Formative evaluation of the prostate cancer screening practices of African-American physicians

Background: Clinical guidelines for using the prostate-specific antigen (PSA) test as a population-based tool vary. This study qualitatively explores the prostate cancer screening practices of African-American primary care physicians. Methods: Eight telephone focus groups were conducted with 41 African-American primary care physicians from 22 states. Data were coded on five major topic areas relative to provider screening practices: use of serum PSA and digital rectal examination (DRE), counseling routine, factors influencing screening practices, familiarity with clinical guidelines, and use of educational materials Results: Almost all (95%) of the physicians routinely recommended and offered prostate cancer screening to their patients, which was universally defined as consisting of both a PSA test and DRE. Most physicians reported offering the PSA test to asymptomatic, non-African-American men beginning around age 50, but African-American men or men with a family history of prostate cancer were offered the PSA test 5-10 years earlier. Conclusions: The observed practice patterns for prostate cancer screening among African-American primary care physicians do not evenly reflect both sides of the PSA screening controversy. For most physicians, concerns about prostate cancer in their patients outweighed concerns about the potential limitations of screening and the untoward side effects of treatment. These physicians adopted a more proactive approach toward use of the PSA test in asymptomatic men irrespective of their race or ethnicity.