“What guidelines,” you ask? Last fall, the U.S. Preventative Services Task Force (USPSTF) drafted new screening guidelines for prostate cancer that recommended against routine prostate specific antigen (PSA) testing in men of average-risk for the disease. The panel concluded that there was “moderate certainty” that the harms associated with routine screening (like exposing men to invasive tests and treatments that they might not need) overshadow the benefits of early detection.
“It was quite a controversial decision, as some of the trials have led to differing positions,” said Dr. Craig Pollack from the Johns Hopkins University School of Medicine in Baltimore, who worked on the new study.
Only about half of all doctors and nurse practitioners agreed with the draft guidelines according to Pollack’s survey. Even though half of them seemingly agreed to the guidelines, only a handful said they would cut back on routine screenings. “I was surprised that many clinicians did not expect the draft recommendations would affect their decision making, and there were many other barriers” to cutting back on screening, said Pollack. Despite the half-and-half results, only a few doctors said that they would stop offering PSA testing due to the USPSTF guidelines. Pollack’s findings were published in the Archives of Internal Medicine.
Despite this, convincing doctors and patients that screening isn’t always effective is a tough step, as it defies conventional wisdom.
“There’s probably a very small benefit (to PSA testing) at best, and we know there’s harm, but conventional wisdom is: early detection is always best,” said Robert Volk, a professor of internal medicine who has studied prostate cancer screening at the M.D. Anderson Cancer Center in Houston. “Physicians are concerned about patients’ expectations. Patients typically want to be screened,” Volk said.
Dr. Michael LeFevre, co-chair of the USPSTF, said that he’s not surprised that there’s still some resistance to screening guidelines. “We don’t necessarily expect a dramatic turnaround in the way this test is being used,” he said. “Change is not easy.”
Still, educational materials that inform men of the risks that come with regular prostate cancer screenings could help men weigh risk vs. reward regarding PSA tests. That will help challenge the conventional wisdom, as well as prevent doctors from being sued, which happens disconcertingly often, according to Volk. Pollack concurs, saying that prostate cancer screening-related alerts being added to electronic medical records could also help doctors and patients find the right path.