Study Supports 'Decision Aids' For Men Considering Prostate Test

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 27 Feb 2008 - 0:00 PDT

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Healthy middle-aged men who watch extensive online presentations about prostate cancer are more likely to understand the disease than those who simply visit health Web sites, according to a new study. The men are also slightly less inclined to undergo a routine but somewhat controversial prostate test.

The findings show how "decision aids" can "help people understand what the options are in a neutral way so they can make the decisions that fit best with their health," said lead study author Dominick Frosch, an assistant professor of medicine at the University of California at Los Angeles.

At issue is how to help men decisions about whether to undergo a prostate-specific antigen (PSA) test. While some doctors support routinely giving the test to healthy men, others question its value.

"We don't have any evidence that would tell us that screening for prostate cancer in men without symptoms would help them live longer," Frosch said. In many cases, men go on to die of other causes because the prostate cancer never reaches a fatal stage.

"What men are really facing is a difficult decision between an uncertain benefit in terms of prolonging your life and a treatment that can really hamper your quality of life," Frosch said.

In the study, 611 healthy men ages 50 and older who visited a Kaiser Permanente clinic in San Diego were assigned to visit public prostate-cancer Web sites or view online presentations designed to help them make decisions.

The study findings appear in the February 25 issue of Archives of Internal Medicine.

Those who watched the online presentations scored higher on tests about prostate knowledge than those who visited the public Web sites. After taking part in the study, they were about 9 percent less likely to want to undergo a PSA test than those who only visited Web sites, who were about 3 percent less likely to undergo the test.

At the beginning of the study, 96 percent of the men expressed interest in a PSA test. By the end, 89 percent did.

Dr. David Rovner, a professor emeritus at Michigan State University who studies medical decision-making, said the study did not examine whether rejecting the test was "an appropriate decision for specific men."

Dr. Steven Freedland, an assistant professor of urology and pathology at Duke University, said the study is "somewhat biased" against PSA screening. Even after learning more about the topic, however, men still wanted to take the test, he said.

"The moral of the story is that men want PSA tests," Freedland said. "And even when highly educated (about the topic) they want PSA tests."

Frosch DL, et al. A randomized controlled trial comparing alternative approaches for men considering prostate cancer screening. Arch Intern Med 168(4), 2008.

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