Factors influencing primary care physicians’ decision to order prostate-specific antigen (PSA) test for men without prostate cancer

2013 ◽  
Vol 52 (8) ◽  
pp. 1602-1608 ◽  
Author(s):  
Afsaneh Hayat Roshanai ◽  
Karin Nordin ◽  
Gunilla Berglund
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Prostate Specific Antigen ◽  
Primary Care Physicians ◽  
Specific Antigen ◽  
Psa Test ◽  
Factors Influencing

Serum prostate-specific antigen screening for prostate cancer: Analysis of the costs and benefits

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15602-15602
Author(s):  
W. Mermershtain ◽  
D. Bone ◽  
T. Shteiman ◽  
S. Ariad
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Health Services ◽  
Prostate Specific Antigen ◽  
Primary Care Physicians ◽  
Specific Antigen ◽  
Defensive Medicine ◽  
High Rate ◽  
Phase 3 ◽  
Psa Test

15602 Background: PSA (prostate specific antigen) blood test used as a diagnosing aid for prostate cancer. Physicians disagree on the test performance policy and its necessity, and as a result the referring practices vary from physician to another. We examine whether the use of PSA test in General Health Services, was performed rationally, and cost effectively. Methods: Phase 1: Collection of data on all the prostate cancer patients registered at the Soroka University Medical Center until 2004 and people insured by the Clalit Health Services, that underwent PSA tests in 2002–2004. Phase 2: Cross examination of the patients’ data with data on patients undergoing the test. Phase 3: Determining the number of excessive tests (over 4 tests per person a year). Phase 4: A random study of 90 medical files of patients that underwent a PSA test. The number of references made not according to the instructions (in the files) was multiplied by the number of conducted tests (except those in phase 3), thus reaching the number of irrational tests. Phase 5: Multiplying the number of tests in phases 3–4 by the public rates of the Health Ministry for PSA tests (62 NIS). In addition, a questionnaire was distributed among primary care physicians to learn about their attitudes regarding defensive medicine. Results: In years 2002–2004, 19,418 patients underwent 25,674 PSA tests. 88.6% of the tests turned out as irrational - accumulating to a cost of 1,410,438 NIS. In the course of the recent years there is a trend of increase in the number of tests provided not according to the custom instructions, and this state of affairs suggests lack of awareness to such a high rate of irrational tests, or alternatively, awareness and failure to assign appropriate importance to the problem. Likewise, it was found that there are doctors referring patients to PSA tests as a result of defensive medicine. Conclusions: High percentage of the referrals to PSA test was provided not according to the customary instructions, and some of these referrals stems from defensive medicine. We suggest, guiding rules must be set for referring patients to PSA tests. It is necessary to update primary care doctors on the use and miss use of the tests. No significant financial relationships to disclose.

scholarly journals Prostate-specific antigen testing for prostate cancer screening: A national survey of Canadian primary care physicians’ opinions and practices

2017 ◽  
Vol 11 (12) ◽  
pp. 396-403 ◽  
Author(s):  
Mitchell Geoffrey Goldenberg ◽  
Sean C. Skeldon ◽  
Madhur Nayan ◽  
Yegappan Suppiah ◽  
Linda Chow ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Cancer Screening ◽  
Prostate Specific Antigen ◽  
National Survey ◽  
Primary Care Physicians ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Psa Screening

Introduction: In 2014, the Canadian Task Force on Preventive Health Care (CTFPHC) recommended against routine prostate cancer screening with the prostate-specific antigen (PSA) blood test.1 We surveyed Canadian primary care physicians (PCPs) to understand their opinions and attitudes towards prostate cancer screening in 2016.Methods: Twenty PCPs piloted the survey to assess its accessibility. We distributed a flyer to 19 633 PCPs as an insert in a large mailed package inviting them to attend a national meeting, and later promoted the survey at the meeting. Multinomial logistic regression models examined factors associated with agreement of key guideline statements and the overall benefit of PSA screening.Results: A total of 1254 PCPs responded (rate of 6.4%); 54.7% of physicians aware of the CTFPHC recommendations report screening less often as a result. Overall, 55.6% of PCPs feel that the risks of PSA screening outweigh the benefits. On multivariable analysis, physicians who did not read the guidelines, did not have an academic appointment, or were in practice for over 20 years were significantly more likely to disagree with the statement that men 55‒69 years old should not be screened for prostate cancer with PSA.Conclusions: Our national survey found that the prostate cancer screening practices of Canadian PCPs varies widely across physician demographic groups, with almost equal numbers for or against. This has significant ethical, medical, and legal implications. The poor response rate to highly incentivized survey request may suggest a reluctance or general apathy towards this subject because of the Task Force recommendations. Future efforts should provide physicians with objective guidance around PSA screening, incorporating input from all stakeholders, including PCPs, urologists, and patients.

