening in their own regions, while for colorectal screening, 34 and 20% of the patients living in the pilot versus other departments were screened. Overall, prostate cancer screening is recommended by the GP panel for 77.1% of patients aged 50 to 75 years. This study shows a good adhesion of screening procedures for GP and patients, shows that screening is improved by general screening policy in colorectal cancer, but that prostate cancer screening practices exceed what is recommended according to evidence based medicine.