DEBATE OVER PSA SCREENING

Many men are not fully informed of the pros and cons of prostate-specific antigen (PSA) testing and do not share in the decision-making process, according to a new U.S. study.

"Somewhat surprisingly, among men with no PSA test, only one in ten reported any component of shared decision making, which did not change over time,” epidemiologist Ann Goding Sauer of the American Cancer Society, in Atlanta, Georgia, told Reuters Health by email. “There are still many men who reported receiving the test without any shared decision making.”

Most experts agree that PSA testing should not occur without shared decision-making, a process in which clinicians convey what is known about a particular intervention, such as a screening test.

Sauer and colleagues used data from the National Health Interview Survey on nearly 9,600 men aged 50 years and older to investigate whether self-reported shared decision-making for PSA testing changed between 2010 and 2015.

They examined responses to three questions about whether a physician had ever discussed the advantages and the disadvantages of testing and that some doctors disagree about the benefits of PSA testing. They categorized the completeness of shared decision-making into four mutually exclusive groups: none, full, advantages only, and advantages and disadvantages.

The fraction of men reporting PSA testing in the past year decreased between 2010 (38.1%) and 2015 (32.1%), whereas similar fractions reported PSA testing more than one year ago (19.2% and 23.2%, respectively).

Among all men, 37.2% in 2010 and 37.9% in 2015 received one or more shared decision-making elements, the researchers report in the March/April issue of Annals of Family Medicine.

The percent of men with recent PSA testing who received at least one shared decision-making element increased non-significantly from 58.5% in 2010 to 62.6% in 2015. It changed even less among men with non-recent PSA testing (54.6% vs. 56.8%, respectively).

Only about one in 10 men with no previous PSA testing reported receiving any shared decision-making component.

Among men with recent PSA testing, being told about the advantages only was the most commonly reported shared decision-making situation, although an increasing proportion reported full shared decision-making between 2010 (12.2%) and 2015 (17.4%).

The pattern was similar among men with non-recent testing and among those with PSA testing in the past two years. There was no change in patients being told only about the advantages or in receiving full shared decision-making among men who had never had a PSA test.

Full shared decision-making was significantly less common in men without a high school diploma than in college graduates.

“Decision aids are already available to help facilitate shared decision making for prostate cancer screening,” Sauer said. “Such aids have been shown to improve patient knowledge and involvement in the decision making process.”

She added that this situation could be improved by “creating innovative strategies to help achieve more widespread application of shared decision making while also continuing to encourage clinicians to engage in full shared decision making by communicating the benefits, risks, and uncertainties associated with PSA testing.”