<p>Early detection of prostate cancer using prostate-specific antigen testing: an empirical evaluation among general practitioners and urologists</p>

Abstract

Background: Prostate cancer (PCa) is the most frequent cancer and the third leading cause of cancer death among German men. One option for PCa early detection is prostate-specific antigen (PSA) testing, which is still under debate regarding its risk benefits. Besides recommendations on the early PCa detection, daily practice on PSA testing varies in, for example, information communication and usage of the test. This pilot study assessed potential differences between general practitioners (GPs) and urologists in handling PSA testing and guidelines on early detection of PCa. Methods: 172 GPs belonging to the teaching network of the University of Oldenburg in Lower Saxony and Bremen and 128 practicing urologists were included in the online survey focusing on PSA testing. The questionnaire covered 43 questions on topics as the usage of the test, information communication, handling of test results and handling of/knowledge about national and international guidelines on PCa. Wether PSA testing is used in accordance with guidelines was also explored in four standardized case scenarios. Statistical analysis was done at a descriptive level. Results: In total, 65 doctors participated in the survey (response proportion: 21.7%, n=65; 27.9%, n=48 [GPs]; 13.2%, n=17 [urologists]). Results of 41 GPs and 14 urologists were analyzed. The PSA test was judged as useful by all urologists, while almost half of the GPs valued the test as ambivalent or not useful. Urologists showed a more proactive approach of informing men on PSA testing. Regarding guidelines and recommendations on PSA testing, GPs were less familiar with them compared to the urologists. Doctors of both specialties did not always treat men in consistence with the guidelines. This was partially in contradiction to their self-appraisal. Conclusion: This pilot study is highlighting differences in PSA testing practices between GPs and urologists in Germany. Urologists showed a more proactive approach. For further verification, we plan a more comprehensive study covering several German states.

Temporal trends and regional disparities in cancer screening utilization: an observational Swiss claims-based study

“…A high density of related specialist physicians had null or even a negative association with screening utilization in our study. This is in contrast to a German online survey where PSA testing was judged as useful by all urologists but only by half of the general practitioners, and where PSA testing practices varied between both clinician groups [ 50 ]. Higher PSA screening rates were also seen in regions where the primary care specialist was unlikely to be the predominant physician for ambulatory visits [ 22 ].…”

Differences in Prostate Cancer Incidence and Mortality in Lower Saxony (Germany) and Groningen Province (Netherlands): Potential Impact of Prostate-Specific Antigen Testing

“…The higher PCa incidence rates in Lower Saxony than in Groningen identified here could be partly explained by the more intensive PSA testing recommendations in the German S3 guidelines compared with the Dutch guidelines (24,26). This possibility is supported by the fact that all urologists surveyed in Lower Saxony claimed to have detailed knowledge of the S3 guidelines (33). The results of a survey conducted in the northeast of the Netherlands also support this possibility by stating that clinical PSA testing in primary care generally seems to be consistent with the relevant guideline for Dutch GPs that is restrictive to PSA testing (34,35).…”

General practitioners’ approaches to prostate-specific antigen testing in the north-east of the Netherlands

“…The reason for this remains unclear, as do the reports by some of our respondents that they adopt their own (unsuitable) criteria and PSA cut-off values for when not to refer a patient to a urologist. In Lower Saxony, Germany, evidence has also been published showing that GPs and urologists did not treat patients in accordance with established guidelines on prostate cancer [ 22 ]. A systematic review looking at the state of PSA testing policies worldwide revealed significant variation in follow-up policies after a normal or raised PSA level, and that this is often discordant with the available practice guidelines [ 33 ].…”

“…As the questionnaire in this project was conducted in the context of a binational project, a German version of the questionnaire was translated into Dutch. Formal back and forwards translations were performed by native speakers of both German and Dutch [ 22 ]. After translation, the questionnaire was adapted to the Dutch prostate cancer guidelines and the Dutch health care system.…”

“…Physicians should then individualize decisions according to these, also considering patient values, settings, comorbidities, general health, and other relevant characteristics. In terms of PSA testing, it has been shown that the personal beliefs and the specialization of the physician may also be relevant to the usage of PSA testing [21][22][23]. Variability in practice for PSA testing is not unusual among general practitioners (GPs), including those in the Netherlands.…”