Abstract
Prostate-Specific Antigen (PSA)-based screening for prostate cancer remains controversial, having both potential benefits and harms. All guidelines state that a PSA test should not be withheld from a man who wishes to undergo screening; instead, he should be counseled about the benefits and risks of screening so he can make a properly informed decision. In this study, we found that complete information was rarely provided by general practitioners (GPs) and non-urological medical specialists (specialists) alike, leaving patients unable to make an adequate informed decision about whether or not to undergo PSA testing.
Furthermore, guidelines state that physicians should acquire information about the condition of the patients’ prostate by performing a digital rectal exam (DRE). However, we found that a DRE was only performed in 30-50% of the cases.
Follow-up by GPs and specialists after a normal or raised PSA test varied greatly and appeared to be inconsistent with practice guidelines. Reasons not to perform follow-up in patients with an elevated PSA test result included older age at testing, the presence of comorbidities, and a moderately elevated PSA test result (4-10 ng/ml).
Instead of receiving follow-up these patients were either not informed about the result or would receive simple reassurance only. The argument in favor of this approach appears to be that this group is less likely to develop clinically relevant prostate cancer and withholding further testing protects them from concomitant harms. However, given this fact, the indications for the majority of these tests were, at the very least, debatable.
Furthermore, guidelines state that physicians should acquire information about the condition of the patients’ prostate by performing a digital rectal exam (DRE). However, we found that a DRE was only performed in 30-50% of the cases.
Follow-up by GPs and specialists after a normal or raised PSA test varied greatly and appeared to be inconsistent with practice guidelines. Reasons not to perform follow-up in patients with an elevated PSA test result included older age at testing, the presence of comorbidities, and a moderately elevated PSA test result (4-10 ng/ml).
Instead of receiving follow-up these patients were either not informed about the result or would receive simple reassurance only. The argument in favor of this approach appears to be that this group is less likely to develop clinically relevant prostate cancer and withholding further testing protects them from concomitant harms. However, given this fact, the indications for the majority of these tests were, at the very least, debatable.
| Original language | English |
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| Qualification | Doctor of Philosophy |
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| Award date | 21-Oct-2015 |
| Place of Publication | [Groningen] |
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| Print ISBNs | 978-90-6464-920-2 |
| Publication status | Published - 2015 |