Factors influencing primary care physicians' decision to order prostate-specific antigen (PSA) test for men without prostate cancer.

ABSTRACT

BACKGROUND: Despite extensive ongoing clinical trials investigating appropriateness of prostate-specific antigen (PSA)-screening, the benefit of PSA-based screening for prostate cancer remains controversial due to the lack of clear evidence for effectiveness of population-based PSA-screening. Notwithstanding, the need to identify the determinants behind PSA-testing decisions, the number of studies that have examined factors affecting the physicians' decision as to whether PSA-testing should be ordered are few. The aim of the current study was to investigate how physician- and patient-related factors influence Swedish primary care physicians' decision to order a PSA test for men harboring no symptoms of prostate cancer within different age groups. METHODS: A total of 305 physicians filled out the study questionnaire containing items about physicians' attitudes towards PSA-testing and the probability of screening men within different age groups. RESULTS: The majority of physicians reported positive attitude towards PSA-testing. However, the likelihood of offering PSA-testing to young men was low, but increased with age. Physicians' opinion about PSA-test as a sufficient screening tool was the only variable affecting physicians' decision of ordering PSA-test regardless of patient age. The level of the patients' worry, and patients request were the most influential factors in age groups between 40 and 70 years old. Patients' physical symptoms were an indicator in age groups above 60 years. CONCLUSION: The decision to screen for prostate cancer using the PSA-test is influenced by several factors and not only those having direct clinical indication for prostate disease. This may lead to unnecessary treatment of some patients.