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Value of prostate cancer screening may lie in the reassurance it can provide

Prostate cancer is the second leading cause of cancer deaths among men in the United States. In 1999 alone, nearly 180,000 men were diagnosed with the disease, and another 37,000 died of it.

Prostate screening tests such as the digital rectal examination (DRE) and prostate-specific antigen (PSA) test are currently used to identify the early stages of prostate cancer, but the benefits of such tests remain unclear. No clinical trial has yet linked prostate cancer screening results with men's survival or quality of life. Nevertheless, men do gain reassurance from prostate cancer screening, concludes a study supported by the Agency for Healthcare Research and Quality (HS08992).

Researchers led by Robert J. Volk, Ph.D., of Baylor College of Medicine, examined the responses of 168 men (aged 45-70 years) to a hypothetical screening scenario after the men were educated about prostate cancer, screening and diagnostic tests, and possible adverse effects of cancer treatment. During interviews, the researchers asked the men to assume they did not have prostate cancer and to rank three predefined screening states with regard to reassurance value: A, no screening; B, normal by screening (a PSA and DRE); and C, normal by biopsy (abnormal PSA and DRE results, but a negative ultrasound-guided prostate biopsy).

Nearly 97 percent of the men associated some reassurance value with screening, with 87 percent considering health state A, no screening, to be the worst possible health state. Preference for screening state C was associated with a family history of prostate cancer and perceived greater risk for prostate cancer compared with other men. More than half (57 percent) of the men thought screening state B to be the best state (only 2 percent considered it to be the worst), and 39 percent considered screening state C to be the best (11 percent considered it to be the worst). Age, ethnicity, education, and income were not significantly related to a preference for screening state C over state B.

See "Psychological benefits of prostate cancer screening: The role of reassurance," by Scott B. Cantor, Ph.D., Dr. Volk, Alvah R. Cass, M.D., S.M., and others, in Health Expectations 5, pp. 104-113, 2002.

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