Prostate cancer screening practices and beliefs

To examine primary care physician prostate-specific antigen (PSA) testing and prostate cancer screening beliefs, practices, and trends over time.

Longitudinal physician survey.

Community and academic primary care practices in a major East Coast city.

Physicians with > or =100 patients enrolled in an HMO serving 90,000 patients were surveyed in 1993 and 1998 regarding prostate cancer screening beliefs and practices. In 1993, 176 physicians (76%) completed the survey. In 1998, 76% of the 1993 respondents responded to a second survey. Associations between and changes over time in beliefs and self-reported PSA testing were analyzed.

Physicians reported ordering PSA tests in 73% of health maintenance exams (HMEs) in 1993 and 81% of HMEs in 1998. PSA testing significantly increased between 1993 and 1998 with 43% of physicians reporting increased testing and only 13% reporting reduced testing. Between 1993 and 1998, physician attitudes favoring PSA testing increased although less than half of physicians believed that aggressive early treatment improved patient outcomes. Community versus academic practice location was also associated with PSA testing.

Physicians reported high and increasing rates of PSA testing from 1993 to 1998 and more favorable attitudes toward PSA testing. Despite conflicting expert recommendations and a lack of consistent, high-quality supporting evidence, PSA screening appears to be increasingly considered a standard of care by practicing physicians. However, beliefs other than improved patient outcomes due to screening may be the primary drivers of increased PSA testing.