Exploring shared decision-making in prostate cancer screening within primary health care settings in Portugal: a cross-sectional study.

backgroundThis study aims to assess how Primary Care Physicians (PCPs) in Portugal currently approach opportunistic prostate cancer (PCa) screening using Prostate Specific Antigen (PSA) testing, and to explore variations in both screening and shared decision-making (SDM) practices.

methodsAn electronic survey was distributed in 25 Health Centers in Portugal between June 2024 and June 2025. The questionnaire assessed respondents' demographic and practice characteristics, PSA screening criteria and frequency, implementation of SDM, knowledge and use of decision aids, and urology referral patterns. Associations between provider characteristics and screening practices were analyzed using Pearson chi-square or Fisher's exact tests.

resultsA total of 107 PCPs participated in the study, the majority being female (81.3%) and under 40 years old (72.9%). Those with less than 10 years of experience were more likely to adjust PSA testing frequency based on initial PSA levels, especially for men aged 50-59 (p = 0.015) and 60-74 (p = 0.004). Routine screening of younger men or those over 75 was uncommon unless specific clinical factors were present. National guidelines were the primary influence on clinical practice (75.7%), particularly among less experienced physicians (p = 0.027). In terms of SDM, most PCPs explained PSA testing (80.4%), but only 64.5% consistently discussed its benefits and risks or explored patient preferences, with those in the South region of Portugal more likely to do so (p = 0.012 and p = 0.002 respectively) than those in the North/Centre. Decision aid awareness and use were low; only 6.5% reported having used them, while 72% were unfamiliar with these tools. Most referrals to urology were triggered by abnormal transrectal ultrasound findings (72%) rather than elevated PSA alone (16.8%). Full support for population-based PCa screening was limited (12.2%), and male physicians were significantly more likely to endorse it (p = 0.007).

conclusionsPCa screening practices among Portuguese PCPs remain a complex area of primary care, characterized by variability in clinical approaches, inconsistent guideline adherence, and limited application of SDM. Despite general awareness, notable gaps persist in the use of decision aids and evidence-based referral criteria. These results highlight the need for clearer national guidance and greater support for individualized, patient-centered screening strategies.

trial registrationnot applicable.