Practice patterns in screening and managementof prostate cancer in elderly men

Objectives. To determine the practice preferences for prostate cancer screening and treatment in men 75 years of age or older among healthcare providers in Iowa. Methods. 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. Results. 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. Conclusions. 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.