title: Prostate cancer screening in Primary Health Care: the current state of affairs.
abstract: This study aims to examine the current practice of General practitioners (GPs)/primary care physicians in opportunistic screening for prostate cancer (PC) by digital rectal examination(DRE) and Prostate Specific Antigen(PSA) testing and identify any difference in screening practice. Printed copies and/or electronic versions of a survey was distributed amongst 438 GPs throughout Australia in 2012. Statistical analyses (Wilcoxon rank-sum test, Fisher's exact test or Pearson chi-square test)were performed by outcomes and GP characteristics.There were a total of 149 responses received (34%), with similar gender distribution in rural and metropolitan settings. 74% GPs believed PSA testing was at least 'somewhat effective' in reducing PC mortality with annual PSA screening being conducted by more GPs in the metropolitan setting compared to the rural GPs (35% vs 18.4%), while 25% of rural GPs would not advocate routine PSA screening. When examining the concordance between DRE and PSA testing by gender of GP, the male GPs reported performing PSA testing more frequently than DRE in patients between ages 40 to 69 (p = 0.011). Urology Society guidelines (77.2%) and College of GPs (73.2%) recommendations for PC screening were thought to be at least 'somewhat useful'. Although reference ranges for PSA tests were felt to be useful, the majority (65.8%) found it easier to refer to an urologist due to the disagreements in guidelines. In conclusion, the current guidelines for PSA screening appear to cause more confusion due to their conflicting advice, leaving GPs to formulate their own practice methods, calling for an urgent need for uniform collaborative guidelines.
authors.affiliation: Department of Urology, Monash Medical Centre, 823-865 Centre Road, Bentleigh, Victoria 3165 Australia.
authors.forename: Weranja Kb
authors.initials: WK
authors.lastname: Ranasinghe
authors.affiliation: Yale University; Department of Urology; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut USA ; University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, Ohio USA.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Papa
authors.affiliation: Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: Shomik
authors.initials: S
authors.lastname: Sengupta
authors.affiliation: Department of Urology, Monash Medical Centre, 823-865 Centre Road, Bentleigh, Victoria 3165 Australia ; Department of Surgery, Monash University, Melbourne, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Frydenberg
authors.affiliation: Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: Damien
authors.initials: D
authors.lastname: Bolton
authors.affiliation: University of Newcastle, Newcastle, Australia.
authors.forename: Dimity
authors.initials: D
authors.lastname: Pond
authors.affiliation: National Institute of Integrative Medicine, Melbourne, Australia.
authors.forename: Karin
authors.initials: K
authors.lastname: Ried
authors.affiliation: University of New South Wales, NSW (on behalf of PHReNet-GP, a Practice Based Research Network, University of New South Wales), Paddington, Australia.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Marshall
authors.affiliation: University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: Raj
authors.initials: R
authors.lastname: Persad
authors.affiliation: University of Melbourne, Dept of Surgery, Olivia Newton-John Cancer Research Institute, Austin Hospital and Peter MacCallum Cancer Centre, Dept of Surgical Oncology, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lawrentschuk