Prostate cancer screening practices and beliefs.

Area of Science:

• Urology
• Primary Care Medicine
• Health Services Research

Background:

• Prostate-specific antigen (PSA) testing for prostate cancer screening is a subject of ongoing debate.
• Physician beliefs and practices regarding PSA testing are crucial for understanding screening trends.
• Previous studies have indicated variability in PSA testing rates and physician attitudes.

Purpose of the Study:

• To evaluate trends in primary care physician (PCP) beliefs and practices concerning PSA testing for prostate cancer screening.
• To analyze changes in PSA testing rates and associated physician attitudes over a five-year period (1993-1998).
• To identify factors influencing PSA testing decisions among PCPs.

Main Methods:

• A longitudinal survey design was employed, tracking physicians over time.
• Participants included primary care physicians in community and academic practices in a major East Coast city.
• Physicians with at least 100 patients in an HMO were surveyed in 1993 and again in 1998 regarding their screening beliefs and self-reported PSA testing practices.

Main Results:

• Physicians reported ordering PSA tests in 73% of health maintenance exams (HMEs) in 1993, increasing to 81% in 1998.
• A significant increase in PSA testing was observed, with 43% of physicians reporting increased testing and only 13% reporting reduced testing between survey years.
• Physician attitudes favoring PSA testing grew, though less than half believed aggressive early treatment improved outcomes; practice location (community vs. academic) also correlated with testing rates.

Conclusions:

• Physicians reported high and rising rates of PSA testing and more positive attitudes toward screening from 1993 to 1998.
• Despite conflicting recommendations and limited high-quality evidence, PSA screening is increasingly viewed as a standard of care by practicing physicians.
• Factors beyond perceived patient outcome improvements may be driving the increase in PSA testing.