The decision-making process in prostate cancer screening in primary care with a prostate-specific antigen: A systematic review

Routine use of prostate-specific antigen (PSA) tests for early detection of prostate cancer remains highly controversial, particularly for older patients. It is thus paramount to examine the factors that influence the decision-making process in prostate cancer screening in primary care (PC). A systematic review was conducted, searching eight databases for articles published - in English, German, French or Dutch - or in press between January 2000 and February 2011 on studies on the self-reported practices and attitudes of primary care physicians (PCPs) with regard to the use of PSA tests as well as older patients' points of view regarding PSA testing. Study selections, data extraction and assessment of the quality of the studies were conducted independently by two reviewers. A taxonomy of factors influencing the decision-making process was developed to support data extraction. The analysis involved 20 studies conducted in North America and Europe. Screening with PSA represents a routine practice in PC, even for the most elderly patients. The primary drivers of the decision-making process, as acknowledged by both PCPs and patients, are interactions between patients and PCPs and patient characteristics (e.g. high risk, older age). Other factors are related to the PCP (characteristics, working environment, perceived responsibility, knowledge, perception of PSA test) and the patient (awareness). Even if guidelines are precautious about screening for prostate cancer, using a PSA test in PC is routine practice in a variety of countries. This review has identified factors influencing prostate cancer screening for older adults. The results suggest that multi-component system changes at the physician and patient levels are needed in order to optimize prostate cancer screening practices in PC, particularly for older men who will not benefit from it. (C) 2011 Elsevier Ltd. All rights reserved.