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Informed consent for cancer screening with prostate-specific antigen: how well are men getting the message?
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P.R. Carroll / Urologic Oncology: Seminars and Original Investigations 21 (2003) 480 – 491
Commentary The authors of this study suggest that the reduction in mortality seen in African American and White men reflects the increased use of serum PSA testing that occurred in the mid-1980s. The enthusiasm for this concept must be balanced by other findings. Lu-Yao et al. found that the more intensive screening for prostate cancer and aggressive treatment with radical prostatectomy and external beam radiotherapy among Medicare beneficiaries in the Seattle area as compared to the Connecticut area was not associated with lower prostate cancer specific mortality over 11 years of follow up [1]. In addition, physicians interested and committed to early detection efforts should be advised that recent results of screening trials performed in Europe suggest that the prostate cancer over-detection rate could be as high as 50% [2]. doi:10.1016/S1078-1439(03)00149-2 Peter R. Carroll, M.D.
References [1] Lu-Yao G, Albertsen PC, Stanford JL, et al. Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut. Br Med J 2002;325:740. [2] Draisma G, Boer R, Otto SJ, et al. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 2003;95:868 – 878.
Informed consent for cancer screening with prostate-specific antigen: how well are men getting the message? Chan EC, Vernon SW, O’Donnell FT, Ahn C, Greisinger A, Aga DW, Division of General Internal Medicine, University of Texas-Houston Medical School, Houston, TX. Am J Public Health 2003;93:779 –785. Objectives: This study examined knowledge about prostate-specific antigen (PSA) screening among African Americans and Whites: Because PSA screening for prostate cancer is controversial, professional organizations recommend informed consent for screening. Methods: Men (n ⫽ 304) attending outpatient clinics were surveyed for their knowledge about and experience with screening. Results: Most men did not know the key facts about screening with PSA. African Americans appeared less knowledgeable than Whites, but these differences were mediated by differences in educational level and experience with prostate cancer screening. Conclusions: Public health efforts to improve informed consent for prostate cancer screening should focus on highlighting the key facts and developing different approaches for men at different levels of formal education and prior experience with screening.
Commentary Despite the promulgation of guidelines on the issues associated with prostate cancer screening, Chan and colleagues showed that most men do not know the key facts about prostate cancer and/or screening with serum PSA. The survey was composed of 36 questions covering knowledge about prostate cancer, screening and treatment. Differences in knowledge appear to be more related to educational level than ethnicity. Although this issue deals only with screening, patients face similar levels of uncertainty when discussing treatment options after being diagnosed with prostate cancer [1]. doi:10.1016/S1078-1439(03)00156-X Peter R. Carroll, M.D.
Reference [1] Fowler FJ Jr, McNaughton CM, Albertsen PC, Zietman A, Elliott DB, Barry MJ. Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer. JAMA 2000;283:3217–3222.
Nomograms are superior to staging and risk grouping systems for identifying high-risk patients: preoperative application in prostate cancer. Kattan MW, Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY. Curr Opin Urol 2003; 13:111–116. Purpose of Review: We outline a generic approach to using a nomogram to predict a continuous probability of failure in high-risk patients (rather than putting patients into groups), to identify patients whose risk exceeds a cutoff point. We discuss the goals of any staging system, what markers should be included, and models of markers.
P.R. Carroll / Urologic Oncology: Seminars and Original Investigations 21 (2003) 480 – 491
Commentary The authors of this study suggest that the reduction in mortality seen in African American and White men reflects the increased use of serum PSA testing that occurred in the mid-1980s. The enthusiasm for this concept must be balanced by other findings. Lu-Yao et al. found that the more intensive screening for prostate cancer and aggressive treatment with radical prostatectomy and external beam radiotherapy among Medicare beneficiaries in the Seattle area as compared to the Connecticut area was not associated with lower prostate cancer specific mortality over 11 years of follow up [1]. In addition, physicians interested and committed to early detection efforts should be advised that recent results of screening trials performed in Europe suggest that the prostate cancer over-detection rate could be as high as 50% [2]. doi:10.1016/S1078-1439(03)00149-2 Peter R. Carroll, M.D.
References [1] Lu-Yao G, Albertsen PC, Stanford JL, et al. Natural experiment examining impact of aggressive screening and treatment on prostate cancer mortality in two fixed cohorts from Seattle area and Connecticut. Br Med J 2002;325:740. [2] Draisma G, Boer R, Otto SJ, et al. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst 2003;95:868 – 878.
Informed consent for cancer screening with prostate-specific antigen: how well are men getting the message? Chan EC, Vernon SW, O’Donnell FT, Ahn C, Greisinger A, Aga DW, Division of General Internal Medicine, University of Texas-Houston Medical School, Houston, TX. Am J Public Health 2003;93:779 –785. Objectives: This study examined knowledge about prostate-specific antigen (PSA) screening among African Americans and Whites: Because PSA screening for prostate cancer is controversial, professional organizations recommend informed consent for screening. Methods: Men (n ⫽ 304) attending outpatient clinics were surveyed for their knowledge about and experience with screening. Results: Most men did not know the key facts about screening with PSA. African Americans appeared less knowledgeable than Whites, but these differences were mediated by differences in educational level and experience with prostate cancer screening. Conclusions: Public health efforts to improve informed consent for prostate cancer screening should focus on highlighting the key facts and developing different approaches for men at different levels of formal education and prior experience with screening.
Commentary Despite the promulgation of guidelines on the issues associated with prostate cancer screening, Chan and colleagues showed that most men do not know the key facts about prostate cancer and/or screening with serum PSA. The survey was composed of 36 questions covering knowledge about prostate cancer, screening and treatment. Differences in knowledge appear to be more related to educational level than ethnicity. Although this issue deals only with screening, patients face similar levels of uncertainty when discussing treatment options after being diagnosed with prostate cancer [1]. doi:10.1016/S1078-1439(03)00156-X Peter R. Carroll, M.D.
Reference [1] Fowler FJ Jr, McNaughton CM, Albertsen PC, Zietman A, Elliott DB, Barry MJ. Comparison of recommendations by urologists and radiation oncologists for treatment of clinically localized prostate cancer. JAMA 2000;283:3217–3222.
Nomograms are superior to staging and risk grouping systems for identifying high-risk patients: preoperative application in prostate cancer. Kattan MW, Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY. Curr Opin Urol 2003; 13:111–116. Purpose of Review: We outline a generic approach to using a nomogram to predict a continuous probability of failure in high-risk patients (rather than putting patients into groups), to identify patients whose risk exceeds a cutoff point. We discuss the goals of any staging system, what markers should be included, and models of markers.