Rm. Hoffman et al., ATTITUDES AND PRACTICES OF PRIMARY-CARE PHYSICIANS FOR PROSTATE-CANCER SCREENING, American journal of preventive medicine, 12(4), 1996, pp. 277-281
Prostate cancer screening with digital rectal examination (DRE) and pr
ostate-specific antigen (PSA) is recommended by several professional o
rganizations. Our objective was to assess the prostate cancer screenin
g practices and attitudes reported by primary care physicians. We rand
omly surveyed 454 Arizona primary care physicians, subsequently exclud
ing 124 ineligible subjects. Overall, 141 of 329 eligible physicians c
ompleted the survey (42.9%). Survey data included physician demographi
cs, practice characteristics, screening and follow-up strategies, and
attitudes toward screening. One hundred thirty-one physicians (93%) re
ported screening asymptomatic men with DRE or PSA. Respondents general
ly agreed that screening tests were accurate and that early detection
was beneficial. Screening began at an average patient age of 45 years,
though 7.8% of respondents began screening men younger than 40 years
and 7.0% began screening men older than 50 years. PSA levels ranging f
rom 3.9 to 40 ng/mL were considered abnormal, and 11.6% of respondents
used a cutpoint higher than 10 ng/mL. Primary care physicians report
a high rate of screening for prostate cancer and consider PSA and DRE
accurate and useful tests. Screening practices, however, varied consid
erably between physicians. The screening of younger men reported by pr
actitioners would tend to increase the rate of false-positive tests, w
hile using a high cutpoint for PSA and delaying screening beyond age 5
0 years would decrease the chance for early detection. These screening
practices may increase health care costs without necessarily leading
to improved health outcomes.