gms | German Medical Science

Background and current state of (inter)national research: Prostate cancer (PCa) has the second highest cancer incidence in men worldwide. Due to overdiagnosis and overtreatment, early detection of PCa by prostate-specific antigen (PSA) testing is still under debate, leading to different guidelines on PCa. In Germany, no reliable secondary data on the usage of PSA testing are available.

Research questions and objectives: Are there differences in clinical practice of PSA testing between urologists and general practitioners (GPs) in Germany and is the clinical practice in accordance with the respective recommendations on PSA testing? This study aimed to assess attitudes and approaches of urologists and GPs toward PCa early detection by PSA testing in Germany.

Methods or hypothesis: A questionnaire was sent by email to all urologists being members of the Professional Association of German Urologists (Berufsverband der Deutschen Urologen) or the German Urological Society (Deutsche Gesellschaft für Urologie). The version for GPs was sent to the available email addresses of the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung) Lower Saxony. Besides demographic data and practice characteristics, the online questionnaires covered questions relating to attitudes, clinical practice, and adherence to recommendations with respect to PSA testing. Statistical analysis was done at a descriptive level.

Results: 432 out of 6,568 urologists (6.6%) participated in the survey and 98 out of 1,579 GPs (6.2%). Urologists and GPs differ in their attitudes and approaches toward PSA testing. Almost all urologists (97.6%, n=375) judge the test as “very useful” or “useful”, against 60.3% (n=50) of the GPs. About three quarters of the urologists (72.4%, n=278) view the PCa mortality reduction by PSA testing as proven, against one quarter (24.1%, n=20) of the GPs. The percentage of men aged 45 years or older receiving (at least) one PSA test is lower among GPs than among urologists (categories “almost all” and “about three quarters” in urologists: 63.8%, n=243; GPs: 21.6%, n=19).

Discussion: Urologists are more convinced about the PSA test compared to the GPs. Accordingly, PSA testing is used more often in the urological setting where a preselected patient population must be considered. In accordance to the different guidelines, GPs show a more reserved approach toward PSA testing.

Practical implications: Instead of different attitudes and recommendations on PSA testing, the exchange between specialist groups should be improved to achieve a consistent approach on PSA testing. The common development of information material could be helpful to make an evidence-based informed decision-making available for patients.