Introduction

Prostate-specific antigen (PSA) based prostate cancer (PCa) screening and treatment choice for localized PCa remain highly controversial. The physician surrogate method seeks to identify acceptable healthcare interventions by ascertaining the interventions physicians select for themselves. We surveyed urologists, radiation oncologists, and medical oncologists with respect to their personal practices and recommendations to immediate family members regarding PSA screening and the treatment of localized PCa.

Methods

A hierarchical, contingent survey was developed by consensus among a team of urologists, radiation oncologists, and medical oncologists. After piloting, it was electronically circulated to eligible members of the Canadian Urological Association, Genitourinary Radiation Oncologists of Canada, Urologist, Medical Oncologist and Radiation Oncologist Members of the American Medical Association, Urological Society of Australia and New Zealand and Confederacion Americana de Urologia. We characterized physicians’ choices regarding PSA screening and PCa treatment. Among urologists and radiation oncologists, we assessed for correlation between specialty and treatment selection.

Results

Of 893 respondents, 869 provided consent and completed the survey. Their median age was 50 years (IQR 41-60 years) and most were male (n=807; 93%) and lived in Canada (n=413; 47%) or the United States (n=143; 16%). 719 (83%) were urologists, 89 (10%) radiation oncologists, 9 (1%) medical oncologists, 8 (1%) other specialties (e.g. internist) and 45 did not provide specialty information. Of 807 male respondents, 494 (61%) had personally undergone PSA screening and 662 (82%) planned to in the future. Of 62 female respondents, 43 (69%) had recommended PSA testing to immediate family members. In total, 784 of 869 respondents (90%) endorsed past or future screening for themselves or for relatives. 30 (4%) of men had been diagnosed with PCa personally and 16 (26%) of women had recommended PCa treatment to an immediate family member. After restricting to responses from urologists and radiation oncologists, there was a significant correlation between physician specialty and the treatment selected (Phi coefficient=0.61; p=0.001).

Conclusions

Physicians who routinely treat PCa are very likely to undertake PCa screening themselves or recommend it for their immediate family members. Among those diagnosed with prostate cancer, there is a significant correlation between specialty and treatment selection.

Funding

None