Include prostate screening risks

Providers emphasized the benefits of testing in 71.4% of the discussions by the cons in only 32%.
Providers emphasized the benefits of testing in 71.4% of the discussions by the cons in only 32%.

Men should be made aware of the possible harms of prostate cancer screening as well as the benefits, but many don't appear to be getting that information from their clinician.

Given the uncertain benefit of screening and known treatment risks that can result (e.g., complications arising from early-stage cancer treatment), researchers looked at decision-making data from 375 men (Arch Intern Med. 2009;169:1611-1618).

Overall, 69.9% of the men had discussed screening with a health-care provider before making a testing decision, including 14.4% who did not undergo testing. Investigators found the fact that 30.1% of the men underwent prostate-specific antigen (PSA) testing without first discussing it with a provider “disconcerting” but consistent with other reports in the medical literature.

The men surveyed also reported that most providers (73.4%) recommended PSA testing and that providers emphasized the benefits of testing in 71.4% of the discussions but addressed the risks in just 32%. Only 54.8% of the men said they were asked for their screening preferences.

The researchers conclude that discussions about PSA testing did not meet criteria for shared decision-making and urge clinicians to employ decision aids and other strategies to ensure that the patient gets the information he needs and that his preferences and values are incorporated into the decision-making process.

In other men's health news, the American College of Physicians recently issued recommendations regarding the treatment of erectile dysfunction (Ann Intern Med. 2009;151:639-649). Clinicians are strongly advised to initiate therapy with an oral phosphodiesterase type 5 (PDE-5) inhibitor in men who seek treatment unless they are currently on nitrate therapy or have another contraindication to PDE-5 inhibitors.

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