ASCO GU 2018: TPS 159 -What Fixes PSA Screening Guidelines Gone Wrong?

San Francisco, CA ( The authors report their study examining patient factors that alter correct recommendation and physician (MD) advice in real-time cancer screening discussions in a 2x2 cluster-randomized trial of MD educational supports.


The authors enrolled an age-(30-89 years) and sex-stratified sample of 18 patients (PTs) who underwent a physical examination at 2 urban hospitals by 12 primary care MDs. Screening guideline formatting (color-coding [CC]) and academic detailing (AD) were randomly assigned to MDs. Immediate post-encounter surveys recorded PT and MD recall of screening discussions. The authors defined correct recommendations as those going against screening for men older than 75 yrs, or younger (African American [AA] < 40 or non-AA < 50). For other men, either recommendation was considered correct. MD-reported serious comorbidity or PT choice against screening were also valid reasons against screening.


Of the first 174 patients seen by the MDs, 92 were male. They were racially diverse (69% white) and highly educated (87% attended and 61% graduated college). Using the parameters of age and race alone, 49% of men should not have been screened. However, this increased to 65% by adding comorbidity issues (1%) and PT choice (15%). By these criteria, MDs advised correctly in 91% of encounters. In univariate analysis, CC, PT education, shared decision making and age tended to increase correct recommendations.


In a highly educated, racially diverse patient population, including comorbidity factors and PT choice, increased the correct recommendation rate against screening in up to 16% more men. An educational support (CC) tended to increase the rate of correct recommendation. Clinical trial information: NCT02430948

Presented by: James Austin Talcott, Strang Cancer Prevention Institute, New York, NY

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA

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