BERKELEY, CA (UroToday.com) - The harms and benefits of prostate cancer screening are the subject of much debate, and there is disagreement on the use of serum prostate-specific antigen (PSA) testing. Screening and early treatment of prostate cancer reduces prostate-specific mortality but to the cost of over diagnosis and overtreatment. In view of this controversy, there is consensus that men need to be well informed on the pros and cons of PSA-based screening before they undergo a PSA test. This can be achieved by providing men with balanced, evidence-based information on the harms and benefits of PSA testing.
In 2007, National Guidelines on detection, diagnostic work-up, and treatment of prostate cancer were issued by the National Board of Health and Welfare in Sweden. These guidelines strongly recommended that, in order to make an informed decision on PSA testing, all asymptomatic men considering PSA testing should receive written information on the pros and cons of the PSA test prior to the blood draw. To that end, a brochure with patient information was published. We assessed the proportion of men who received such information according to the guidelines. In a mailed questionnaire, 1 800 men who were randomly selected from the National Prostate Cancer Register (NPCR) of Sweden, were asked if and how they had received information on the pros and cons of PSA testing. Asymptomatic men with screen-detected T1c prostate cancer in the years 2006-2008 were included. Furthermore, the men were asked about the reason for their first PSA test, if the information influenced their decision on having the test, and whether and how they had been informed about their PSA level.
In total, 1 621 out of 1 800 men (90%) responded to the questionnaire. Only 14% of men in this survey recalled that they had received written or both oral and written information about the pros and cons of PSA testing before the blood draw. There was only a small increase in the proportion of men who had received written, or both oral and written information after the National Guidelines had been issued - from 12% in 2006 to 16% in 2008 (Figure 1). Interestingly, 22% of the men reported receiving information about PSA testing from the media, a higher proportion than those who received written information from the health care provider. Somewhat disturbingly, 10% of the men were not aware that they had undergone PSA testing.
The main strength of the study is the high response rate and the high capture rate of NPCR that was used in the study. The main drawback of the study is that only men with prostate cancer were included, which limits the applicability of the results. Another limitation is that the results are susceptible to recall bias as there was a long time between PSA testing and data collection.
This study indicates that in clinical day-to-day practice, the proportion of men who receive written information on the pros and cons of PSA testing is low. We concluded that improvements in the distribution of information and the use of existing decision aids are warranted.
Figure 1. Ratio of men receiving information on PSA test (oral, oral and written, or written information) and those not receiving information or not aware of PSA testing, stratified by calendar time.
Written by:
Jon Fridriksson, MD1 and Pär Stattin, MD, PhD2 as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
1 Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
2 Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York City, USA
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