Does Educational Printed Material Manage To Change Compliance With Prostate Cancer Screening?

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 13 Jun 2008 - 3:00 PDT

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UroToday.com - Currently, there is no conclusive evidence that screening based on serum prostate-specific antigen tests decreases prostate-cancer mortality. On one hand, the decline in prostate-cancer mortality in some countries coincided with the introduction of PSA serum examination and consequently the higher uptake of prostate cancer screening. On the other hand, mortality rates in other countries remained unchanged despite the increased intensity of the PSA screening.

Explanations for the different trends in mortality include different approaches to treatment among countries, bias related to the misattribution of cause of death and -as in our case- inappropriate performing of PSA screening as well.

In Greece there is currently no official recommendation and PC screening is being performed unofficially in patients visiting outpatient departments of most Greek hospitals, as well as in men visiting consulting rooms. The exact magnitude of this opportunistic screening is not known, however according to the official reports of the ministry of public health 31% of men between 45-54 years of age and more than 50% of men over 65 undergo serum PSA test yearly.

Discrepancies in the distribution and the availability of health care services between different even neighbouring- regions of Greece resulted in different screening behavior between Greeks in favor of urban residents. Educational and socio-economical levels create another barrier to compliance with prostate cancer screening as well. As shown in this study, prostate cancer screening is significantly more prevalent among those with higher education. In contrast, low-literacy populations show low prostate cancer screening rates. Our findings confirmed previous observations of Toundas, G, Society and Health, Odisseas-Nea Igia, Athens 2004, who found that more than 80% of men of higher socio-economical level and less than 65% of men of median and low socio-economical level are seeking consultation from health care providers. The relative percentages for PSA testing and digital rectal examination are 60.4% and 52.4% versus 19.7% and 8.2%. It is worth mentioning that in our study, the leaflet decision-aid has been found effective in increasing knowledge of prostate cancer, without modifying the screening behavior towards a single direction (PSA only or DRE only).

According to the perspective of the authors, patients should be thoroughly informed of the limitations of PSA screening and make the personal decision of whether to undergo it or not. Moreover, prostate cancer screening with PSA should be performed in conjunction with the digital rectal exam in consultation with urological specialists. Therefore, a project to support shared decision-making and informed choice for men considering testing for prostate cancer should be undertaken.

Written by Kostantinos Stamatiou, MD, as part of Beyond the Abstract on UroToday.com.

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