From Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA (JL, TBR); DB Consulting Group INC, Silver spring, MD (HD); Division of Cancer Prevention, National Cancer Institute, Bethesda, (IM); Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, (SK, PMM).
J Am Board Fam Med. 2018 Jul-Aug;31(4):658-662. doi: 10.3122/jabfm.2018.04.170448.
Despite recommendations against prostate cancer screening with prostate-specific antigen (PSA) tests, about one-fourth of men age ≥40 years received PSA tests in 2015. This study aimed to answer 3 questions for men who had a PSA test in the past year: (1) What percentage of these men received the test first suggested by physicians? (2) What factors were associated with physician-initiated PSA testing (PIPT) versus patient/someone else-initiated testing? (3) What percentage of patients ever had shared decision-making when tests were initiated by physicians?
We analyzed the 2000 and 2015 National Health Interview Survey data. We calculated age-standardized prevalence of PIPT for both years. For 2015, we used logistic regression to calculate adjusted prevalence ratios for PIPT. We also calculated the prevalence of ever discussing both advantages and disadvantages.
The age-standardized prevalence of PIPT was significantly higher in 2015 (84.9%) than in 2000 (72.3%). In 2015, nearly 90% of PSA screenings for men aged ≥70 years were suggested by physicians. PIPT was positively associated with 2 or more comorbid conditions and number of patient visits to the doctor. Less than one-third of men reported they had ever participated in a discussion of advantages and disadvantages of PSA testing.
The majority of men who had PSA testing in the past year reported that their physicians were the first to suggest testing, including men aged ≥70 years. Our study also points to the challenges and needs in conducting shared decision-making before PSA testing in clinical practice.
尽管有建议反对使用前列腺特异性抗原（PSA）检测进行前列腺癌筛查，但在 2015 年，仍有约四分之一的 40 岁以上男性接受了 PSA 检测。本研究旨在回答过去一年接受过 PSA 检测的男性的 3 个问题：（1）这些男性中有多少人接受了医生首次建议的检测？（2）哪些因素与医生发起的 PSA 检测（PIPT）与患者/他人发起的检测相关？（3）当医生发起检测时，有多少患者曾经进行过共同决策？
我们分析了 2000 年和 2015 年全国健康访谈调查数据。我们计算了这两年 PIPT 的年龄标准化患病率。对于 2015 年，我们使用逻辑回归计算了 PIPT 的调整后患病率比。我们还计算了讨论检测的优缺点的比例。
PIPT 的年龄标准化患病率在 2015 年（84.9%）显著高于 2000 年（72.3%）。在 2015 年，近 90%的 70 岁以上男性的 PSA 筛查是由医生建议的。PIPT 与 2 种或更多合并症以及患者就诊次数呈正相关。不到三分之一的男性报告说他们曾经参与过 PSA 检测的优缺点讨论。
过去一年接受过 PSA 检测的男性中，大多数报告说他们的医生是第一个建议检测的人，包括 70 岁以上的男性。我们的研究还指出了在临床实践中进行 PSA 检测前共同决策的挑战和需求。
