PSYCHOLOGICAL REACTIONS IN MEN SCREENED FOR PROSTATE-CANCER

Objective To investigate the possible negative psychological impact of screening for prostate cancer with special focus on the impact of fal se positive and true positive test results. Subjects and methods As pa rt of an early detection study for prostate cancer psychological and p sychophysiological reactions to various phases of the diagnostic proce dures were examined in 2400 randomly selected men divided into various groups. Their psychophysiological reactions were assessed by measurem ents of serum cortisol and their psychological reactions by questionna ires directed at determining emotional states and sleep disturbance. I n a stratified sample of the population (100 men) measurements were ma de at the time of the screening examination and again 2 weeks later. I n patients undergoing biopsy (307 men) measurements were made 2 weeks after screening, but before they were informed of the biopsy results, and again 4 and 16 weeks after screening. Results Serum cortisol level s at the screening examination were higher than corresponding levels o f a comparable sample of Swedish men during normal daily activity, ind icating that an invitation to examination for prostate cancer per se m ight create emotional stress. Two weeks after the screening the elevat ed levels had decreased to normal. The highest cortisol levels were fo und in men who had undergone biopsy, immediately before they were info rmed of the results 2 weeks after screening. After they were informed, cortisol levels fell, regardless of the results of the biopsy. The pa tterns of emotional state and sleep disturbance were similar except th at sleep disturbance was delayed. Conclusion In screening programmes f or prostate cancer it is important to define clearly the high-risk gro ups to minimize the risk of adverse psychological reactions in those s ubjects with a low risk of having the disease. The results also emphas ize the need to reduce the number of false positive results by choosin g diagnostic tests of high specificity. The interval between a test an d informing the subject of the results should be minimized to decrease the duration of the increased emotional stress.