Table 2.

Analysis of the main results obtained from the 14 studies included in the review according to the following categories: knowledge, beliefs and practice.

Author, year	Results
	Knowledge	Beliefs	Practice
GPs and other primary care professionals
Elstad, 2015 (21)		Benefits and risks Clinicians listed more harms than benefits of PSA testing. Benefits most frequently mentioned: Early detection and treatment: 72% Psychological effects (e.g., peace of mind): 37% Harms most frequently mentioned: Unnecessary treatment: 56% Psychological effects (e.g., anxiety): 53% Follow-up: 47%
Malik, 2016 (22)	Risk factors/characteristics of the test 56-64% overestimated the positive predictive value of PSA. Risk factors: 82.7% knew that having a relative with PCa and 97.4% that being >50 years old was a risk of PCa. 31.1% knew that having a first-degree relative with breast cancer increased the risk.	Usefulness of the test 51.5% believed that healthy men aged 50 years should be tested for PSA annually or less. 22.4% thought that a PSA test should be performed only when a man with risk factors develops lower urinary tract symptoms. 89.8% considered undergoing a PSA test themselves.	Use of PSA test in practice 49.5% usually screened asymptomatic patients and 94.9% used PSA for screening. 76% informed patients that their PSA was being checked. SDM 61.2% discussed the implication of an abnormal result. 20.4% discussed treatment for PCa before PSA testing.
Miller, 2016 (23)	Guidelines 30% were very familiar with the USPSTF guidelines (90% from somewhat to very familiar).	Benefits and risks 71% agreed that PSA testing may impart more harm than benefit to patient. Usefulness of the test 22% were concerned that not recommending PSA screening could lead to future litigation.	SDM 24% felt very comfortable discussing the risks and benefits with patients. 75% claimed to have changed their PSA screening routine based on the guidelines. 59% engaged patients in a shared decision making. 64% support patients having a PSA test if they had weighed the benefits and risks.
Panach-Navarrete, 2016 (24)	Risk factors/characteristics of the test 83.5% claimed to have sufficient knowledge about PSA characteristics.	Usefulness of the test 64.1% questioned the true usefulness of PSA test. 29.1% believed PSA test is not very useful and 66% quite useful in diagnosing PCa.	Use of PSA test in practice 53.4% would not order their first PSA until their 50s, and up to 49% order their first PSA until their 80s. 53.9% would order a PSA per year in a 65-year-old man with no treatment and with a last PSA test of 3 ng/mL one year ago.
Hall, 2017 (25)		Usefulness of the test 74% felt that men with risk factors should be tested annually for PSA and 37% felt it should be done in patients >50 years even if they were asymptomatic. 40% agreed that the test has adequate characteristics to be considered a screening test. 75% did not agree with the age range at which the test should be done.	Use of PSA test in practice 60% only recommended the test considering individual risk, 25% routinely did it, and 14% did not offer it. The recommendation of the test was related to years of practice, patient request and belief in the efficacy of the test. GPs had greater odds (adjusted OR = 1.54, 95%CI 1.15, 2.07) of considering patient request for the PSA test than internal medicine providers.
Giménez, 2018 (26)	Guidelines The professionals’ knowledge of the clinical practice guidelines did not score 5 points on a scale of 1 to 10. Laboratory professionals gave the highest score to the European Guideline on Tumour Markers (4.9 ± 2.8 points). GPs mostly followed (3.6 ± 2.7 points), the recommendations of the Spanish Society of Family and Community Medicine.	Usefulness of the test GPs (5 ± 2.4 points) and laboratory clinicians (5.7 ± 2.4 points) showed uncertainty when ordering PSA as a screening test. The main concerns were delayed diagnosis of PCa (GPs: 5.7 ± 2.6 points and laboratory clinicians 6.5 ± 2.3 points) and overdiagnosis and overtreatment of PCa (GPs: 5.8 ± 2.5 points and laboratory clinicians 7.3 ± 2.1 points).	Use of PSA test in practice GPs (8.9 ± 1.7 points) and laboratory clinicians (8.3 ± 2 points) showed interest in assessing the prostate clinic before requesting PSA test. GPs explained the consequences about a high PSA test (8.3 ± 2.0 points); they thought that the most suitable age range for PSA screening was 60 years and older (6.4 ± 2.8 points) and the most appropriate time interval for requesting a new PSA test was annually (6.6 ± 2.9 points). Laboratory clinicians showed concerns about false-positive PSA in cancer screening (6.7 ± 2.2 points). Laboratory clinicians (6 ± 2.1 points) showed more interest in asking a PSA test as opportunistic screening than GPs (4.9 ± 2.9 points) and as populational screening (5.5 ± 1.5) points vs. (3.3 ± 2.5 points).
