Twenty per cent of men can feel distressed at the prospect of having a biopsy after finding out they have a raised PSA level, and nine per cent continue to feel this way even after being informed they don’t have cancer, concluded UK researchers who recommended doctors clearly explain the psychological effects of prostate cancer screening to their male patients and how it can lead to anxiety and distress.
You can read about the findings in a paper published online on 6 April in the British Journal of Cancer.
A high level of Prostate-specific antigen (PSA) can indicate cancer, but it can also be a sign of infection, an enlarged but not cancerous prostate, or even a reaction to recent exercise.
For up to 70 per cent of men who have a biopsy as a result of a raised PSA, the result is negative (ie the biopsy, a surgical procedure that removes small pieces of the prostate gland which are then tested for cancer cells, does not show evidence of cancer).
In the UK, men are not routinely offered a PSA test, but if they are concerned they may have prostate cancer, they can discuss the risks and benefits of having one with their GP.
Lead author Professor Kavita Vedhara from the University of Bristol told the media that:
“At the moment, doctors are asked to warn men about the difficulties of interpreting the results of a PSA test. The test misses some cases and can produce false alarms.”
“While it’s crucial that men are aware of the difficulties they may face when deciding what to do with their results, it’s also important they’re aware that they may find the whole process stressful”, she added.
Vedhara explained that in some men, the psychological effects appear to last even after they have been told they don’t have cancer, that the biopsy was benign.
“Even 12 weeks after receiving a negative biopsy result, nine per cent of men said they still felt distressed,” said Vedhara, stressing that it was important doctors know about this and fully inform their male patients about the psychological challenge of undergoing a PSA test.
For the study, Vedhara and colleagues used data on 330 men aged 50 to 69 who took part in a Cancer Research UK funded survey that is linked to the ProtecT trial, which is investigating the best ways to detect and treat prostate cancer.
The participants all had a PSA level greater than or equal to 3 ng/mL and a negative biopsy result and completed distress and negative mood measures at four points in time: two during the diagnosis phase and two after receiving a negative biopsy.
When they analysed the data the researchers found that:
- Most of the men were not greatly affected by testing or a negative biopsy result.
- The impact on psychological health was highest at the time of biopsy, with around 20 per cent reporting high distress and tense/anxious moods.
- A longitudinal analysis on 195 participants showed a significant increase in distress at biopsy time compared with PSA testing time, and these levels persisted after the negative biopsy result and 12 weeks later.
- Psychological mood at the time of the PSA test predicted high levels of distress and anxiety in measures taken after that.
The researchers concluded that:
“Most men coped well with the testing process, although a minority experienced elevated distress at the time of biopsy and after a negative result.”
They recommended men be informed of the risk of distress linked to the uncertainty of diagnosis (and presumably the fact the distress could continue for months) before they agree to have the PSA test.
Martin Ledwick, head cancer information nurse at Cancer Research UK, said that for many men, an early diagnosis of prostate cancer could save their lives, but for about one in eight the test will be abnormal but not be followed by a cancer diagnosis at that time.
“Further tests and biopsies are usually needed to rule out cancer for these men,” said Ledwick, adding that this study shows “just how important it is that men in their 50s and 60s can talk to their doctor about the pros and cons of having a PSA test and only have the test if they feel it is right for them”.
“Impact of prostate cancer testing: an evaluation of the emotional consequences of a negative biopsy result.”
R C Macefield, C Metcalfe, J A Lane, J L Donovan, K N L Avery, J M Blazeby, L Down, D E Neal, F C Hamdy, K Vedhara.
DOI:10.1038/sj.bjc.6605648
Source: Cancer Research UK.
Written by: Catharine Paddock, PhD