Attitudes Toward and Use of Prostate-Specific Antigen Testing Among Urologists and General Practitioners in Germany: A Survey

Abstract

BackgroundIn 2020, around 1.4 million new prostate cancer (PCa) cases were recorded worldwide. Early detection of PCa by prostate-specific antigen (PSA) screening remains debated, leading to different specialist-specific recommendations in PCa guidelines. This study aimed to assess attitudes toward and use of PSA testing among urologists in Germany and general practitioners (GPs) in Lower Saxony (Germany).MethodsA nationwide questionnaire was sent to urologists via the mailing lists of the Professional Association of German Urologists and the German Urological Society. A version of the questionnaire for GPs was sent to email addresses via the Association of Statutory Health Insurance Physicians Lower Saxony. The online questionnaires covered use of PSA testing, information communication, handling of test results, and handling of/knowledge about national and international guidelines and recommendations on early detection of PCa. Statistical analysis was performed at a descriptive level.ResultsIn total, 432 of 6,568 urologists (6.6%) and 96 of 1,579 GPs (6.1%) participated in this survey. Urologists and GPs differed in their attitudes and approaches toward PSA testing. Most urologists (86.8%, n=375) judged the test as “very meaningful” or “meaningful”, compared with 52.1% (n=50) of GPs. Almost two-thirds of the urologists (64.4%, n=278) viewed the PCa mortality reduction by PSA testing as proven, compared with one-fifth of GPs (20.8%, n=20). Almost 80% of male urologists (79.9%, n=291) indicated that they would undergo a PSA test in the future (again), compared with 55.1% of male GPs (n=38). In addition, 56.3% (n=243) of urologists stated that “considerably more than half” or “almost all” men aged 45 years or older received a PSA test, compared with 19.8% (n=19) of GPs.ConclusionsUrologists are more convinced about the PSA test than GPs. PSA testing is therefore used more often in urological settings, although the preselected patient population must be considered. In accordance with specialist-specific recommendations, GPs show a more reserved approach toward PSA testing. Instead of focusing on different attitudes and recommendations on PSA testing, the exchange between specialist groups should be improved to achieve a consistent approach to PSA testing.

Commentary: Kappen S, Jürgens V, Freitag MH, Winter A. Attitudes Toward and Use of Prostate-Specific Antigen Testing Among Urologists and General Practitioners in Germany: A Survey

“…Table 1 compares results on selected items from the current and another study by Kappen et al. with our own results obtained some years earlier within a German population of GPs and internists ( 8 , 9 , 11 , 12 ). The willingness of non-urologists to perform PSA-based early detection of PCa in asymptomatic men has decreased over the years (83.9% vs. 51.2% and 55.2%, respectively, both tests with p<0.001; Table 1 ).…”

“…For colleagues from countries in which PSA-based early detection of PCa is at least in part provided by non-urology specialties, Kappen et al. present extremely important data ( 11 ). In Germany (as, for example, in the US), GPs perform a large part of opportunistic PSA-based screening ( 5 , 8 – 13 ).…”

“… p*, statistical difference calculated using the Chi² test (Fisher´s exact test, two-sided) between the study of Kappen et al. ( 11 ) and our own study [8,9]; p**, statistical difference calculated using the Chi² test (Fisher´s exact test, two-sided) between the study of Kappen et al. ( 12 ) and our own study [8,9]; ED, early detection; GP, general practitioners; n.a., not available; PCa, prostate cancer; PSA, prostate-specific antigen.…”

“…A tiny downer in the otherwise excellent work of Kappen et al. is certainly that the authors solely opted for a purely descriptive analysis of their data ( 11 ). Considering multivariate analysis of our own survey study, it was striking that non-urologists who never attended topic-specific education by urological colleagues were almost 4 times more likely to perform opportunistic PSA-based screening of patients (compared with those who attended urological education events; OR 3.95, p=0.002) ( 9 ).…”

“…Meritoriously, the working group around Sanny Kappen analyzed the attitudes of dominant professional groups responsible for opportunistic PSA-based screening in Germany (namely general practitioners (GPs) and urologists) using a comprehensive survey ( 5 , 8 – 13 ). With great interest we noticed their recently published results which we would like to comment ( 11 ).…”