WHAT SHOULD MEN KNOW ABOUT PROSTATE-SPECIFIC ANTIGEN SCREENING BEFOREGIVING INFORMED CONSENT

PURPOSE: Since prostate-specific antigen (PSA) screening is controvers ial, some authorities recommend that patients give informed consent be fore testing. We identified and compared what facts experts and patien ts thought men should know. SUBJECTS AND METHODS: We recruited a Delph i panel of national experts (6 urologists and 6 non-urologists) and co nducted 6 focus groups of couples (48 subjects) with 24 screened and u nscreened men from a university hospital. We ranked key facts that exp erts and couples thought men ought to know before consenting to PSA sc reening and conducted a multidisciplinary focus group to help interpre t the findings. RESULTS: All participants would disclose that false po sitive and false negative results can occur and that it is not known w hether PSA screening reduces prostate cancer mortality. The 12 experts would disclose the uncertain benefits of treating early, localized pr ostate cancer. All 24 couples would disclose that the PSA test is a bl ood test and that patients may worry about results. The 6 urologists w ould disclose that prostate cancer is often incurable when symptoms ap pear; the 6 non-urologists, that it can be asymptomatic. The 12 couple s with screened men would disclose that the PSA test can detect cancer sooner than the digital rectal examination; the 12 couples with unscr eened men, that PSA testing is controversial. CONCLUSIONS: Physicians and patients agree upon some facts that men should know about PSA scre ening before giving informed consent. However, physicians fail to emph asize other facts that patients find important. Physicians may differ by expertise; patients, by experience. Our findings provide content fo r informed consent for PSA screening, and our method may be useful for other controversial tests. (C) 1998 by Excerpta Medica, Inc.