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BACKGROUND: Guidelines for Prostate-Specific Antigen (PSA) screening are controversial and variably applied. Current AUA guidelines do not recommend PSA screening in men less than 55 years old with an average risk of prostate cancer. Recent recommendations from the United States Preventative Services Task Force (USPSTF) discourage PSA screening entirely. Furthermore, most attention has been directed towards PSA screening of non-physicians. To our knowledge, personal PSA screening practices among urologists has not been reported. Our objective was to analyze self-PSA screening practices among urologists as well as
recommendations they would provide to friends and family regarding PSA screening.
METHODS: A questionnaire was created and sent to 387 urologists registered with the New England section of the AUA. The questionnaire covered age, ethnicity, and gender before splitting pathways based on gender. Men were surveyed regarding personal and familial prostate cancer history, PSA screening history, and recommendations they would provide to friends or family at average risk for prostate cancer. For women, the survey evaluated recommendations they would provide to friends or family at average risk for prostate cancer. Average risk of prostate cancer was defined as White race and no first-degree relatives with prostate cancer.
RESULTS: One hundred and three urologists responded to the survey. The respondents were 93% male and 92% White. Overall, 93% of males over the age of 50 and 100% over the age of 60 have had PSA testing. Twenty-eight percent of male respondents - of which 70% were of average risk - had their first PSA test prior to the age of 50, contrary to current and previous AUA guidelines. Furthermore, 91% of respondents would recommend screening to 50 year-old friends and family members at average prostate cancer risk, contrary to current AUA guidelines.
CONCLUSIONS: PSA screening guidelines are controversial and application remains variable. Our data indicate that personal PSA screening among urologists and their recommendations for screening of friends and family are more aggressive than current AUA PSA screening guidelines. These findings would argue against claims that aggressive screening simply serves to increase procedural volumes.