Men still worry after ‘all clear’ prostate biopsy

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Men who undergo a prostate biopsy because they’ve had a suspicious screening test result and then are given the good news that the biopsy is negative continue to worry about developing the cancer, study findings show.

“This underrecognized human cost of screening should be considered in the debate about the benefits and harms of prostate cancer screening,” Dr. Mary McNaughton-Collins of Massachusetts General Hospital and her colleagues write in the American Journal of Medicine.

Screenings for breast cancer and colon cancer are known to be effective in reducing the risk of death from these conditions among at-risk individuals. However, the benefits of prostate cancer screening, which has a high rate of false-positive results, are less clear.

To investigate the psychological effects of false-positive prostate cancer screenings, McNaughton-Collins and her team studied 400 men, aged 40 to 88, who had a PSA blood test to screen for prostate cancer.

Out of that group, 167 had a positive PSA result but a negative biopsy, while 233 had a negative PSA and did not need a biopsy.

Nearly half (49 percent) of the men who underwent the biopsy continued to worry—even though the result was reassuring. They said they thought about prostate cancer “a lot” or “some of the time” afterwards, while the same was true of less than 20 percent of those who did not undergo biopsy.

And, the report indicates, 40 percent of the biopsy group said they worried “a lot” or “some of the time” about developing prostate cancer, in comparison to 8 percent of the comparison group.

Men in the biopsy group were more likely to say that their lives had changed for the better because of their test results, yet they also were more likely to believe they had a higher than average risk of developing prostate cancer, the report indicates.

Based on these findings, McNaughton-Collins and her team recommend that men who choose to be screened for prostate cancer should receive counseling about the risks of false-positive results before undergoing screening.

Further, the researchers advise, instead of annual prostate cancer screenings, men should be screened every two years or less frequently to guard against false-positive results.

In an accompanying editorial, Drs. Timothy J. Wilt and Melissa R. Partin, of the Minneapolis VA Center, write that “counseling is likely to be preferable to routine testing,” given the high rate of false positive results and their “potentially quite important” adverse psychological effects.

Such counseling should include discussions that “highlight the use of diagnostic tests and treatments that are most likely to improve length and quality of life while minimizing adverse effects and unnecessary costs,” they write.

The American Cancer Society does not recommend routine testing for prostate cancer, since little concrete data is available about its benefits, Dr. Robert Smith, director of cancer screening told Reuters Health.

Yet, “men need to have the opportunity to make informed decisions,” he said. They should have “frank discussions” with their physicians about the potential benefits and harm, including incontinence and impotence, associated with prostate cancer testing and treatment.

SOURCE: American Journal of Medicine, November 15, 2004.

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