Screening for prostate cancer: Who and how often?
Better use could be made of the PSA assay, and less frequent testing may not jeopardize patients’ outcomes.
Counseling recommendations
However, providing men with information on prostate cancer screening before they discussed it with their family physician, rather than after the visit, resulted in patients having a significantly more active role in making a screening decision, and lower levels of decisional conflict (LOE: 2b).61 Informational pamphlets are available through the AAFP and CDC websites listed in TABLE 4. Additional websites containing prostate cancer screening information are found in TABLE 4. We also provide a bullet item list of key points for discussion with patients (TABLE 5), which can be used along with the balance sheet provided here (TABLE 2).
Shared decision-making is not an easy or quick process. Yet, the majority of patients will benefit from the discussion, regardless of the final decision. Of course, there are instances when a shared decision-making process is well-documented, and still results in an undesirable outcome;62 however, while the evidence for screening remains controversial, patients have the right to know that those controversies exist and why they exist.
TABLE 4
Useful websites for patients to find prostate cancer screening information
| CENTERS FOR DISEASE CONTROL AND PREVENTION |
| www.cdc.gov/cancer/prostate/decisionguide/index.htm |
| 10th grade reading level* |
| Good coverage of screening and treatment controversies |
| Offers downloadable PDF version |
| NATIONAL CANCER INSTITUTE |
| cis.nci.nih.gov/asp/FactSheetPub/AlphaSubList.asp?alpha=47 |
| 10th grade reading level |
| FAQ format |
| Offers Spanish version |
| AMERICAN CANCER SOCIETY |
| www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_prostate_ cancer_be_found_early_36.asp |
| 12th grade reading level |
| Lacks discussion of treatment options and their side effects |
| Biased in favor of screening but acknowledges that other distinguished organizations are not |
| AMERICAN UROLOGICAL ASSOCIATION |
| www.urologyhealth.org/adult/index.cfm?cat=09 |
| 12th grade reading level |
| Easy to navigate among screening and specific treatment pages |
| Biased in favor of PSA screening |
| AMERICAN ACADEMY OF FAMILY PHYSICIANS |
| familydoctor.org/healthfacts/361/ |
| 11th grade reading level |
| Question/answer format |
| Very straightforward, lacks depth |
| www.aafp.org/x19519.xml |
| 7th grade reading level |
| Separate information sheet for patients and physicians |
| Presents possible outcomes of PSA test and prostate cancer treatment in easy-to-follow format |
| WEBMD |
| my.webmd.com/medical_information/condition_centers/prostate_cancer/default.htm |
| 9th grade reading level |
| Question/answer format |
| Specifically addresses false negative and positives with current estimates |
| DARTMOUTH CENTER FOR SHARED DECISION MAKING |
| www.dhmc.org/dhmc-internet-upload/file_collection/PSA.pdf |
| 6th grade reading level |
| Well-designed, simple presentation of pros and cons of PSA testing |
| *Fleish-Kincaid grade level score based on average sentence length and average number of syllables per word. |
TABLE 5
Talking points for patients and physicians
| Prostate cancer is an important men’s health problem |
| Screening may prevent early prostate cancer death |
| DRE alone has little value as a screening test |
| Age, prostate size, prostatitis, ejaculation, prostate biopsy, and prostate surgery can cause a falsely elevated PSA test |
| Approximately 70% of men with an elevated serum PSA do not have cancer |
| The percentage of PSA screening false negatives ranges from 10%–22% in large studies |
| If the test is abnormal, a biopsy will be recommended |
| If the biopsy is positive, treatment options will be given |
| Many men experience long-term urinary incontinence and impotence related to their treatment |
CORRESPONDING AUTHOR
Kendra Schwartz, MD, MSPH, 101 E. Alexandrine, Detroit, MI 48201, E-mail: kensch@med.wayne.edu
