AUA 2018: Impact of Perceived Ambiguity and Other Psychological Factors on Previous Prostate Cancer Screening Behavior Among 45-year-old Men: Findings from the PROBASE-Study

San Francisco, CA USA ( The German risk-adapted prostate cancer screening trial PROBASE is currently the largest ongoing screening trial and aims to accrue 50,000 men within 5 years in a prospective and randomized fashion. The trial opened in April 2014 and is powered for superiority in terms of specificity of risk-adapted PSA screening starting at age 50 as compared to 45 years with non-inferiority in terms of metastasis from prostate cancer. Men that are 45 years old are randomly assigned to risk-adapted screening beginning at age 45 or five years later at age 50. Both groups receive risk-adapted PSA screening based on baseline PSA values: < 1.5 ng/ml (low risk) – 5-yearly PSA (expected 90%), 1.5-2.99 ng/ml (intermediate risk) – 2-yearly PSA (expected 7.5%), ≥3.0 ng/ml (high risk) MRI and combined systematic and MRI/TRUS fusion-guided biopsy recommended. In the trial, screening ends at age 60. Controversial discussions and study results regarding prostate cancer screening have led to uncertainty/ambiguity regarding prostate cancer screening behavior among men. Dr. Herkommer and colleagues aimed to assess the 45-year-old patient arm of the PROBASE study to analyze whether high perceived ambiguity and other psychological factors are associated with men’s prostate cancer screening behavior in the past.

For this study, 45-year old men in the PROBASE study between April 2014 and April 2016 were asked about their previous prostate cancer screening behavior and categorized into three groups: PSA test, digital-rectal examination (DRE), no test. Additionally, data about psychological as well as sociodemographic and medical characteristics were collected and examined to assess for potential association with prostate cancer screening behavior/uptake using both univariate and multivariable analysis.

There were 14,526 men that met inclusion criteria and were analyzed. In total, 42.3% have had a previous prostate cancer screening measure: 17.8% had a PSA test and 24.5% had a DRE only. There were 34.8% of men that stated a high level of perceived ambiguity regarding prostate cancer screening recommendations. Among these men, they were less likely to have had a prior PSA test or a DRE (p<0.001). Men that perceived their absolute risk of developing prostate cancer as high (32.8%) were more likely to have had a PSA test. Other significant predictors (all p<0.05) of having had a previous prostate cancer screening measure were:

• A steady partnership status
• Private health insurance
• Smaller waist circumference
• No cigarette consumption
• Personal history of a urological cancer
• Family history of prostate cancer or family history of another type of cancer
• Benign prostate symptoms (IPSS>7)
• Consulting a urologist

The strength of the current study is the ability to survey more than 10,000 men 45 years of age regarding their perception of PSA screening as part of an overall large clinical trial. A limitation of this study is a potential lack of generalizability of these findings to men in other countries/cultures. Secondly, whether men as young as 45 years old should be undergoing prostate cancer screening at all (or thinking about it) is debatable. The authors concluded that based on survey results of 45-year-old men in the PROBASE trial, there is a high perceived ambiguity because of inconsistent and heterogeneous prostate cancer screening recommendations. This may keep young men from participating in prostate cancer screening measures and underlines the need for clear guidelines and practice statements.

Presented by: Kathleen Herkommer, Technical University of Munich Klinikum rechts der Isar, Munich, Germany

Co-Authors: Jamila Strüh, Andreas Dinkel, Munich, Germany, Peters Albers, Christian Arsov, Dusseldorf, Germany, Markus Hohenfellner, Heidelberg, Germany, Boris Hadaschik, Essen, Germany, Markus Kucyk, Florian Imkamp, Hannover, Germany, Jürgen Gschwend, Munich, Germany

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md, at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA

Read more on the PROBASE Study from AUA 2018: The German Risk-Adapted Prostate Cancer Screening Trial (PROBASE) – First Results After Recruitment of 30,000 Men