Guidance and recommendations for prostate cancer screening have changed over the years. While there is no standard screening test, doctors may use a prostate-specific antigen (PSA) test to help diagnose prostate cancer. Doctors may follow a positive PSA test with a prostate biopsy.
Most recommending bodies emphasize a shared decision-making (SDM) approach for prostate cancer screening by PSA testing. This strategy moves away from doctors making treatment decisions and instead relies on collaborative interactions between patients and healthcare teams.
Why do expert opinions on prostate cancer screening differ? This remains a complex question with a lot to unpack. First, we have limited treatment options for cancer that has already spread outside of the prostate. Thus, detecting these cases will often not improve health or prolong life. Second, many cases of slow-growing prostate cancer will never become life-threatening; detection of these cases can be considered overdiagnosis and may lead to anxiety, unnecessary treatment, and accompanying side effects. Unnecessary biopsies, which provide no additional value to patients and physicians in decision-making, can also come with complications such as bleeding and infection.
The inconsistency in prostate cancer screening and recommendations for enacting treatment based on elevated PSA levels can lead to a complicated and confusing situation for patients. As such, patients diagnosed with prostate cancer also have to make decisions with little clarity on the risks and benefits of treatment. This uncertainty and inconsistency have led to a decline in screening rates.
A recent review published in the Annals of Family Medicine examined the implementation and effectiveness of SDM for prostate cancer screening. The researchers analyzed 29 published studies to understand men’s communication preferences for discussion with their doctors regarding prostate cancer screening.
The researchers identified four critical components necessary for productive discussions about prostate cancer screening risks and benefits. First, doctors must use everyday language that patients without a medical background can understand and process. In addition, men need to receive enough information to make an informed decision. Similarly, the review found that successful SDM requires doctors to spend sufficient time with patients. Finally, the researchers report that men must share a relationship based on trust and respect with their doctor.
The study also identified three themes that prevented men from participating in effective SDM. These components included circumstances when men had already decided to pursue prostate cancer screening before meeting with their doctor and feeling threatened by the interactions. The review reports that black men can face racism and cultural insensitivity, preventing the successful implementation of an SDM approach. This finding presents an immediate area to target to improve health disparity outcomes.
Identifying specific factors enhancing SDM strategies provides doctors and healthcare providers valuable resources to improve their practice. Implementing new procedures catering to men’s communication preferences, particularly the time requirement needed to facilitate desired interactions between patients and healthcare providers, may present a challenge for busy doctors. However, this study provides critical information to enhance the doctor-patient relationship.
Sources: Urolog Clinic North Am, Annals Fam Med (Fedewa), Annals Fam Med (Fong)
