Shared decision-making for prostate cancer screening? Fuhgeddaboudit!

The news, unfortunately, is that there’s nothing new here.

Shared decision-making uncommon for PSA tests,” Reuters Health reports. Excerpts:

“Most men have not discussed the potential advantages and disadvantages of prostate cancer screening with their doctor, according to a new study.

Guidelines from groups including the American Urological Association and American College of Physicians call for shared decision-making when it comes to prostate specific antigen (PSA) testing, taking into account each man’s values regarding screening.

“There’s a lot of scientific uncertainty about its benefits and harms for any one person,” said Dr. Paul Han, from the Maine Medical Center in Portland, who led the new study.

Han and his colleagues analyzed questionnaires completed by about 3,400 men in their 50s, 60s and early 70s as part of a 2010 national health survey.

They found 64 percent of those men had not discussed the pluses and minuses of PSA tests with their doctors, or the scientific uncertainty of their effect. Of the rest, about half had talked only about the advantages of screening.

About 44 percent of study participants hadn’t been screened for prostate cancer in the past five years. The majority of those – 88 percent – reported no discussions regarding that choice, according to findings published in the Annals of Family Medicine.

The PSA test is the “poster child for uncertainty,” said Dr. Michael Wilkes, from the University of California, Davis.

“The test is horrible, yet there are still reasonable men who still might opt to have the test because they feel that knowing the information, even though it’s not perfect, is better than not knowing it,” he told Reuters Health.

“In this situation, reasonable people can look at the data and because of their own values and their own preferences decide, ‘I want the test’ or, ‘I don’t want the test.'”

In two studies published in the same journal, Wilkes and his colleagues looked at whether educating doctors about prostate cancer screening and prompting patients to ask about it boosted rates of shared decision-making.

Their studies included about 120 doctors who either were given typical brochures about PSA tests or completed an interactive program that included video vignettes showing the possible benefits and harms of screening.

When faced with a test patient a few months later, doctors in the intervention group were a little better at leading shared decision-making discussions – but not much.

“Studies are converging to the same conclusion, that (shared decision-making) really doesn’t happen very often in PSA screening,” he said.

“It’s one of these things like world peace. Everyone agrees with it as an ideal, but how to actually achieve it, we don’t know.”

Reuters, in a sound journalistic practice, included links to the 3 Annals papers:, and

Earlier this week, a paper in the American Journal of Preventive Medicine addressed a similar theme, “Prostate-Specific Antigen Testing: Men’s Responses to 2012 Recommendation Against Screening.”   The survey concluded:

“Study findings suggest that consumers are favorably disposed to PSA testing, despite new evidence suggesting that the harms outweigh the benefits. The new USPSTF recommendation against PSA testing in all men may be met with resistance.”

But the survey was not able to assess the quality of the decision-making process.  What it did touch on was concerning:

“Most (70%) respondents (including those who have never had a PSA test) reported that they had not discussed the benef ts and potential harm of PSA screening with their healthcare provider (55%) or did not recall having had such a discussion (15%). When PSA testing was discussed, respondents reported that providers were more likely to discuss only the benefits of PSA testing versus both the benefits and potential harm together (19% vs 11%, respectively).”

Shared decision-making in prostate cancer screening?  Fuhgeddaboudit!  (If you need an explanation, watch this video.  Warning:  if you’re sensitive to a little blue language, do not watch.)


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