Decision-Making About PSA Testing And Prostate Biopsies: A Qualitative Study Embedded In A Primary Care Randomized Trial

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 22 Oct 2007 - 0:00 PDT

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UroToday.com- Most men surveyed in a study in the UK felt that PSA testing and prostate biopsy were acceptable, according to an online report by Dr. Avery and colleagues that appears in European Urology.

The study investigated men's views of PSA testing and biopsy and sought to explore how beliefs influence health behavior. Participants in the study were 50-69 years of age in general practices around nine UK cities. They received a letter to participate and were solicited as part of the larger ProtecT study. ProtecT participants are randomized into either an intervention arm if they are diagnosed with prostate cancer (surgery, radiotherapy or active surveillance) or a standard of care group. The aim of ProtecT is to evaluate the effectiveness, costs, and acceptability of active monitoring, surgery, and radiotherapy for men with localized CaP.

A single interviewer interviewed men participating in the behavioral component and those who declined involvement were approached a second time and a subset agreed to be evaluated for why they would not respond to participate. A total of 48% of men responded to a single invitation, 11% had an abnormal PSA, and 1 in 4 of these had a prostate biopsy showing cancer. Of the 12% who refused biopsy, 58 of 72 agreed to an interview to discuss why.

The data revealed the following behaviors: men who accepted PSA screening did so quickly, passively, felt that they had nothing to lose, did so to reassure themselves that they did not have CaP, but did so under the misconception that CaP would present with symptoms. Most men made the decision to have PSA testing independently and considered it an opportunity they would not have sought themselves.

Reasons for not responding included the perception of the low risk of having CaP, although some were afraid of the diagnosis or had the conception that a blood test was invasive. Regarding prostate biopsy, most men felt compelled to proceed if their PSA was abnormal otherwise the situation would be unresolved leading to anxiety. Men thought the biopsy uncomfortable and unpleasant, but largely reported positively on the experience. Men who refused biopsy, although a small number to assess (13 were interviewed) provided 4 reasons: fear of embarrassment, fear of side-effects, concerns about PSA inaccuracy, and perception of low-risk.

Overall, the authors note that the 52% of men who do not take up the invitation to get PSA testing and the 12% who refuse biopsy must be improved upon to have a successful testing program.

Avery KNL, Blazeby JM, Lane JA, Neal DE, Hamdy FC, Donovan JL

Euro Urol. ePub: August 16, 2007
Doi: 10.1016/j.eururo.2007.07.040

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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