Nassir, 2019 (27)			Use of PSA test in practice 2.8% of respondents did not routinely recommend PSA. 58.2% of respondents recommended PSA to >80 years (especially residents).
Kappen, 2020 (29)	Guidelines 95% reported to have at least read the Dutch guideline for GPs. 50% reported to be aware of the guideline content.	Usefulness of the test 39.1% declared not afraid and 47.1% neutral about their concern on missing PCa in a patient. 28.7% thought screening for PCa is important and 43.7% declared it was neutral.	SDM 46% would offer detailed advice before ordering a PSA test to an asymptomatic man who asked for it. Use of PSA test in practice 25% would not recommend the test to their family members and 38% would probably not.
Shungu, 2022 (29)	Guidelines 70.1% correctly identified the most recent USPSTF PCa screening recommendation.		Use of PSA test in practice 87% used the USPSTF as their primary source of information. 69.4% screened with PSA alone and 24.8% with PSA and digital rectal exam. SDM 29.2% informed black men aged 55–69 years of their increased risk of developing PCa and 12.1% only if the patient introduces the topic. They engaged in shared decision-making for PCa screening in about 50.4% of eligible white men vs. 54.8% black men.
Benedict, 2023 (30)	Risk factors/characteristics of the test 64.8% had poor knowledge about PCa screening, 30.1% had moderate knowledge and 5.1% had good knowledge. Medical officers or GPs, more state-employed participants, participants with prior working experience in urology, participants involved with the training of medical students, and those following PCa screening guidelines in their practice, had better knowledge.	Usefulness of the test 58.6% had a neutral attitude towards PCa screening, 40.7% had a negative attitude and 0.7% had a positive attitude. Female participants and professional nurses and community health workers were moer uncomfortable with practice: those with 1–5 years’ working experience had a positive attitude.	SDM 40.0% had poor practice regarding PCa screening and SDM, 35.8% had fair practice and 24.3% had good practice. Female participants and participants without additional postgraduate qualifications had poor practice; medical officers or GPs had good practice, state-employed participants, participants with 1–5 years’ working experience, participants involved with training of medical students, and those following PCa screening guidelines in their practice, had good practice.
Urologists
Rudichuk, 2017 (31)	Risk factors/characteristics of the test 83% linked family history and race (92.9%) to an increased risk of PCa.		Use of PSA test in practice Respondents chose the recommendation to start PSA testing earlier (<55 years) if patients have a family history of PCa. 87.4% reviewed family history of PCa when considering screening options.
Persaud, 2018 (32)		Benefits and risks 66.7% believed thar PSA screening had positively impacted survival in their patient population. Usefulness of the test 76.7% supported PSA screening in the asymptomatic Afro-Caribbean men. 35.7% of urologists felt that the patient understood the discussion on screening. 22% believed the international screening guidelines were applicable to the Caribbean and 63% believed that a multinational committee should lead Caribbean screening guidelines.	SDM 50% always fully discussed pros and contra PSA screening with patients.
Scherer, 2023 (33)			Use of PSA test in practice Male urologists >50 years of age screened themselves more often than male internists >50 years of age (89% vs. 70%, p < 0.05). Urologists reported recommending screening statistically significantly more often than internists to their brother, father or partner regardless of their sex (men: 38.1% vs. 18.5%; p < 0.05; women: 81.8% vs. 32.2%; p < 0.05).
GPs and urologists
Kappen, 2019 (11)			Use of PSA test in practice 65.9% GPs had a standard procedure regarding PSA testing vs. 85.7% urologists. 100% urologists inquired if the patient wishes to do a PSA test (85.7% orally). 24.4% GPs did not ask the patient if he wishes to do a PSA test (73.2% orally). 75.6% GPs and all urologists always or often informed on PSA testing during an early detection of cancer examination. In case of discomfort in the lower urinary tract, 78.5% urologists showed a more proactive approach of informing men on PSA testing vs. 41.5% GPs and in case of a positive family anamnesis (92.9% urologists vs. 75.7% GPs). 53.7% GPs replied that the proportion of men aged 45 years and older that finally receives (at least) one PSA test is almost none vs. 78.5% urologists. 57.1% urologists chose 10–14 years of life expectancy for an asymptomatic patient to recommend a PSA test vs. 39% GPs which would not recommend a test at all.