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Men's Health: Prostate test misuse increases among older male doctors

Researcher suggests physician-patient empathy may lead to overly aggressive tumour screening

Whether a man gets appropriately tested for prostate cancer may have something to do with the sex and age of his doctor.

When American researchers reviewed cases of prostate cancer testing from 1997 to 2004, they found that inappropriate ordering of tests increased with age for male health providers, but decreased with age for female health providers.

The test measures the amount of prostate-specific antigen (PSA) in the blood. This protein is produced in the prostate, and high levels may indicate cancer. The researchers defined “inappropriate” as a PSA test done in men older than 75 or younger than 40 who did not have any prostate-related symptoms.

The researchers suggest that as male doctors age, they increasingly empathize with their older male patients over prostate cancer concerns. As a result, “prostatempathy” may then lead to more aggressive screenings in this group.

“Many people think (PSA) is just a benign blood test, so what’s the big deal? But actually there’s quite a bit of data to suggest otherwise,” says Dr. B. Price Kerfoot, the lead author of the study and an assistant professor of surgery at Harvard Medical School in Boston. “In elderly gentlemen, where ultimately there is an abnormal test, they’re at higher risk in terms of complications for many sorts of therapeutic or diagnostic procedures that result.”

Additionally, Kerfoot says many of the prostate tumours found in these elderly men would not be fatal. “And so running the risk of incontinence and erectile dysfunction resulting from treatments for this cancer may be unnecessary.”

Kerfoot and his team studied more than 180,000 men and 4,800 health-care providers, including doctors, nurses and physician assistants. Sixteen per cent of the more than 230,000 PSA tests ordered were considered inappropriate. Inappropriate testing was more common among urologists, male health-care providers and providers who ordered the test more often. Nurses and physician assistants were 19 per cent less likely to order an inappropriate test than doctors.

At ages 46 to 50 years, the male health-care providers were nine per cent more likely than female practitioners to test inappropriately. This increased to 51 per cent at ages 51 to 55 years and 95 per cent at ages older than 55 years.