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Many cancer centers not following prostate-screening recommendations

JAMA Internal Medicine
Reuters Health - 09/03/2022 - More than a quarter of U.S. cancer centers do not follow national guidelines for using prostate-specific antigen (PSA) to screen for prostate cancer, new findings show.

"We found that many cancer centers recommend that all men start receiving prostate-cancer screening at a certain age," said Dr. Jennifer Marti of Weill Cornell Medicine in New York. "We found that a subset of cancer centers, 26%, make this recommendation, which diverges from national-society . . . guidelines."

"These national societies recommend that, before a man undergoes screening for prostate cancer, he should have the opportunity to discuss the pros and cons of the test with his doctor, in a process called 'shared decision-making,'" Dr. Marti told Reuters Health by email. "Men in the age group 50-70 should have the discussion, but in general, there is no reason to consider screening in average risk men younger than 50 or older than 70."

Dr. Marti and her colleagues reviewed PSA screening recommendations on the public websites of 1,119 cancer centers accredited by the Commission on Cancer. The researchers focused on age, shared decision-making and potential harms when comparing the website recommendations with those of the U.S. Preventive Services Task Force, the American Cancer Society and the American Urological Society.

Of the 607 centers providing recommendations on their websites, 451 (74%) recommended that men discuss screening with healthcare professionals, in agreement with national guidelines. Thirty-four percent of these centers advised starting discussions when men are age 50 and 17% at age 55, the researchers report in JAMA Internal Medicine.

Twenty-six percent of the centers with recommendations on their websites urged all men universally to start screening, with 4% suggesting screening start before age 50, 19% at age 50 and 3% at age 55.

Among the centers providing recommendations, 78% did not suggest an upper age limit at which men should stop getting screened, in contrast to most national guidelines, which recommend discontinuing at age 70.

Thirty-eight percent of these centers acknowledged that there were potential harms associated with screening and 19% detailed the specific risks.

It's not known why "so many centers are not following guidelines," Dr. Marti said. "I suspect a large part of it comes from good intentions, more so than other reasons like financial incentives. Many of us in medicine intuitively think that screening for disease is a good thing because it allows us to 'catch a cancer early' and 'save lives.'"

The problem, Dr. Marti explained, is that prostate cancer is heterogeneous and many tumors grow so slowly that a man will die of something else before the prostate cancer becomes life-threatening. Treatment of these indolent cancers can cause harms, such as urinary incontinence or impotence, she added.

Informed decision-making is the best way to go, said Dr. Otis Brawley, professor of oncology and epidemiology at the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, who was not involved in the study.

"The problem is that informed decision-making requires time and doctors generally have a very limited amount of time with each patient," Dr. Brawley told Reuters Health by phone. "Typically they have 20, at most 30, minutes with a patient and they can spend 10 to 15 minutes talking about the pros and cons of prostate screening or talking about diet, exercise, blood pressure control and smoking. It's hard to get all those things into the compressed time they have."

Dr. Brawley suspects that some doctors offer the PSA to all patients to avoid potential lawsuits. "There are several cases now in which the patients admitted they were informed and that they decided not to get screened and were later diagnosed with cancer. Nobody ever gets sued because they screen."

Still, he said, many are probably doing it "because they believe it works. They are screening everybody because they think if they find disease they must be saving lives."

SOURCE: https://bit.ly/34oEq3p JAMA Internal Medicine, online March 7, 2022.

By Linda Carroll

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