A community study using specified and unspecified scenarios to investigate men's views about PSA screening

Objective  We explored the influence of different but factual scenarios about prostate‐specific antigen (PSA) screening on men's interest in having PSA screening to detect early prostate cancer. Design  Cross‐sectional, representative community survey. Setting and participants  A total of 514 men (89% response fraction) aged 50–70 years randomly selected from a telephone directory database in Sydney, Australia. Main variables studied  Demographic, health and psychological variables. Main outcome variables  Interest in undergoing screening in response to five unspecified scenarios and, elsewhere in our interview, a specified scenario in which PSA screening was mentioned explicitly. Results  When presented with a scenario describing a lack of evidence underpinning the efficacy of screening for an unspecified cancer, 61.2% of men reported that they ‘probably’ or ‘definitely’ wanted to undergo screening for an unspecified cancer. Similar proportions reported that they ‘probably’ or ‘definitely’ wanted to undergo screening even at the risk of unmasking indolent cancer (60.9%) or without expert consensus about the value of screening (62.8%). Greatest interest in screening was elicited in that scenario describing life‐time risk of dying from prostate cancer (72.6%) ( P  < 0.001). Significantly fewer indicated they would ‘probably’ or ‘definitely’ want to undergo screening for a cancer for which there was uncertainty about treatment efficacy and known side‐effects (46.1%) ( P  < 0.001). Increasing age was a consistent predictor of positive interest in screening. When asked later in our survey specifically about PSA screening, 68.1%‘probably’ or definitely’ wanted PSA screening. Conclusion  Public health policy makers need to ensure that men are provided with the scope of medical evidence germane to prostate cancer screening and treatment, thereby potentially improving prostate cancer screening decisions.