Study finds prostate cancer screening talks are rare

The prostate-specific antigen, or PSA, blood test can detect prostate cancer early and has been shown to reduce deaths from the disease. However, the test is not perfect. As men age, the prostate naturally enlarges and produces more PSA, which can raise blood test levels even when cancer is not present. Because the PSA test cannot determine why levels are elevated, some men without cancer may undergo unnecessary biopsies. At the same time, many prostate cancers grow slowly and may never cause symptoms or become life-threatening, raising concerns about overtreatment. These factors have shaped the ongoing discussion around prostate cancer screening.

Historically, those concerns led experts to question whether the benefits of screening outweighed the risks. But Shungu said the landscape has changed dramatically in recent years.

New tools such as prostate MRI can help doctors to determine which patients need additional testing, while many low-risk cancers can be safely monitored through active surveillance. Those advances, he said, have reduced some of the concerns that originally fueled resistance to widespread screening.

"We've moved away from the idea that everyone should automatically be screened or not be screened," he said. "The recommendation now is that patients and clinicians have a discussion and decide together what's right for that individual."

As screening and treatment options have become more sophisticated, Shungu said that conversations between patients and clinicians have become even more important.

Looking at what happens in practice

To determine whether those conversations were taking place, the researchers reviewed the medical records of 600 men ages 45 to 69 who received care at MUSC family medicine clinics between 2019 and 2020.

"Different guideline organizations recommend slightly different ages to start screening discussions, particularly for higher-risk groups such as Black men," Shungu said. "We wanted to be fairly broad in who we included so we could capture the population for whom these conversations should be taking place."

This study builds on Shungu's previous research by examining what happens during real-world clinical encounters. The researchers examined whether clinicians documented shared decision-making conversations about prostate cancer screening in patients’ medical records and whether those patients went on to receive PSA testing.

The results revealed a substantial gap between guideline recommendations and clinical practice. Overall, conversations about prostate cancer screening were uncommon, with only 6% of patients having a documented discussion. Documentation rates did not differ significantly by race, age, insurance status or family history of cancer.

One important caveat is that some discussions may have occurred without being documented in the medical record.

"With any chart review study, there's always the possibility that clinicians had the conversation but didn't document it," Shungu said. "Even with that limitation, though, the numbers were surprisingly low."

Conversations linked to higher screening rates

Although the conversations themselves were uncommon, their impact was striking.

Among men with documented shared decision-making discussions, nearly 72% went on to receive a screening PSA test. Among those without a documented conversation, only about 36% received screening.