Prostatic cancer screening: knowledge, attitudes and practices of Gauteng family practitioners

Abstract

Background: Despite the multitude of studies that have been carried out, controversy still exists as to the benefits of routine screening for prostate cancer. How often, and with what criteria, prostate cancer screening tests are conducted by family practitioners in South Africa, is unknown.

Objectives: To establish the knowledge, attitudes and practices of Gauteng Family Practitioners, ith regards to screening for prostate cancer; to determine if there are racial differences in screening practices in South Africa; and to determine whether uniform guidelines for screening are needed by family practitioners.

Materials and Methods: Four hundred randomly selected family practitioners in Gauteng were chosen and asked to respond to a postal survey comprising 24 questions. A response rate of 23% (i.e. 88 completed questionnaires) was received.

Data Extraction and Results: Whilst 87.4% of respondents felt that the Digital Rectal Examination (DFIE) was effective in prostate cancer screening, a slightly lower proportion (75.6%) actually used the ORE in screening. Older doctors, i.e. >46 years old, use the ORE more than younger doctors for screening. The DRE alone was responsible for a pick-up of 114 asymptomatic cases of prostate cancer in the study sample in one year, and 315 patients in five years.

There was a high congruence between the number of patients that felt the prostate specific antigen (PSA) was an effective screening test (89.5%), and the number of doctors that actually used the PSA (84.5%).

The majority of doctors (88.6%) do not screen with the Transrectal Ultrasound (TRUS).

Most Doctors (83.0%) preferred doctor-initiated (as opposed to patient-initiated) screening.

Only 4 (10%) out of 42 respondents who felt they had received adequate knowledge about prostate cancer screening, obtained their knowledge as undergraduates. An overwhelming 96.5% of doctors felt that screening was the sole responsibility of the family practitioner, not specialist.

It was felt by the respondents that more Whites than Blacks (Africans, Indians, Coloureds) are screened for prostate cancer in South Africa. In addition, they felt that this may be due to the affordability of the tests, and greater accessibility to private, rather than public (clinic) medical facilities by White patients.

One-third of doctors prefer to screen annually from age 40, whilst more than 60% of doctors would prefer to screen annually from age 50. At age 70 onwards, equal numbers of doctors prefer to screen 6 monthly and annually.

The majority of doctors (97.7%) felt that there was a need for uniform guidelines for prostate cancer screening by South African family practitioners.

Conclusion: Despite the global controversy surrounding prostate cancer screening, Gauteng family practitioners use the DRE and PSA extensively to screen for prostate cancer. Racial differences to screening do exist, with screening taking place predominantly amongst Whites in private family practice, rather than in Blacks in state hospital (clinic) practice. Uniform guidelines to screening are eagerly awaited by South African family practitioners.

It is recommended that further research be done to establish what proportion of Blacks to Whites are screened for prostate cancer in South Africa, and whether screening influences the pick-up rates for cancer of the prostate, as this study has suggested.