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The Importance of Shared Decision-making in PSA Screening

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Anthony Raphael
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The Importance of Shared Decision-making in PSA Screening

The Importance of Shared Decision-making in PSA Screening

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Shared decision-making (SDM) is a vital aspect of clinical practice in which patients actively participate in decisions that affect their health. This collaborative approach is particularly important for preference-sensitive decisions, such as prostate-specific antigen (PSA) screening for prostate cancer. Despite the clear evidence supporting the benefits of SDM for PSA screening, its implementation in clinical settings remains a challenge. The use of decision aids and open conversations between patients and physicians can facilitate SDM. However, these aids are rarely used in clinical practice, leading to a low prevalence of SDM in clinical settings for PSA screening decisions.

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PSA Screening and Prostate Cancer

A recent study evaluated the association between county-level PSA screening rates and the incidence of metastatic prostate cancer, as well as prostate cancer mortality in the USA. The study found that higher PSA screening rates were associated with a lower incidence of regional distant prostate cancer and lower prostate cancer mortality. The findings suggest that a 10% higher county-level probability of PSA screening was associated with a 14% lower incidence of regional distant prostate cancer and a 10% lower prostate cancer mortality. This study underscores the potential benefits of PSA screening in reducing the risk and severity of prostate cancer.

Prostate Cancer Screening Guidelines

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Prostate cancer screening guidelines recommend that men of average risk should be offered the option for prostate cancer screening beginning at age 50, and PSA tests may be used as a screening test for prostate cancer. Spectrum Health, for instance, has adopted new guidelines for screening men for the possibility of prostate cancer in response to an increase in the number of prostate cancer patients being diagnosed in advanced stages. The evidence is substantial that delaying these screenings carries a real risk to patients. In most cases, men should continue PSA screening until the age of 70.

Importance of Shared Decision-making in PSA Screening

The benefits and risks of PSA screening underscore the importance of shared decision-making in clinical practice. Patients and healthcare providers need to work together to make informed decisions about PSA screening, taking into account individual preferences, values, and the potential benefits and harms of screening. A study on testosterone replacement therapy in men with hypogonadism found that the PSA concentrations increased more in testosterone-treated men than in placebo-treated men. These findings may facilitate a more informed appraisal of the potential risks of PSA screening.

Facilitating Shared Decision-making

Despite the clear benefits of SDM, it remains underutilized in clinical practice. To overcome this challenge, patients and healthcare providers need access to tools and resources that facilitate shared decision-making. Such resources can provide valuable information on the potential benefits and risks of PSA screening, helping patients and physicians make informed decisions. The adoption of shared decision-making in clinical practice can significantly improve patient outcomes and ensure that patients are actively involved in decisions that affect their health.

Prostate Cancer Prostate-Specific Antigen
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