{"id":21977,"date":"2026-06-02T14:46:59","date_gmt":"2026-06-02T18:46:59","guid":{"rendered":"https:\/\/www.med.unc.edu\/fammed\/?p=21977"},"modified":"2026-06-02T14:46:59","modified_gmt":"2026-06-02T18:46:59","slug":"unc-physician-experts-call-for-systems-based-approach-to-prostate-cancer-screening-decisions","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/fammed\/2026\/06\/02\/unc-physician-experts-call-for-systems-based-approach-to-prostate-cancer-screening-decisions\/","title":{"rendered":"UNC Physician Experts Call for Systems-Based Approach to Prostate Cancer Screening Decisions"},"content":{"rendered":"

\"\"CHAPEL HILL, N.C.<\/strong> – Prostate cancer screening is one of the most common decisions men face in primary care, yet many patients make that choice without fully understanding the potential benefits and harms. A new editorial by UNC physician experts argues that shared decision-making should no longer depend on individual clinician effort but instead be built into health care systems.<\/p>\n

Published in The Journal of Urology<\/em>, the editorial calls for health systems to take responsibility for ensuring that patients are meaningfully involved in decisions about prostate\u2011specific antigen (PSA) screening.<\/p>\n

\u201cMillions of men make decisions every year about prostate cancer screening without meaningful conversations about risks and benefits,\u201d said Adam Goldstein, MD, MPH, Elizabeth and Oscar Goodwin Distinguished Professor in the UNC Department of Family Medicine. \u201cThat is more than a gap in care; it is a system failure.\u201d<\/p>\n

Goldstein also serves as Director of Tobacco Intervention Programs at the UNC School of Medicine, where his work has focused on building health\u2011system approaches that reliably deliver evidence\u2011based tobacco treatment and prevention services. He says prostate cancer screening presents a similar challenge.<\/p>\n

A decision with real tradeoffs<\/strong><\/p>\n

PSA screening can reduce prostate cancer deaths for some men, but it also carries risks, including false\u2011positive results, unnecessary biopsies, and overtreatment. Because outcomes vary based on age, family history, race, and personal values, national guidelines recommend that screening decisions be made using shared decision making.<\/p>\n

Shared decision making involves clinicians and patients discussing both the benefits and potential harms associated with screening, along with the patient\u2019s individual risk and preferences. However, studies show that fewer than one in three men who receive PSA screening recall having those discussions.<\/p>\n

Impact on equity and trust<\/strong><\/p>\n

The editorial emphasizes that inconsistent shared decision making has important equity implications. Black men have significantly higher rates of prostate cancer and more than double the mortality compared with White men, yet they are less likely to report conversations about screening risks and benefits.<\/p>\n

\u201cWhen patients are not invited into decisions, inequities deepen and trust in the healthcare system can erode,\u201d Goldstein said. He noted that similar patterns have been well documented in tobacco treatment, where system\u2011level approaches have been essential to reducing disparities and improving outcomes.<\/p>\n

Moving beyond individual effort<\/strong><\/p>\n

Rather than framing shared decision making as something clinicians should do when time allows, the authors argue it should be treated as a high\u2011reliability process, similar to medication safety or surgical timeouts.<\/p>\n

\u201cWe have too often treated shared decision making around prostate cancer screening as something individual clinicians should do when they have time,\u201d Goldstein said. \u201cIn reality, it must be built into the system to work consistently.\u201d<\/p>\n

The editorial calls for practical, system\u2011level solutions, including automatically identifying eligible patients, embedding decision aids into electronic health records, using structured documentation, and monitoring whether shared decision making is delivered reliably.<\/p>\n

Shared commitment across specialties<\/strong><\/p>\n

Marc Bjurlin, DO, MSc, FACOS, associate professor of urology at the UNC School of Medicine and a urologic oncologist at UNC Lineberger Comprehensive Cancer Center, emphasized that shared decision making is essential given the balance of benefit and potential harm.<\/p>\n

\u201cProstate cancer screening involves real tradeoffs, which makes shared decision making essential, not optional,\u201d Bjurlin said.<\/p>\n

Bjurlin\u2019s clinical and research work has also focused on the role of smoking and other modifiable risk factors in urologic cancers, including prostate and bladder cancer. He notes that addressing cancer risk through prevention, screening, or treatment requires health systems that consistently support informed, patient\u2011centered decisions.<\/p>\n

Looking ahead<\/strong><\/p>\n

The authors conclude that improving prostate cancer screening is not about ordering more or fewer tests, but about ensuring patients are informed partners in the decision.<\/p>\n

\u201cShared decision making is how we navigate uncertainty in a way that is ethical, patient\u2011centered, and equitable,\u201d Goldstein said. \u201cHealth systems have a responsibility to make that happen.\u201d<\/p>\n

 <\/p>\n

Read the article, \u201cShared Decision Making for Prostate Cancer Screening is a System Responsibility,\u201d (paid) here<\/a><\/strong>.<\/p>\n","protected":false},"excerpt":{"rendered":"

CHAPEL HILL, N.C. – Prostate cancer screening is one of the most common decisions men face in primary care, yet many patients make that choice without fully understanding the potential benefits and harms. 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