ASCO GU 2018: Shared decision making for prostate cancer screening: Reality or farce?

San Francisco, CA ( Dr. Daniel Pucheril and colleagues presented their assessment of shared decision making for prostate cancer screening. One of the core tenants of major cancer society guidelines with regards to prostate cancer screening is that providers must discuss both the advantages and disadvantages of screening with eligible patients in a shared decision making process. Shared decision making for prostate cancer screening includes a bi-directional sharing of information followed by consensus regarding the patient’s healthcare preferences. The objective of this study was to determine contemporary trends of shared decision making with regards to prostate cancer screening.

For this study, the authors abstracted data from the 2012-2016 Behavioral Risk Factor Surveillance System. Consistent with the AUA guidelines for prostate cancer screening [1], this included men 55-69, without a personal history of prostate cancer, and having answered all questions within the prostate cancer screening module. The authors deemed prostate cancer screening to have occurred if a man had a PSA test within the last two years for reasons other than "a prostate problem” or “prostate cancer”. Shared decision making occurred if the respondent was informed about both advantages and disadvantages of prostate cancer screening by a health professional. Separate multivariable logistic regression models were built to identify independent predictors of both receipt of PSA screening and shared decision making.

A weighted estimate of 56.7 million men (n = 138,492) met inclusion criteria, among which reported rates of prostate cancer screening decreased each year of the study (56.7% in 2012 to 52.6% in 2014 to 49.1% in 2016, p < 0001). However, there were no significant changes in rates of shared decision making (p = 0.82), in that for all three years, less than one-third of respondents reported shared decision making. After controlling for known confounders, the authors found that possession of a personal physician (OR 2.24, 95%CI 2.02-2.48), receipt of information regarding the advantages of prostate cancer screening (OR 3.93, 95%CI 3.63-4.26), and receiving a physician recommendation to undergo prostate cancer screening (OR 7.78, 95%CI 7.25-8.35) were most strongly associated with odds of receiving prostate cancer screening. Odds of participation in shared decision making were strongest amongst black respondents (OR2.09 95%CI 1.92-2.28) and those who received a physician recommendation to undergo prostate cancer screening (OR 4.64, 95%CI 4.32-4.99).

Dr. Pucheril concluded that despite recommendations that physicians engage patients in a shared decision making process with their patients, less than a third of patients are advised of both the advantages and disadvantages of prostate cancer. Considering the current landscape of criticism against prostate cancer screening given recent USPSTF reports, a renewed effort towards shared decision making is needed.

1. Carter HB, Albertsen PC, Barry MJ et al: Early detection of prostate cancer: AUA Guideline. J Urol 2013; 190: 419.

Presnted by: Daniel Pucheril, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Co-Authors: Sean A. Fletcher, Dimitar V. Zlatev, Matthew Mossanen, Matthew D. Ingham, Steven Lee Chang, Adam S. Kibel, Quoc-Dien Trinh

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA