THE IMPORTANCE OF PATIENT PREFERENCE IN THE DECISION TO SCREEN FOR PROSTATE-CANCER

OBJECTIVE: Routine screening for prostate cancer is controversial beca use of frequent false-positive results, the potential for slow, non-li fe-threatening growth of untreated cancer, the uncertainty regarding w hether treatment can extend life, and the potential for treatment comp lications. This study examines how information about prostate-specific antigen (PSA) testing and the uncertain benefits of treating prostate cancer affects patients' desire for PSA testing. DESIGN: An education al videotape designed to inform men about the uncertainty surrounding PSA screening and the treatment of early-stage prostate cancer was pre sented to two groups of male patients 50 years of age or older. SETTIN G: Dartmouth-Hitchcock Medical Center. PATIENTS/PARTICIPANTS: For stud y 1, men seeking a free prostate cancer screening were preassigned to view the educational videotape (N = 184) or another videotape (N = 188 ). For study 2, men scheduled to visit a general internal medicine cli nic viewed either the educational videotape (N = 103) or no videotape (N = 93). MEASUREMENTS AND MAIN RESULTS: The men's information and pre ferences about prostate cancer screening and treatment and actual choi ce of PSA test at the next test opportunity were measured. Men who vie wed the educational videotape were: better informed about PSA tests, p rostate cancer, and its treatment; preferred no active treatment if ca ncer were found; and preferred not to be screened (all significant at p less than or equal to .002 in both studies). Men viewing the educati onal video were less likely to have a PSA test (p = .041, study 2). Th is tendency was not significant at the free-PSA clinic (p = .079). CON CLUSIONS: Preference regarding cancer screening and treatment is great ly affected by information about medical uncertainties. Because inform ed patient choices vary, PSA screening decisions should incorporate in dividual preferences.