Kirkegaard Pia, Edwards Adrian, Nielsen Trine Laura Overgaard, Ørntoft Torben Falck, Sørensen Karina Dalsgaard, Borre Michael, Bro Flemming
Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NO, Denmark.
Division of Population Medicine, Cardiff University, Cardiff, UK.
BMC Fam Pract. 2018 Feb 17;19(1):32. doi: 10.1186/s12875-018-0717-6.
Most health authorities do not recommend screening for prostate cancer with PSA tests in asymptomatic patients who are not at increased risk. However, opportunistic screening for prostate cancer is still wanted by many patients and it is widely used in primary care clinics, with potential for overdiagnosis and overtreatment. Better tools for risk assessment have been called for, to better target such opportunistic screening. Our aim was to explore perceptions about prostate cancer risk and subsequent opportunistic screening among patients who were not at increased risk of prostate cancer after a first PSA test plus a genetic lifetime risk assessment.
We undertook semi-structured patient interviews with recording and verbatim transcription of interviews. Data were analysed thematically.
Three themes were identified: uncertainty of the nature of prostate cancer; perceived benefits of testing; and conflicting public health recommendations. Prostate cancer was spoken of as an inescapable risk in older age. The aphorism "you die with it, not from it" was prominent in the interviews but patients focused on the benefits of testing now rather than the future risks associated with treatment relating to potential overdiagnosis. Many expressed frustration with perceived mixed messages about early detection of cancer, in which on one side men feel that they are encouraged to seek medical testing to act responsibly regarding the most common cancer disease in men, and on the other side they are asked to refrain from opportunistic testing for prostate cancer. Taken together, personal risks of prostate cancer were perceived as high in spite of a normal PSA test and a genetic lifetime risk assessment showing no increased risk.
Patients saw prostate cancer risk as high and increasing with age. They focused on the perceived benefit of early detection using PSA testing. It was also commonly acknowledged that most cases are indolent causing no symptoms and not shortening life expectancy. There was a frustration with mixed messages about the benefit of early detection and risk of overdiagnosis. These men's genetic lifetime risk assessment showing no increased risk did not appear to influence current intentions to get PSA testing in the future.
大多数卫生当局不建议对无前列腺癌风险增加的无症状患者进行前列腺特异性抗原（PSA）检测筛查。然而，许多患者仍希望进行前列腺癌机会性筛查，并且该筛查在基层医疗诊所中广泛应用，存在过度诊断和过度治疗的可能性。人们呼吁使用更好的风险评估工具，以便更精准地进行此类机会性筛查。我们的目的是探讨首次PSA检测加上遗传终生风险评估后无前列腺癌风险增加的患者对前列腺癌风险以及后续机会性筛查的看法。
我们进行了半结构化患者访谈，并对访谈进行录音和逐字转录。对数据进行了主题分析。
确定了三个主题：前列腺癌性质的不确定性；检测的感知益处；以及相互矛盾的公共卫生建议。前列腺癌被视为老年人不可避免的风险。格言“你与它相伴而终，而非死于它”在访谈中很突出，但患者关注的是当下检测的益处，而非与潜在过度诊断相关的治疗未来风险。许多人对关于癌症早期检测的信息混乱表示沮丧，一方面男性觉得鼓励他们进行医学检测是对男性最常见癌症疾病负责，另一方面又要求他们避免进行前列腺癌机会性检测。尽管PSA检测正常且遗传终生风险评估显示风险未增加，但总体而言，患者认为个人患前列腺癌的风险很高。
患者认为前列腺癌风险很高且随年龄增长而增加。他们关注使用PSA检测进行早期检测的感知益处。人们也普遍认识到大多数病例进展缓慢，无症状且不缩短预期寿命。对于早期检测的益处和过度诊断风险的信息混乱，人们感到沮丧。这些男性的遗传终生风险评估显示风险未增加，这似乎并未影响他们未来进行PSA检测的当前意愿。
