AN EXPLORATION OF SCREENING PRACTICES FOR PROSTATE-CANCER AND THE ASSOCIATED COMMUNITY EXPENDITURE

Objectives To determine: (i) the prevalence, reasons for. and demograp hic and psychosocial predictors of prostate cancer screening among a r andomly selected sample of men; and (ii) to estimate the community exp enditure involved in the screening of asymptomatic men. Subjects and m ethods A random sample of men aged 40-79 years was selected from the S tate Electoral Register of New South Wales, Australia, and asked to co mplete a computer-assisted telephone interview. The questions determin ed their demographic characteristics, their subjective health rating c ompared with others of the same age (5-point scale), the prevalence an d reasons for any screening for prostate cancer ('ever screened' and ' screened within the last 12 months'), whether they had undergone a dig ital rectal examination (DRE), a blood test for prostate-specific anti gen (PSA) or transrectal ultrasonography (TRUS), and the prevalence of urinary symptoms. Those who had been screened were then asked to nomi nate the single most important factor in the decision to undergo prost ate cancer screening. To estimate community expenditure, the costs for prostate cancer screening were estimated by applying Medicare schedul e charges to the screening and subsequent diagnostic tests performed. Two scenarios were developed to estimate costs; the first used guideli nes which do not recommend the use of routine screening for all asympt omatic men, and the second was based on guidelines where the routine u se of PSA or TRUS as part of a periodic health examination is not reco mmended, but the use of DRE in asymptomatic men aged 50-70 years is. R esults Of the 551 eligible participants, 86% completed the interview; 44% of participants reported that they had 'ever' been screened, whils t 23% had been screened in the year before the study. Among those who had been screened. the reason reported most, often for screening, apar t from symptoms and family history, was the doctor's recommendation af ter a medical assessment of their prostate cancer risk status. Screeni ng status was predicted both by the age of the man and his symptom sco re. As a result, the community expenditure in New South Wales for scre ening among asymptomatic men was estimated to be A$6.4 million and A$5 .2 million for the first and second scenarios, respectively. Conclusio ns The results of this study suggest that, despite the recommendations of primary bodies that asymptomatic men not be screened for prostate cancer, screening is occurring at a high level and with significant co sts to the healthcare system.