Prostate specific antigen screening for prostate cancer: Knowledge of, attitudes towards, and utilization among primary care physicians

Objective: Prostate specific antigen (PSA) screening for prostate cancer screening is not uniformly recommended by national organizations or primary care physicians (PCPs). Given this lack of consensus, we sought to identify patterns in physician knowledge of and attitudes towards PSA screening and to determine how these patterns along with patient and provider demographics influence PSA screening practices. Methods: A self-administered questionnaire, which assessed provider's knowledge of prostate cancer, confidence in his/her knowledge, and PSA screening practices, was mailed to PCPs at an academic medical center. Frequencies of responses were summarized and 3 outcome variables (knowledge, confidence, and propensity to screen) were derived. Association of covariates with the outcome variables was determined using multivariable logistic regression. Results: Eight-two (30.4%) physicians completed the survey; 98% identified African-American race as a prostate cancer risk factor, 42% identified digital rectal exam and PSA as the accepted screening method, and 59% underestimated the likelihood of prostate cancer in a man with a PSA level > 4 ng/ml; 19% were confident in their knowledge of prostate cancer; 86% screened fewer than 60% of their male patients over 50. A knowledge score above the median was not associated with a higher propensity to screen (r = 0.06, P = 0.61). Confidence in one's knowledge was correlated with ordering PSA testing (r = 0.33, P < 0.01). Physician (e.g., ethnicity) and patient (e.g., request for PSA testing) related factors, as well as practice guidelines, particularly those of the US Preventative Services Task Force, influenced providers' decision to offer PSA screening. Conclusions: Respondents correctly identified prostate cancer risk factors but were less knowledgeable about prostate cancer screening tests and overall prostate cancer risk. Most respondents were not confident in their knowledge and did not screen men over 50. Multiple patient- and provider-specific factors influence the decision to offer or not offer PSA screening.