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The State of Prescreening Discussions About Prostate-specific Antigen Testing Following Implementation of the 2012 United States Preventive Services Task Force Statement

      Objective

      To determine if the quality of prescreening discussions has changed following release of the United States Preventive Services Task Force statement against prostate cancer screening.

      Methods

      This cross-sectional study used the 2012 and 2014 Behavioral Risk Factor Surveillance System surveys. Respondents were categorized based on the year in which they responded to the Behavioral Risk Factor Surveillance System Survey. Quality of prescreening discussion was operationalized as having discussed only advantages, only disadvantages, both advantages and disadvantages, or neither. Race/ethnicity, education level, income, insurance status, and having a prostate-specific antigen (PSA) level actually drawn after prescreening counseling served as confounders in our multivariate analysis.

      Results

      Among 217,053 men in the analytic sample, 37% were told about only advantages of PSA screening compared to 30% of men who were advised about both advantages and disadvantages. Men who were told about neither advantages nor disadvantages were more likely to be Hispanic, not graduate high school, have low income, and not have insurance. Controlling for covariates, men in 2014 were significantly more likely to have undergone PSA testing without having discussed either advantages or disadvantages than men in 2012.

      Conclusion

      Comprehensive prescreening discussions about advantages and disadvantages of PSA testing are critical to informed decision making about prostate cancer screening. Disparities not only exist with regard to the quality of prescreening discussions that patients receive from their providers prior to PSA testing across categories of race/ethnicity, education, income, and insurance status, but these disparities became more substantial between 2012 and 2014. Further investigation is warranted to elicit more specific reasons behind these variations.
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      Linked Article

      • Re: Turini et al.: The State of Prescreening Discussions About Prostate-specific Antigen Testing Following Implementation of the 2012 United States Preventive Services Task Force Statement (Urology 2017;104:122-130)
        UrologyVol. 114
        • Preview
          We read the article with great interest. The authors analyzed the occurrence of prescreening discussions (also called “shared decision making”) that patients received from their providers before prostate-specific antigen (PSA) testing and found a declining rate between 2012 and 2014. As outlined in this article, the majority of screening is done by primary care providers and not by urologists. From the perspective of primary care, even after more than 25 years since the introduction of routine PSA screening for prostate cancer (PCa), there is still no clarity about the usefulness and desirability of this test.
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      • Reply by the Author
        UrologyVol. 114
        • Preview
          As presented in this Letter to the Editor, we strongly agree with the authors that the 2012 US Preventive Services Task Force (USPSTF) Statement against prostate-specific antigen (PSA)-based screening for prostate cancer has led to significant confusion within the medical community, especially among our primary care provider (PCP) colleagues. The grade D recommendation served not only to raise question among PCPs about the practice of using PSA-based screening but also took 1 step further by actually recommending against that laboratory work.
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