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What should men know about prostate-specific antigen screening before giving informed consent?

  • Evelyn C.Y Chan
    Affiliations
    Division of General Internal Medicine (ECYC), University of Texas Health Sciences Center, Houston, Texas, USA
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  • Daniel P Sulmasy
    Correspondence
    Requests for reprints should be addressed to Daniel Sulmasy, OFM, MD, PhD, The John J. Conley Department of Ethics, St. Vincents Hospital and Medical Center, 153 W. 11th Street, New York, NY 10011
    Affiliations
    Center for Clinical Bioethics and the Division of General Internal Medicine (DPS), Georgetown University Medical Center, Washington, DC.USA
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      Abstract

      Purpose: Since prostate-specific antigen (PSA) screening is controversial, some authorities recommend that patients give informed consent before testing. We identified and compared what facts experts and patients thought men should know.
      Subjects and Methods: We recruited a Delphi panel of national experts (6 urologists and 6 non-urologists) and conducted 6 focus groups of couples (48 subjects) with 24 screened and unscreened men from a university hospital. We ranked key facts that experts and couples thought men ought to know before consenting to PSA screening and conducted a multidisciplinary focus group to help interpret the findings.
      Results: All participants would disclose that false positive and false negative results can occur and that it is not known whether PSA screening reduces prostate cancer mortality. The 12 experts would disclose the uncertain benefits of treating early, localized prostate cancer. All 24 couples would disclose that the PSA test is a blood test and that patients may worry about results. The 6 urologists would disclose that prostate cancer is often incurable when symptoms appear; the 6 non-urologists, that it can be asymptomatic. The 12 couples with screened men would disclose that the PSA test can detect cancer sooner than the digital rectal examination; the 12 couples with unscreened men, that PSA testing is controversial.
      Conclusions: Physicians and patients agree upon some facts that men should know about PSA screening before giving informed consent. However, physicians fail to emphasize other facts that patients find important. Physicians may differ by expertise; patients, by experience. Our findings provide content for informed consent for PSA screening, and our method may be useful for other controversial tests.
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