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Health Perceptions in Patients Who Undergo Screening and Workup for Prostate Cancer

  • David A. Katz
    Correspondence
    Reprint requests: David A. Katz, M.D., M.Sc., VA Iowa City Health Care System (152), 601 Highway 6 West, Iowa City, IA 52246-2208.
    Affiliations
    Departments of Medicine and Epidemiology, University of Iowa Carver College of Medicine and College of Public Health, Iowa City, Iowa

    Center for Research in Innovative Strategies and Practices, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
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  • David F. Jarrard
    Affiliations
    Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Author Footnotes
    1 Dr. McHorney is currently with Merck & Co., Inc.
    Colleen A. McHorney
    Footnotes
    1 Dr. McHorney is currently with Merck & Co., Inc.
    Affiliations
    Regenstrief Institute, Indiana University School of Medicine and Veterans Affairs Health Services Research and Development, Indianapolis, Indiana
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  • Stephen L. Hillis
    Affiliations
    Center for Research in Innovative Strategies and Practices, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
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  • Donald A. Wiebe
    Affiliations
    Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Dennis G. Fryback
    Affiliations
    Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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  • Author Footnotes
    1 Dr. McHorney is currently with Merck & Co., Inc.

      Objectives

      False-positive screening tests may induce persistent psychological distress. This study was designed to determine whether a positive screening test with negative biopsy findings for prostate cancer is associated with worsened mental health during short-term follow-up.

      Methods

      We conducted a cross-sectional telephone survey of two groups of men approximately 2 months after testing: group 1, 109 men with an abnormal prostate-specific antigen level or digital rectal examination findings but with negative biopsy findings for prostate cancer; and group 2, 101 age-matched primary care patients with PSA screening levels in the reference range (less than 4 ng/mL). Primary outcomes included state anxiety and prostate cancer-related worry. Secondary outcomes included Medical Outcomes Study Short Form 36-item Health Survey subscales and sexual function items. Multivariate regression techniques were used to adjust for differences in baseline covariates.

      Results

      Group 1 patients were more worried than group 2 patients about getting prostate cancer (mean worry 3.9 versus 4.5, P = 0.0001, using a 5-point scale, with 1 indicating extreme worry and 5 no worry). Group 1 patients also perceived their risk of prostate cancer to be significantly greater than that of controls (P = 0.001). No significant differences were found across state anxiety or Medical Outcomes Study Short Form 36-item Health Survey subscales. Sexual bother was greater for group 1 patients, with 19% reporting that sexual function was a moderate to big problem compared with 10% of group 2 patients (P = 0.0001).

      Conclusions

      Men with abnormal prostate cancer screening tests report increased cancer-related worry and more problems with sexual function, despite having a negative biopsy result. Effective counseling interventions are needed before prostate cancer screening and during follow-up.
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