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General Practitioners attitudes and practices towards PSA screening in asymptomatic men

No. 118. General Practitioners attitudes and practices towards PSA screening in asymptomatic men. Van Rij S*^, Dowell T # , Nacey J^ * Wellington Hospital , # Otago University Department of General practice, ^Otago University Department of Surgery. Introduction

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General Practitioners attitudes and practices towards PSA screening in asymptomatic men

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  1. No. 118 General Practitioners attitudes and practices towards PSA screening in asymptomatic men Van Rij S*^, Dowell T#, Nacey J^ * Wellington Hospital , # Otago University Department of General practice, ^Otago University Department of Surgery • Introduction • PSA screening of asymptomatic men remains a controversial topic for busy primary care doctors (GPs). • Recent position papers on prostate cancer screening have advocated in certain circumstances for PSA testing in younger age groups then was previously stated.1 • The most recent published data on Australian population PSA testing percentages was over 13 years ago. 2,3 Since then there has been a number of key trials which have addressed the benefits of PSA screening.4 • Results • 334,100 PSA tests were performed by NZ GPs during 2011 . • Of the 931,923 males >40y, 267,037 had a PSA test (28.3%) • Fig 1 breaks down this percentage in to age bands highlighting the lower percentage in the younger age groups and a peak in the 65-75 age groups. • On average a GP will refer 75 patients for a PSA test per year. • There is marked variation in PSA testing between GPs based on geographical location, years in practice and decile rating of the area they practice in. • Of the 1000 surveys sent 280 GPs responded: • 60% of the respondents would initiate discussion on PSA testing with patients under the age of 60. • 18% of respondents would not initiate discussion at any age in an asymptomatic man. • 70% of GPs were influenced in their screening attitudes by the potential harm and over treatment that further testing and therapy could cause. • 53% of GPs felt there was only weak evidence showing improvement in overall survival with PSA screening. • Aim • Define what current GP’s attitudes and practises are around the use of PSA as a screening tool • Accurately define the percentage of eligible men who are having PSA tests and compare this with GP’s responses. • Methods • A questionnaire was created which included demographic data, case vignettes and current PSA practice questions. After a pilot trial it was mailed to 1000 randomly selected GPs in New Zealand • A sample size of 641 was calculated to reflect within a 3.5% confidence interval the actual response of all GPs in New Zealand with 95% confidence level. • A non-identifiable prospective audit of all New Zealand GP’s laboratory testing patterns was used to access all PSA tests performed from the year 2011. In particular looking at the age range of the patients tested, and the frequency at which patients were tested in that calendar year. These results were stratified by GP characteristics to assess for variability in practice. • This study is the first in combining both a questionnaire and actual PSA testing to show clearly the actual current practices of PSA testing by New Zealand GP’s. • Conclusions • 1/5 of all males in New Zealand 40-60y have had a PSA test in the last year • Independent of a man’s risk factors his GP will have a large bearing on whether or not he has a PSA test. • Despite increasing evidence for PSA screening in younger men reducing cancer mortality4, most men in our community do not have a PSA test and most GP’s feel there is weak evidence for PSA screening. • References • 1. Urological Society of Australia and New Zealand PSA Testing Policy 2009 • 2. PA Shaw, R Etzioni, SB Zeliadt An ecologic study of prostate-specific antigen screening and prostate cancer mortality in nine geographic areas of the United States.Am J Epidemiol. 2004 Dec • 3. David P Smith and Bruce K Armstrong. Prostate-specific antigen testing in Australia and association with prostate cancer incidence in New South Wales. Med J Aust 1998; 169 (1): 17-20. • 4. Hugosson, J., Carlsson, S., Aus, G., Bergdahl, S., Khatami, A., Lodding, P., et al. Mortality results from the Göteborg randomised population-based prostate-cancer screening trial. Jul 2010 The Lancet Oncology, Volume 11, Issue 8, Pages 725 - 732 Acknowledgements Wellington Hospital Urology Department BPACNZ – Better medicine Poster presentation sponsor

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