Prostate cancer screening behaviour

Abstract

Prostate cancer remains the most common non-cutaneous malignancy, and it is diagnosed by measurement of prostatespecific antigen (PSA), digital rectal examination (DRE), transrectal ultrasound and biopsies. Routine screening with measurement of PSA cannot be justified until long-term randomized studies demonstrate that PSA screening has a significant impact on morbidity and mortality.1 Hopefully, the results of the European Randomized Screening for Prostate Cancer Study among 190,000 men and of the Prostate, Lung, Colorectal and Ovary Screening Study of the US National Cancer Institute upon 74,000 Americans will be available for discussion in 2008.1 Furthermore, PSA screening may result in false-positive cases and diagnosis of clinically insignificant (non-life-threatening) cancers, while there is absence of definitive biopsy results. The controversy regarding routine screening reflects the uncertainty about treating all prostate cancer cases in terms of survival and quality of life. Last but not least is the public health issue of funding for prevention. The American Cancer Society guidelines suggest that men over the age of 50 years should be offered annual DRE and PSA screening (45 years for African Americans and those with a positive family history) as long as they are informed of the benefits and limitations of screening and have a life expectancy of at least 10 years.3 In the UK, the National Screening Committee has introduced a PSA informed choice programme entitled ‘Prostate Cancer Risk Management Programme’. The objective of this programme is to ensure that men receive clear and balanced information about the PSA screening test, and relevant information packs have been sent to general practitioners (GPs) to assist them with screening counselling. However, evidence is scarce regarding the psychological