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How Should Men Decide About Testing For Prostate Cancer?

prostate cancerBy Brad Broker

Most men overestimate the value of early screening for prostate cancer.

Prostate cancer is the number 1 diagnosed cancer in men and the second leading cause of death in male cancer fatalities.  Because of those stats, men are sometimes too quick to jump into screening for the disease without properly understanding the limitations of those tests.

“Mixed evidence about the benefits of screening, and growing concerns about harms, have led the U.S. Preventive Services Task Force to recommend against routinely screening all men for prostate cancer,” according to researchers of a new study published in JAMA Internal Medicine.

The Task Force determined that PSA-based screening leads to substantial overdiagnosis of prostate tumors.  The PSA test often produces false-positive results, which leads to additional testing and at least one, if not multiple biopsies.  “Roughly one third of men who have prostate biopsy experience pain, fever, bleeding, infection, transient urinary difficulties, or other issues requiring clinician follow-up that the men consider a ‘moderate or major problem.'”

Researchers led by Kathryn L. Taylor, PhD, of the Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, hypothesized that patients are ill-informed of the effects of prostate cancer screening and devised a trial to determine effectiveness of print and web-based decision aids.

“The tools were intended neither to encourage nor discourage screening but instead to present the benefits and limitations of screening to help men make choices consistent with their preferences,” said Taylor.

The study included almost 1,900 men between 45-70 with no history of prostate cancer. Both versions of the decision aids contained the same material based on a 24-page educational booklet published in 2004 entitled Prostate Cancer Screening: Making an Informed Decision.

“We found that the print-based and web-based decision aids were more effective than usual care in increasing knowledge and reducing decisional conflict,” Taylor said in the article. “The decision aids offer neutrality, shown by the fact that they did not influence the screening decision in either direction compared with usual care, which allows patients and providers to individualize the decision.”

The researchers had expected the web to be more influential than print, but there was no significant difference, perhaps due to the age of the participants and likelihood of a preference toward print.

Physicians should properly inform patients of the risks of screening and encourage the use of decision aids prior to any treatment.  The American Cancer Society emphasizes informed decision making for prostate cancer screening: men at average risk should receive information beginning at age 50 years, and black men or men with a family history of prostate cancer should receive information at age 45 years.

(Image: “Prostate adenocarcinoma 2 high mag hps” by Nephron via Wikimedia Commons)

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