scholarly journals Perception of Abnormal Serum Prostate-Specific Antigen (PSA) Test Results amongst Family Practitioners

2008 ◽  
Vol 90 (5) ◽  
pp. 398-402 ◽  
Author(s):  
MA Rochester ◽  
PJ Donaldson ◽  
J McLoughlin
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Psa Test ◽  
Serum Prostate Specific Antigen ◽  
Psa Testing ◽  
Family Practitioners ◽  
Younger Men ◽  
Psa Velocity

INTRODUCTION With increased use of serum prostate-specific antigen (PSA) testing, prostate cancers are diagnosed at an earlier stage in younger men, when radical curative treatments are appropriate. Modifications of the PSA test such as PSA velocity and age-adjusted values are available to aid in the selection of patients for biopsy. However, it is not clear whether these data are used in general practice. PATIENTS AND METHODS A self-administered questionnaire was mailed to all primary care practices within one region in the UK. A series of visual analogue questions designed to identify referral thresholds for age-adjusted PSA levels and PSA velocity were used to identify patterns in referral behaviour. RESULTS Individual family practitioners see only small numbers of patients requesting PSA tests or with newly diagnosed prostate cancer each year. The median (range) thresholds considered for referral at ages 45, 55, 65, 75 and 85 years were 4.5 ng/ml (2.5–15.5 ng/ml), 5.5 ng/ml (3.0–15.5 ng/ml), 6.5 ng/ml (3.5–15.5 ng/ml), 6.5 ng/ml (3.5–25.5 ng/ml), and 7.5 ng/ml (3.5–25.5 ng/ml), respectively. Only 5% of practitioners correctly identified the age-specific PSA threshold for referral of a 45-year-old man. CONCLUSIONS It is important to remember that younger men (even those in their forties and fifties) may be at risk of prostate cancer even if asymptomatic. It is important in a climate of increasing demand for PSA testing that those who initiate the process understand the implications and limitations of testing, including appropriate triggers for referral to secondary care. The exact approach required for the successful dissemination of this information to primary care is not clear, but our data suggest that a better understanding is required.

scholarly journals Lack of Follow-up of Prostate-Specific Antigen Test Results

2009 ◽  
Vol 124 (5) ◽  
pp. 718-725 ◽  
Author(s):  
Stephanie L. McFall ◽  
David W. Smith
Keyword(s):  
Prostate Cancer ◽  
Family History ◽  
Prostate Specific Antigen ◽  
Perceived Risk ◽  
Primary Care Physicians ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Psa Test ◽  
Risk Of Cancer

Objectives. We obtained population estimates of the prevalence of lack of diagnostic follow-up after an abnormal prostate-specific antigen (PSA) result and assessed the role of sociodemographic, access, and risk perception factors on follow-up of abnormal tests. Methods. We used data from the 2000 National Health Interview Survey cancer control supplement. For 3,310 men aged 40 or older with a PSA test, 463 men reported an abnormal PSA test. Outcomes were abnormal PSA and lack of diagnostic follow-up in the latter group. Covariates for logistic regression included sociodemographic variables (age, race/ethnicity, and education), access to care (health insurance and usual source), and risk of cancer (family history and perceived risk). Survey analysis procedures accounted for the complex survey design. Results. Abnormal PSA results were associated with age, family history, and perceived risk of cancer. Approximately 15% of men with abnormal PSA tests reported no follow-up. The estimated number was 423,549 (95% confidence interval [CI] 317,755, 529,343). No follow-up was more likely in Hispanic men (odds ratio [OR] = 2.21, 95% CI 1.04, 4.70) and men without insurance (OR=6.56, 95% CI 2.02, 21.29), but less likely in men with a family history of prostate cancer or higher perceived risk of cancer. Conclusions. Substantial numbers of men had no follow-up of abnormal PSA tests. Primary care physicians should assess continuity of care following abnormal PSA results. Data about prostate cancer screening and follow-up are needed to support clinical and policy decisions.

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