Prostate Cancer Screening Guidelines Can Confuse Clinicians

Prostate Cancer Screening Guidelines Can Confuse Clinicians

doctorAccording to a recent study, current guidelines for prostate cancer screening cause confusion to clinicians who are in need of more uniform, collaborative guidelines. The study, entitled “Prostate cancer screening in Primary Health Care: the current state of affairs” was published in Springer Plus.

Australia and New Zealand have the highest incidence of prostate cancer (PC) worldwide, with cancer specific five-year survival rates exceeding 90%. This high prevalence is driven by high rates of opportunistic PSA screening as evidenced by recent large increases in PSA testing in Australia, with a substantial proportion of detected cancers classified as lower grade tumors in younger men. At the other end of the age spectrum, a recent Concord Health and Ageing in Men Project (CHAMP) study in Australia reported that a significant proportion of men over 70 years of age were screened for PC.

The research team led by Weranja Ranasinghe from the Department of Urology at the Monash Medical Centre in Victoria, Australia assessed current practice of general practitioners and primary care physicians in screening for prostate cancer using digital rectal examination (DRE) and prostate specific antigen (PSA) testing. The main objective was to identify differences in screening practice.

A total of 438 general practitioners and primary care physicians were invited to participate in the trial, of which 149 were surveyed. Results revealed that the majority of general practitioners and primary care physicians (74%) thought that PSA assessment is somewhat effective in reducing PC mortality. Results also showed that annual PSA screening is being conducted by more GPs in metropolitan areas compared to GPs in rural areas (35% versus 18.4%). Routine PSA is not typically recommended by 25% of rural GPs. Male GPs said they asked for PSA analysis more frequently than for DRE in patients aged between 40 and 69 years.

Most clinicians reported that the Urology Society guidelines and College of GPs recommendations for PC screening were useful (77.2% and 73.2%, respectively) and felt that the PSA test reference ranges were useful. However, the majority of the clinicians (65,8%) reported it would be easier to refer patients to specialists due to guideline disagreements.

Based on these results, researchers suggest that current guidelines for PSA screening seem to cause confusion to general practice clinicians, suggesting an urgent need to create uniform and collaborative guidelines.