Men who learn more about PSA test are less likely to seek screening

Oct 3 2007

When men get a little extra help in understanding prostate cancer screening tests, they come away more educated and confident about their choices.

However, they might also be less likely to go ahead with the tests, according to a closer look at some recent studies.

More than 6,000 men took part in the studies, which looked at the effects of “decision aids” such as pamphlets, videotaped programs and Web sites that discussed the pros and cons of prostate cancer screening.

Men who used the decision aids “learned a lot, became more assured of their screening choices and increased to their desire to be active partners in decision-making,” said Robert Volk, Ph.D., of Baylor College of Medicine.

However, “it appears that this greater knowledge leads some patients to question the value of prostate cancer screening and to decide against it,” Volk and his colleagues write in the November issue of the American Journal of Preventive Medicine.

Decision aids can help people learn more about the options and outcomes involved in a particular screening test or treatment. In some cases, they encourage patients to think beyond the “facts” of a treatment and consider how a procedure might affect their daily lives or fit into their personal health goals.

The aids can be particularly important in cases such as prostate cancer screening, since there is still some disagreement over whether early detection methods such as the prostate-specific antigen (PSA) test actually reduce prostate cancer deaths.

The researchers found that the decision aids had the greatest impact on men seeking routine care — they were significantly less likely to go ahead with the PSA test after using the aids. By contrast, patients already preparing for prostate screening were not affected one way or another by having the extra information.

When prostate cancer was discovered later in some of the men, they were much more likely to prefer “watchful waiting” to more aggressive treatments after receiving the decision aids, Volk and colleagues discovered.

Decision aids could help certain high-risk groups such as African-Americans understand their personal risk of prostate cancer, the researchers say.

In a June study from the University of Chicago, William Dale, M.D., and colleagues found that African Americans were more likely than their white counterparts were to have prostate cancer, although they were less likely to believe they were at risk.

This belief “may cause these men at highest risk for prostate cancer to delay the pursuit of a diagnosis,” Dale said.

The Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality supported the Volk study; however, Volk said readers should not construe the findings as representing an official position of the CDC or the U.S. Department of Health and Human Services.