Applied Evidence

Screening for prostate cancer: Who and how often?

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References

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

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