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BOSTON -- Doctors who treat prostate cancer practice what they preach when it comes to PSA screening tests, according to a study reported here.

A survey of almost 900 urologists, radiation oncologists, and medical oncologists showed that 90% had undergone screening PSA tests, planned to do so in the future, or (in the case of female physicians) recommended PSA testing to first-degree male relatives.

The survey also showed that, in the subgroup of physicians who identified treatment preferences, they stuck with their own specialties as the preferred treatment modality, as reported at the American Urological Association annual meeting.

"The vast majority of physicians who treat genitourinary cancers choose PSA screening for themselves and immediate family members," said Christopher Wallis, MD, of the University of Toronto. "Physicians favor the treatment they themselves deliver, in keeping with a previously identified specialty bias."

In the U.S., controversy over PSA screening has centered on the U.S. Preventive Services Task Force recommendations, which focus on guidance to primary care physicians. Data on those physicians show they are much less likely to recommend PSA screening, Wallis acknowledged.

"The purpose of this survey was to determine what motivates the recommendations of specialists," he said. "You could say, in theory, that specialists may recommend screening to drive patients to them, so there is a financial motivation to recommend screening.

"That would be borne out in a recommendation of screening for other people, but you wouldn't undertake it yourself because you didn't think it was helpful, but you thought it was good for business. There would be a disconnect between what you recommend for your patients and what you were willing to do yourself. These data show that urologists and radiation oncologists fundamentally believe that PSA screening is a beneficial intervention and that the benefits likely outweigh the risks, because they are willing to undergo it."

Several studies have examined the relationship between physician recommendations to patients and the physicians' personal choices for testing and treatment for themselves. The studies showed that physicians to patients that in their own healthcare.

Most previous studies addressed the disconnect between physicians' recommendations and personal healthcare practices from the perspective of the overall population of physicians. However, at least two studies examined the issue more directly, asking specialists in and about their preferences if they had a disease they were accustomed to treating, the "physician surrogate method."

Wallis' group employed the physician surrogate method to examine the personal practices of prostate cancer specialists with respect to PSA screening. Did male specialists choose PSA screening for themselves and did female specialists recommend PSA screening for first-degree relatives? Secondarily, the investigators wanted to know the specialists' personal treatment preferences for prostate cancer.

After pilot testing, a survey was distributed electronically to the membership of professional organizations representing urologists, radiation oncologists, and medical oncologists in Canada, the U.S., Australia, New Zealand, and South America. The distribution resulted in 869 usable responses.

Male physicians accounted for 807 respondents, and most of the respondents were from Canada (n=413) or the U.S. (n=143). Urologists accounted for 83% of the respondents, radiation oncologists for 10%, and medical oncologists for 1%. The remaining survey participants listed a general specialty (such as internal medicine) or did not identify their specialty.

The results showed that 784 (90%) of the respondents supported PSA screening for patients. The endorsement remained consistent across the specialties represented in the survey:

• Urologists: 92%
• Radiation oncologists: 85%
• Medical oncologists: 89%
• Other: 81%

With respect to the respondents' personal practices and preferences, 61% of male respondents had undergone PSA testing and 82% planned to do so in the future. Among the female respondents, 69% recommended screening PSA tests to first-degree male relatives.

Among men, the apparent gap between endorsement and personal action reflected the subgroup of younger men not yet at the recommended age threshold for screening, said Wallis. A breakdown of data by age showed that 94% of screening-eligible men either had been screened or planned to do so in the future.

The results included 46 responses (30 men, 16 women) to questions about treatment decisions for prostate cancer. The responses showed that 20 of 31 urologists (64.5%) preferred radical prostatectomy, and five of six radiation oncologists preferred radiotherapy. Analysis of the small subset showed a significant correlation between specialty and treatment choice (P=0.001).

"This [correlation] has been previously described, but it's nice to validate it in this cohort and gives credence to our other findings," said Wallis. "If this is concordant with the literature, then perhaps people are responding in a way that is reliable for our other questions."

The study had several limitations, such as lack of information about the respondents, as the survey was submitted through the organizations rather than directly to respondents; reliance on self-reported information; and a predominance of urologists among responding physicians.

"It's nice to know that the doctors practice what they preach, with regard to PSA testing and treatment decisions," said Stacy Loeb, MD, of NYU-Langone Medical Center in New York City. "The data showed that doctors who would recommend surgery would choose it for themselves, and doctors who recommend radiation would choose it for themselves. It suggests they know they data and the benefits and risks, and they would choose to undergo the same treatments they are recommending for patients."

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