The PSA Test for Prostate Cancer: Is it Right for ME?

The significant impact of prostate cancer (CaP) on morbidity and mortality warrants a search for effective early detection and treatment strategies. However, evidence is inconclusive about whether mass prostate cancer screening and early treatment for prostate cancer can reduce mortality. It is therefore important that patients be informed about their choices and participate in decisions about screening. Prostate cancer videos, patient group discussions, and clinician scripts can increase prostate cancer screening knowledge and participation in decision making but can be difficult and costly to implement on a large scale. A mailed pamphlet approach is an attractive alternative strategy because it can be widely implemented at low cost and is as effective as a high-cost, higher-intensity video intervention.

The ''PSA Test for Prostate Cancer: Is it Right for ME?'' pamphlet is aimed at efficiently and effectively promoting informed prostate cancer screening decisions. The pamphlet provides a balanced representation of the potential risks and benefits of screening. Written at a 6th grade-reading level, the pamphlet defines the PSA and provides the reader with reasons why some doctors do not recommend prostate cancer screening. The pamphlet describes the prostate and prostate cancer, in addition to explaining how prostate cancer is different from other common conditions. Furthermore, the pamphlet summarizes the accuracy of the prostate-specific antigen (PSA) test and the unknown efficacy of prostate cancer treatments. The back of the pamphlet provides space for consumers to write questions for subsequent discussions with a health care provider.

Delivery time varies because the 8-page intervention pamphlet is self-administered.

The intended audience is males who are eligible for prostate cancer screening. Evaluation study participants were male veterans ages 50 years and older who had no prostate cancer and scheduled primary care appointments at one of four Veterans Affairs medical facilities in the Midwest. Approximately 80% of the participants finished high school; 95% were White.  Other participants were Alaskan Native, American Indian, Black, and Hispanic.

The intervention is suitable for implementation in a variety of settings but was evaluated in clinic and home settings.

The pamphlet, "The PSA Test for Prostate Cancer: Is it Right for ME?", is required. A cover letter, explaining the pamphlet's intent, is also required. The estimated cost of each pamphlet is less than $2.00.

893 men from four Midwestern Veteran Affairs medical facilities were randomly assigned to: 1) a comparison group that received usual care; 2) a pamphlet group; or 3) a video group. One week prior to a scheduled appointment with their primary care provider, participants were mailed a pamphlet or video, depending on the arm to which they were assigned. The pamphlet, written at a 6th grade-reading level, defined the prostate-specific antigen (PSA) test, and described the prostate and prostate cancer. Discussion about the accuracy of the PSA and the unknown efficacy of prostate cancer treatments provided readers with reasons why some doctors do not recommend the test. Video participants received a 23-minute video developed by the Foundation for Informed Medical Decision Making. Similar to the pamphlet, the video provided viewers with a balanced representation of the risks and benefits of screening. Participants were surveyed by phone approximately one week after their primary care appointments. PSA testing rates were assessed at 2 weeks and 1 year after primary care appointments, by examining records and procedural code information obtained through the Veterans Affairs' databases.

Results indicated:

• Pamphlet and video participants scored moderately higher than the control group on the mean knowledge index.
• Differences between pamphlet and video scores were not statistically significant.

• Pamphlet and video participants scored higher on individual knowledge questions on prostate cancer natural history, treatment efficacy, and expert disagreement about PSA testing.
• Pamphlet but not video participants were more likely to discuss screening with their primary care provider than control group participants.

• Participants who received the pamphlet and participants who received the video were less likely to intend to have a PSA, relative to the controls.