Guidelines recommend that patients be informed about potential benefits and harms from prostate cancer screening and that screening decisions involve a discussion between patients and their physicians.1,2 Despite this consensus, achieving high-quality decision-making processes in practice is difficult. Clinicians function in a time-constrained environment and know that ordering a prostate-specific antigen (PSA) blood test is simple, whereas ensuring that patients fully understand the potential ramifications of entering a screening program is far more difficult and time-consuming. Explaining such concepts as biopsy threshold, false-positive results, overdiagnosis, and uncertainty about magnitude of benefit is challenging and cannot be done quickly.
Reuland DS, Pignone M. Improving the Quality of Decision-Making Processes for Prostate Cancer ScreeningProgress and Challenges. JAMA Intern Med. 2013;173(18):1713–1714. doi:10.1001/jamainternmed.2013.6561