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Invited Commentary
October 14, 2013

Improving the Quality of Decision-Making Processes for Prostate Cancer Screening: Progress and Challenges

Author Affiliations
  • 1Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina, Chapel Hill
  • 2Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
  • 3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
JAMA Intern Med. 2013;173(18):1713-1714. doi:10.1001/jamainternmed.2013.6561

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.