Identifying prostrate cancer in the community: difficulties in communicating the implications of PSA testing

Brindle, L., Donovan, J.L. and Peters, T. (2001) Identifying prostrate cancer in the community: difficulties in communicating the implications of PSA testing. Journal of Epidemiology and Community Health, 55, supplement 1, part A9, A9.

Abstract

Asymptomatic prostate cancer can be detected following a Prostate
Specific Antigen (PSA) blood test with biopsy for those with raised
PSA results. Population screening for prostate cancer is not currently
available because treatments for localised disease carry risks and have
uncertain benefits. A change in NHS policy will shortly remove
restrictions on PSA testing if men consent to receive information
about the implications of testing.

Methods: as part of a feasibility study for a randomised trial of treatment
for localised prostate cancer (ProtecT Study), men aged 50–69
were informed about prostate cancer and treatments and invited to
have a PSA test. Semi-structured interviews elicited men’s reasons for
consenting to PSA testing and study participation, and responses to
information about treatments and outcomes. Interviews were
audio-taped and transcribed verbatim. The constant comparative
method was used to identify salient themes.

Results: 21 men were interviewed, 5 before and 16 after receiving a
raised PSA result. Participants were mostly aware that there was
uncertainty surrounding treatment for localised prostate cancer.
Advantages of ‘catching it early’ were commonly presented as a reason
for PSA testing. PSA testing was compared with routine cervical and
breast cancer screening and an involvement in ‘preventative medicine’
commonly endorsed. There was a general expectation that test results
would be negative and thus give reassurance, and participants tended
to avoid consideration of treatments until an abnormal result was
received.

Conclusion: new NHS policy to informmen about the implications of
PSA testing may be thwarted by the existence of a ‘catching cancer early
enables treatment’ discourse allied with an expectation of negative
results and high levels of compliance with prevention services. Serious
questions are raised about whether it is possible to engage potential
recipients in the consideration of the implications of PSA testing

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Contributors

Author: L. Brindle

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