Department of Medicine, Section of Geriatrics & Palliative Medicine, University of Chicago, Chicago, IL 60637, USA.
Med Care. 2012 Dec;50(12):1037-44. doi: 10.1097/MLR.0b013e318269e096.
Prostate-specific antigen (PSA) testing for prostate cancer is controversial, with concerning rates of both overscreening and underscreening. The reasons for the observed rates of screening are unknown, and few studies have examined the relationship of psychological health to PSA screening rates. Understanding this relationship can help guide interventions to improve informed decision-making for screening.
A nationally representative sample of men 57-85 years old without prostate cancer (N = 1169) from the National Social life, Health and Aging Project was analyzed. The independent relationship of validated psychological health scales measuring stress, anxiety, and depression to PSA testing rates was assessed using multivariable logistic regression analyses.
PSA screening rates were significantly lower for men with higher perceived stress [odds ratio (OR) = 0.76, P = 0.006], but not for higher depressive symptoms (OR = 0.89, P = 0.22) when accounting for stress. Anxiety influences PSA screening through an interaction with number of doctor visits (P = 0.02). Among the men who visited the doctor once those with higher anxiety were less likely to be screened (OR = 0.65, P = 0.04). Conversely, those who visited the doctor 10+ times with higher anxiety were more likely to be screened (OR = 1.71, P = 0.04).
Perceived stress significantly lowers PSA screening likelihood, and it seems to partly mediate the negative relationship of depression with screening likelihood. Anxiety affects PSA screening rates differently for men with different numbers of doctor visits. Interventions to influence PSA screening rates should recognize the role of the patients' psychological state to improve their likelihood of making informed decisions and improve screening appropriateness.
前列腺特异性抗原（PSA）检测用于前列腺癌筛查存在争议，过度筛查和漏筛的情况都令人担忧。目前尚不清楚观察到的筛查率的原因，而且很少有研究探讨心理健康与 PSA 筛查率之间的关系。了解这种关系有助于指导干预措施，以改善筛查的知情决策。
我们对来自全国性社会生活、健康和老龄化项目的年龄在 57-85 岁之间、无前列腺癌的男性（N=1169）进行了一项全国代表性样本分析。采用多变量逻辑回归分析评估了经验证的心理健康量表所测的压力、焦虑和抑郁等指标与 PSA 检测率的独立关系。
在考虑压力因素后，感知压力较高的男性 PSA 筛查率显著降低（比值比[OR] = 0.76，P = 0.006），但抑郁症状较高的男性 PSA 筛查率并无差异（OR = 0.89，P = 0.22）。焦虑通过与就诊次数的交互作用影响 PSA 筛查（P = 0.02）。在仅就诊一次的男性中，焦虑程度较高的人不太可能接受 PSA 筛查（OR = 0.65，P = 0.04）。相反，焦虑程度较高且就诊次数在 10 次以上的男性更有可能接受 PSA 筛查（OR = 1.71，P = 0.04）。
感知压力显著降低了 PSA 筛查的可能性，而且它似乎部分中介了抑郁与筛查可能性之间的负相关关系。焦虑对就诊次数不同的男性 PSA 筛查率的影响不同。影响 PSA 筛查率的干预措施应认识到患者心理状态的作用，以提高其做出知情决策的可能性，并提高筛查的适当性。
