Researchers at the University of New Mexico Cancer Center and colleagues from several other institutions recently found that many patients reported being routinely screened for prostate cancer with prostate specific antigen (PSA) testing without clearly understanding the risks and benefits of the test.
“It sounds like it’s a simple decision of whether or not to get a blood test. But PSA testing has really important implications,” said Richard Hoffman, Professor of Medicine at the UNM Cancer Center and faculty member in the Department of Internal Medicine at the UNM School of Medicine. “You’re going to need more testing if it’s abnormal. There are also a lot of potential harms and uncertainties about treating prostate cancer, and you really should understand these issues before you decide to get tested.”
The study, published in the September issue of Archives of Internal Medicine, surveyed a national sample of 375 randomly selected English-speaking men age 40 and older. Researchers found that more than 90 percent of subjects believed that PSA screening would reduce prostate cancer mortality. However, recently published results from the the American Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial found no survival benefit for PSA testing, and the European Randomized Study of Screening for Prostate Cancer indicated that the benefit of PSA testing is negligible.
“If there’s going to be any benefit, it’s pretty minimal. The tradeoff is a lot of overdiagnosis which then leads to a lot of overtreatment,” said Hoffman, who is a physician at the New Mexico VA Health Care System. “And so there’s been pretty consistent agreement among major professional organizations now for about ten or fifteen years that the first step in approaching screening is really to discuss and explain the risks and benefits of screening and treatment.”
Although subjects most frequently cited their health care providers as a vital source of education about prostate cancer screening, the study found that a surprising majority of patients had inaccurate information. Although most subjects reported feeling well-informed about prostate cancer, 93 percent could not correctly answer more than one out of the three knowledge based questions during the study.
Findings also showed that health care providers were more likely than subjects to first raise the idea of PSA testing, and while most providers discussed the benefits with patients, only about a third discussed the potential downsides of testing. “Providers need to recognize that when they’re discussing screening, they need to present a balanced view because what they say is very influential,” said Hoffman, who is also a medical editor for the Foundation for Medical Decision Making, which funded the study.
Collaborators include researchers from the University of Michigan, the Ann Arbor VA Health Care System and the Massachusetts General Hospital.
The UNM Cancer Center is the Official Cancer Center of the State of New Mexico, and one of only 65 National Cancer Institute designated cancer centers in the nation. It is home to 85 board-certified oncology physicians representing every cancer specialty and more than 120 research scientists hailing from such prestigious institutions as M.D. Anderson, Johns Hopkins and the Mayo Clinic.