Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UK
Measuring the psychosocial impact of population-based prostate-specific antigen testing for prostate cancer in the UK
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DOI：
10.1111/j.1464-410x.2006.06401.x
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发表时间：
2006-10-01
影响因子：
4.5
通讯作者：
Peters, Tim J.
中科院分区：
文献类型：
--
作者：
Brindle, Lucy A.;Oliver, Steven E.;Peters, Tim J.
目的：评估参与基于人群的前列腺特异性抗原（PSA）检测项目（类似于筛查）的心理社会影响，并探讨PSA检测前报告的泌尿系统症状与随后PSA结果的反应之间的关系。患者和方法：这项前瞻性问卷研究嵌套在ProtecT（前列腺癌检测和治疗）可行性研究（ISRCTN20141297）的病例发现部分。来自英国三个城市18个全科诊所的年龄在50-69岁的男性在同意在社区诊所进行PSA测试（基线）之前，完成了医院焦虑和抑郁量表（HADS）、简短表格12 （SF-12）健康调查和国际尿失禁协会“男性”（ICS男性）问卷调查。PSA结果“异常”的男性返回进行进一步调查（包括活检），并在活检前重复这些问卷。结果：在基线时，研究参与者的焦虑和抑郁水平与普通男性人群相似。在接受“异常”PSA结果后到活检诊所就诊的患者，HADS评分没有增加，SF-12心理健康成分总结评分也没有降低。在接受PSA结果（基线）之前，泌尿系统症状与焦虑和抑郁水平相关，但在活检时与焦虑和抑郁无关，独立于基线评分。因此，活检时焦虑或抑郁的变化在有和没有泌尿系统症状的患者之间似乎没有差异。结论：本研究证实了其他研究的发现，即在人群筛查期间接受异常PSA结果的有害影响不能通过一般健康状况问卷确定。与测量癌症特异性痛苦和使用定性研究方法的研究结果的比较提出了是否需要前列腺癌筛查特异性仪器的问题。然而，一项标准化的焦虑测量确定了有和没有报告泌尿系统症状的人在基线上的差异。这些发现表明，更好地告知接受PSA检测的男性泌尿系统症状与前列腺癌之间的不确定关系，以尽量减少心理困扰的基线水平，可能是明智的。
OBJECTIVE To evaluate the psychosocial impact of participation in a population-based prostate-specific antigen (PSA) testing programme, akin to screening, and to explore the relationship between urinary symptoms reported before PSA testing and the response to the subsequent PSA result.PATIENTS AND METHODS This prospective questionnaire study was nested within the case-finding component of the ProtecT (prostate testing for cancer and treatment) feasibility study (ISRCTN20141297). Men aged 50-69 years from 18 general practices in three cities in the UK completed the Hospital Anxiety and Depression Scale (HADS), the Short Form-12 (SF-12) Health Survey, and the International Continence Society 'male' (ICS male) questionnaires before giving consent for a PSA test in a community clinic (baseline). Men with an 'abnormal' PSA result returned for further investigation (including biopsy) and repeated these questionnaires before biopsy.RESULTS At baseline, study participants had similar levels of anxiety and depression to the general male population. There was no increase in the HADS scores, or reduction in the SF-12 mental health component summary score, on attendance at the biopsy clinic after receiving an 'abnormal' PSA result. Urinary symptoms were associated with levels of anxiety and depression before receiving a PSA result (baseline), but were not associated with anxiety and depression at biopsy independently of baseline scores. Therefore changes in anxiety or depression at biopsy did not appear to differ between those with and without urinary symptoms.CONCLUSIONS This study confirms the findings of other studies that the deleterious effects of receiving an abnormal PSA result during population screening are not identified by generic health-status questionnaires. Comparisons with outcomes of studies measuring cancer-specific distress and using qualitative research methods raise the question of whether a prostate cancer screening-specific instrument is required. However, a standardized measure of anxiety identified differences at baseline between those who did and did not report urinary symptoms. These findings suggest that it might be advisable to better inform men undergoing PSA testing about the uncertain relationship between urinary symptoms and prostate cancer, to minimize baseline levels of psychological distress.