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Revisiting Prostate Cancer Screening Practices among Vermont Primary Care Physicians
Laura K. Donnelly, B.A., Takamaru Ashikaga, Ph.D., Kevan M. Sternberg, M.D., Francis G. Gause, IV, B.S., Brian H. Irwin, M.D., Mark K. Plante, M.D., Scott D. Perrapato, M.D..
University of Vermont College of Medicine, Burlington, VT, USA.
Introduction The role of prostate-specific antigen (PSA) testing as a screening tool for prostate cancer has been a controversial issue. The United States Preventive Services Task Force (USPSTF) determined that the potential benefit did not outweigh the harm, and thus recommended against PSA-based screening in 20121. However, no consensus has been reached regarding clinical practice guidelines. We assessed the use of PSA testing and digital rectal examination (DRE) as tools to screen for prostate cancer by primary care physicians in Vermont.
Materials & Methods Surveys were emailed to practicing primary care physicians in Vermont. Completed surveys were received from 27.2% of physicians. The percentage of primary care physicians using PSA testing and DRE to screen for prostate cancer was determined. Data was stratified based on number of years in practice. The results were compared with a prior study performed in 20012.
Results 27.7% of physicians in practice <10 years recommended PSA testing, compared with 55.9% of physicians in practice >10 years (p=0.006). 34.0% of physicians in practice <10 years recommended DRE, compared with 58.3% of physicians in practice >10 years (p=0.013). Of those who changed their prostate cancer screening recommendations in the past five years, 96.1% reported that the USPSTF statement influenced their decision. Of the physicians using DREs, respondents were less likely to recommend cessation after age 80 than those previously surveyed (58% in 2014 vs. 93% in 2001; p<0.001). Physicians using PSA testing were also less likely to stop screening after age 80 compared with prior respondents (51% in 2014 vs. 74% in 2001; p<0.001).
Conclusions The use of DRE and PSA by Vermont primary care providers in an effort to detect clinically significant prostate cancer (screening) in the context of the American Urological Association, American Cancer Society, international guidelines, and USPSTF recommendations demonstrated significant practice variations between physicians in practice <10 years and those in practice >10 years. These disparities became more significant when present practice patterns were compared with those in 2001.
Physicians in practice less than 10 years were less likely to recommend PSA screening, suggesting that they are more likely to adapt their practice in accordance with changing guidelines than those in practice for 10 or more years. Nationally, PSA screening has declined among men older than age 50 years since 2012. Despite this, one-third of men aged 75 and older continue to be screened3. Improved informational and educational processes for evolving prostate cancer early detection (screening) nomograms must be developed to improve men's health in light of these discrepancies.
1 Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2012;157:I-44.
2 Sarle R, Zvara P, Bunnell M, Plante M. Statewide prostate cancer screening practices among primary care physicians. Preventive Medicine in Managed Care. 2001;2:137-42.
3 Drazer MW, Huo D, Eggener SE. National Prostate Cancer Screening Rates after the 2012 USPSTF Discouraging PSA-Based Screening. J Clin Oncol. 2015 Aug 1;33(22):2416-23.
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