Prostate Cancer Screening – Attendance and Psychological Consequences

Abstract

Participation in prostate cancer screening may confer both benefits and harms, which can be perceived and weighed differently by individual men. The blood test PSA (prostate-specific antigen) may provide reassurance when the value is below the threshold, whereas an elevated value triggers a diagnostic process. For a screening program to be successful, both adequate participation and a high level of acceptance of the diagnostic process within the population are necessary. Paper I reports a questionnaire survey of men's perceptions of being invited to organized prostate cancer testing and the information about benefits and harms. Most men expressed positive attitudes and found the information clear, although men with higher education were less likely to perceive the information on potential disadvantages as clear. Paper II is an interview study describing which aspects men valued in their decision whether to undergo or to decline an invitation to PSA testing, and how the information presented in the invitation letter was helpful in their understanding of potential benefits and harms. Men reported that this information was not central to their decision-making process. Instead, their decision was shaped by fear (both as a driving force and as a barrier), intuitive reasoning, and perceived risk — highlighting the challenge of achieving truly informed decision-making and requested guidance from authorities. Paper III reports an investigation of the psychological consequences of participating in the diagnostic process within the Göteborg 2 prostate cancer screening trial. Self-reported symptoms of anxiety, depression and intrusive thoughts were assessed through questionnaires. Although many men reported some distress, few reported moderate to severe symptoms of anxiety. Paper IV reports how the diagnostic investigation in the first screening round and individual factors affect re-attendance in the Göteborg 2 trial. The overall re-attendance was high. Re-attendance rates in the targeted and systematic biopsy groups were estimated, and the rates were similar between the groups. Low income, short education, non-Swedish mother tongue, unhealthy lifestyle and erectile dysfunction were all associated with not re-attending