Understanding PSA Controversy Does Not Deter Men From Getting Tested

MedicalResearch.com Interview with:
Michael Fenstermaker MD
NYU School of Medicine | MD, MS | Class of 2015
Northwestern University | BA | Biochemistry, Psychology

Medical Research: What is the background for this study? What are the main findings?

Dr. Fenstermaker: The benefits of using prostate-specific antigen (PSA) testing to screen for prostate cancer are uncertain. In response to this, many medical societies have recently scaled back their recommendations for PSA screening.  One common thread among these groups is that shared decision-making should guide whether or not men get tested. Shared decision-making is a process by which physicians and patients work together to make a medical decision that aligns with the patient’s values and follows the best available medical evidence.

Several studies have shown a decline in PSA testing since new guidelines have been published.  While a decrease in screening is not necessarily problematic itself, it could be an issue if this is the result of fewer physicians discussing screening with their patients. Some experts worry that disparities in screening could develop, such that only informed patients go on to speak with their physicians and receive PSA testing.  By analyzing data from a national survey, we had the chance to investigate just how much men know about the controversies leading to these guidelines changes and whether this knowledge influences PSA usage.

Our findings show that the majority of U.S. males of screening age report that they were not informed of many key facts important to understanding the risks and controversies surrounding PSA testing.  Of particular concern, certain vulnerable populations, such as those without regular healthcare providers were less likely to be informed of these facts. Surprisingly, those men who had more awareness of the controversies about PSA testing were more likely to undergo testing.  

Medical Research: What should clinicians and patients take away from your report?

Dr. Fenstermaker: We hope the extent to which most screening-age males are under informed about the risks, benefits, and controversies of prostate cancer screening is eye-opening to many physicians.  Without definitive evidence that PSA screening is helpful or not, we owe it to our patients to discuss the current controversies surrounding PSA.  The observation that PSA usage was associated with awareness is potentially concerning as well. With shared decision-making, it is important to ensure that variations in PSA usage are the result of patient preferences.

Some patients may also feel shy about participating in shared decision-making.  Patients should realize that they have a say in the decision to be screened for prostate cancer.  By starting a dialog, encouraging their physician to discuss the evidence behind PSA openly, they can reach a choice that better fits their own values.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Fenstermaker: Strategies for better implementing shared decision-making into clinic practice need to be developed.  There is the impression that providing a comprehensive overview of prostate cancer screening in a short clinic visit is too difficult.  However, this is where tools to assist physicians and patients, such as decision aids, may become valuable in helping with the shared decision-making process.


Presented at the 2015 American Urological Association

Friday, May 15, 2015 1:00 PM-3:00 PM
NOMCC: 217-219 
General & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I
Funding: None
MP5-12: Understanding the Limitations of Prostate-Specific Antigen Testing Does not Deter Men from Undergoing Prostate Cancer Screening
Michael Fenstermaker*, Stacy Loeb, Heather T. Gold, Joseph Ravenell, Danil Makarov, New York, NY

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MedicalResearch.com Interview with:, & Michael Fenstermaker MD (2015). Understanding PSA Controversy Does Not Deter Men From Getting Tested