PROSTATE-CANCER SCREENING AND BELIEFS ABOUT TREATMENT EFFICACY - A NATIONAL SURVEY OF PRIMARY-CARE PHYSICIANS AND UROLOGISTS

PURPOSE: To describe practice patterns and beliefs of primary care phy sicians and urologists regarding early detection and treatment of pros tate cancer. SUBJECTS AND METHODS: National probability samples of pri mary care physicians (n = 444) and urologists (n = 394) completed mail survey instruments in 1995. Physicians were asked about their use of prostate-specific antigen (PSA)testing for men of different ages and t heir beliefs about the value of radical prostatectomy, external-beam r adiation therapy, and watchful waiting for men with differing life exp ectancies. RESULTS: Mosi primary care physicians report doing PSA test s during routine examination of men older than 50 years of age. The ma jority say they continue to do them on patients over 80 years and to r efer men with abnormal values for biopsy. In contrast, only a minority of urologists would recommend PSA tests or biopsy for abnormal values for men over 75 years of age. More than 80% of primary care physician s and urologists doubt the value of radical prostatectomy for men with <10 years of life expectancy; more primary care physicians than urolo gists see probable survival benefit in radiation therapy for patients with life expectancy <10 years (48% versus 36%) or >10 years (67% vers us 53%). Thirteen percent of primary care physicians and only 3% of ur ologists consider watchful waiting to be as appropriate as aggressive therapy for men with >10 years of life expectancy. CONCLUSIONS: Primar y care physicians are more aggressive about PSA testing and referral f or biopsy than most urologists recommend. Both groups recommend PSA te sting and believe that aggressive treatment is more beneficial than ex isting evidence indicates. (C) 1998 by Excerpta Medica, Inc.