Research ArticleProstate-Specific Antigen Testing: Men's Responses to 2012 Recommendation Against Screening
Introduction
Because of a lack of evidence regarding mortality reduction, and lingering uncertainty about whether or not the potential benefits outweigh the harm, screening for prostate cancer, in particular prostate-specific antigen (PSA) testing, has been controversial.1, 2, 3, 4 False-positive results of PSA screening range from 7% to 10%, and roughly 100,000 new cases per year are considered low-risk and may not benefit from immediate treatment.5, 6, 7 The U.S. Preventive Services Task Force (USPSTF) had long refrained from recommending for or against PSA testing, citing insufficient evidence to assess the balance of benefits and harm of prostate cancer screening in men aged <75 years.8
Given this lack of evidence, some authoritative bodies (including the USPSTF) have pushed for the use of informed decision making, which the USPSTF defines as “an individual’s overall process of gathering relevant health information from the clinician and from other clinical and non-clinical sources, with or without independent clarification of values.”9 In October 2011, the USPSTF released a new draft recommendation advising against PSA-based screening for prostate cancer10 based on an updated evidence review of screening and treatment for prostate cancer11 (Sidebar). Despite the updated recommendation, clinical guidelines from other medical organizations, such as the American Cancer Society12 and—until recently—the American Urological Association,13 continued to support informed decision making about PSA screening as of June 2012. In May 2013, the American Urological Association altered its position by recommending against routine screening among men age 40–54 years and age 70 and older, but it continued to advocate informed decision-making for men age 55–69 years.14
Studies15, 16, 17, 18 have shown that conflicting health recommendations can confuse consumers; consequently, the varying guidance from these well-regarded organizations may result in confusion among clinicians and consumers. In the past, recommending against cancer screening has caused confusion, as most messages to the general public support cancer prevention and early detection through screening.19 For example, after the updating of the USPSTF mammography recommendations in 2009, considerable media coverage and controversy ensued,20, 21, 22 as well as doubts about the credibility of the USPSTF.20, 23 The new recommendations and surrounding media coverage confused women more than they helped guide their screening behavior. One study22 indicated that 40% of women aged 40–49 years reported confusion about the new mammography recommendations.
In the case of PSA testing for prostate cancer screening, conflicting views have emerged. Some disagree with the USPSTF’s new recommendation, favoring a more nuanced approach that supports informed decision making and personalized risk assessments24, 25, 26, 27; news outlets published articles featuring objections from physicians.28 Others, however, pointed out the need to adjust the public’s longstanding belief about the benefits of cancer screening.29
As research accumulates, and authorities present new recommendations that conflict with previous recommendations, it is important to monitor how consumers respond to such changes. This study assesses men’s initial response to the USPSTF’s 2011 release of the draft PSA testing recommendation (which did not differ from the final recommendation released in May 2012). Specifically, this study assessed consumers’ knowledge, attitudes, and beliefs related to the 2011 draft PSA testing recommendations and examined which factors influence consumers’ likelihood of following them.
Section snippets
Methods
The survey was conducted using the web-enabled KnowledgePanel® (GfK Custom Research, LLC) a probability-based panel designed to be representative of the U.S. population. Survey participants were men aged 40–74 years. They were surveyed to assess their knowledge of and attitudes toward the USPSTF’s newly released draft recommendation.
Results
Appendix B (available online at www.ajpmonline.org) presents the demographic characteristics of respondents, the majority of whom were white (72%). Forty-three percent of respondents had a high school education or less. Slightly more than half of respondents (51%) had an income of $60,000 or more.
Discussion
Some authoritative medical sources and the media have long promoted cancer screening as a way to save lives when it is practiced routinely. As a result, the public is often “sold on the benefits of screening”30, 31, 32 and may not believe that possible harms are associated with screening. This belief makes educating consumers about changes in screening recommendations challenging. The current study supports this phenomenon. Most respondents in the current study agreed with the new PSA testing
Acknowledgments
No financial disclosures were reported by the authors of this paper.
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Cited by (30)
Prostate cancer screening practices and diagnoses in patients age 50 and older, Southeastern Michigan, pre/post 2012
2016, Preventive MedicineCitation Excerpt :The USPSTF arrived at this conclusion based off of evidence demonstrating a small reduction in prostate cancer mortality 10–15 years post PSA screening, but also an immense association between PSA screening and risk of harm in the form of overdiagnosis and overtreatment (Schroder et al., 2009; Andriole et al., 2009). Although many professional associations have followed suit with similar recommendations regarding PSA screening (Qaseem et al., 2013), research has shown that urologists, oncologists and even consumers may disagree with this change in practice (Kim et al., 2014; Squiers et al., 2013). The American Urological Association (AUA) currently recommends PSA screening after informed decision-making in high-risk (e.g., positive family history or African American race) men ages 40–54 and in all men ages 55–69 (Ballentine et al., 2013).
Responses to a decision aid on prostate cancer screening in primary care practices
2015, American Journal of Preventive MedicineCitation Excerpt :The results may not be generalizable to less–well educated or minority men, including African Americans, who have a higher risk of prostate cancer mortality. Prior studies have suggested African American men are more likely to desire PSA tests,13 and both African American and Hispanic men report more discussion of PSA advantages and disadvantages with their clinicians.7 Third, the percentage of patients prescribed a decision aid who also returned a pre- and post-viewing questionnaire was relatively low at 26%.
Pre-screening Discussions and Prostate-Specific Antigen Testing for Prostate Cancer Screening
2015, American Journal of Preventive MedicineCitation Excerpt :Studies have shown that the prevalence of PSA testing among men aged ≥75 years remains high even after release of the 2008 USPSTF prostate cancer recommendations.8,12 Moreover, Squiers et al.13 surveyed men’s responses to the 2012 USPSTF recommendations against screening and found that although 33% were undecided, 54% of the respondents still intended to get a PSA test in the future. It is likely that men who have a family history of prostate cancer may ask for PSA testing regardless of how SDM is performed.