Konety Badrinath R, Sharp Victoria J, Verma Meenakshi, Williams Richard D
Department of Urology, University of Iowa, Iowa City, Iowa, USA.
Urology. 2006 Nov;68(5):1051-6. doi: 10.1016/j.urology.2006.06.011. Epub 2006 Nov 7.
To determine the practice preferences for prostate cancer screening and treatment in men 75 years of age or older among healthcare providers in Iowa.
Practice patterns were determined by an institutional review board-approved 15-item survey mailed to all 3105 Iowa healthcare providers who care for older men. A modified Dillman method was used for the survey. Actual prostate-specific antigen (PSA) testing practices derived from our institutional database were correlated with the survey data.
The survey yielded a response rate of 32% (997 respondents). Of the respondents, 96% of primary care physicians and 97% of urologists preferred to stop PSA-based prostate cancer screening by age 80. This was compatible with our institutional data that indicated a PSA testing rate of 5.2% in men 80 years or older. Most physicians used the digital rectal examination as the first test for screening and reported a lack of educational materials to provide to patients. Older physicians and family practitioners were more likely to continue prostate cancer screening beyond 75 years, and most consented to patient requests for screening.
The predilection for prostate cancer screening among healthcare providers declines with increasing patient age but persists for a small proportion of patients. The education of both patients and healthcare providers to more selectively screen men older than 75 years and the development of educational materials are needed. A consensus among healthcare providers would facilitate adoption of a tailored approach to managing prostate cancer in older men, thereby decreasing healthcare costs and morbidity while limiting the use of unnecessary therapy.
确定爱荷华州医疗服务提供者中75岁及以上男性前列腺癌筛查和治疗的实践偏好。
通过机构审查委员会批准的15项调查问卷来确定实践模式，该问卷邮寄给了爱荷华州所有3105名照顾老年男性的医疗服务提供者。调查采用了改良的迪尔曼方法。从我们的机构数据库中获取的实际前列腺特异性抗原（PSA）检测实践与调查数据相关联。
调查的回复率为32%（997名受访者）。在受访者中，96%的初级保健医生和97%的泌尿科医生倾向于在80岁时停止基于PSA的前列腺癌筛查。这与我们的机构数据相符，该数据表明80岁及以上男性的PSA检测率为5.2%。大多数医生将直肠指检作为筛查的首选检查，并表示缺乏可供患者使用的教育材料。年长的医生和家庭医生更有可能在75岁以后继续进行前列腺癌筛查，并且大多数同意患者的筛查请求。
医疗服务提供者对前列腺癌筛查的偏好随着患者年龄的增加而下降，但仍有一小部分患者持续进行筛查。需要对患者和医疗服务提供者进行教育，以便更有选择性地对75岁以上男性进行筛查，并开发教育材料。医疗服务提供者之间达成共识将有助于采用量身定制的方法来管理老年男性的前列腺癌，从而降低医疗成本和发病率，同时限制不必要治疗的使用。
