How to Counsel Men About PSA Screening.

Prostate cancer is the most common nonskin cancer and causes about 27,000 deaths in U.S. men each year.1 However, the only U.S. randomized trial of prostate-specific antigen (PSA) screening did not find a mortality benefit after 13 years of follow-up.2 Even after results from a European trial found slightly lower prostate cancer– specific (but not all-cause) mortality in screened participants, the U.S. Preventive Services Task Force (USPSTF) concluded in 2012 that the harms of screening outweigh potential benefits in most men and recommended against PSA-based screening for prostate cancer.3 Since the USPSTF made this recommendation, PSA screening rates have decreased substantially.4,5 Some observers think this practice is consistent with current evidence.6 Others note that metastatic prostate cancer rates have declined since PSA screening became widespread,7 and warn that discontinuing screening may result in more men dying from potentially curable prostate cancers. Although the debate continues, guidelines from the American Urological Association, American Cancer Society, and American College of Physicians concur that physicians should discuss the benefits and harms of screening with men 55 to 69 years of age, practice shared decision making, and order PSA screening only if the patient expresses a clear preference to be screened.8-10 For family physicians to put this guidance into practice, they must elicit patients’ preferences and provide accurate, understandable information about the benefits and harms of PSA screening. Web-based and print decision aids can help patients make informed choices and improve their satisfaction with PSA screening decisions.11 These tools range from straightforward infographics (http://www.cancer.gov/types/prostate/ psa-infographic) to more time-consuming questionnaires (http://www.uofmhealth.org/health-library/ aa38144). Regardless of the decision aid used, physicians should provide men with quantitative information on the benefits and harms of screening, represented as numbers needed to screen to benefit or harm,12 or a projected outcomes table (Table 13,12). Compared with Editorials