Prostate Health Awareness Project

Prostate cancer is the most commonly diagnosed cancer and the third leading cause of cancer death among men in the United States. African-American men have a 60% higher incidence rate and are twice as likely to die from prostate cancer as White men. Currently, the efficacy of screening asymptomatic men for prostate cancer is still being studied. While prostate cancer is being diagnosed at earlier stages, and prostate cancer mortality has decreased since the advent of prostate specific antigen (PSA) testing, there is no definitive evidence that early diagnosis and treatment reduces disease-related mortality. As a result, the medical community does not agree on the merits of prostate cancer screening, and millions of asymptomatic men undergo screening each year. Most of these men believe the medical community agrees on the merits of such screening. The disadvantages of screening asymptomatic men include over-diagnosis and detection of disease that otherwise would not have caused a clinical problem. It is important to promote informed decision making concerning prostate cancer screening. This can be accomplished by providing men with accurate and balanced information on the risks, benefits, and limitations of prostate cancer screening. 

African-American men are more likely to have friends and family members affected by prostate cancer. There are also many messages in the media and medical community that favor screening. As a result, African-American men may believe strongly in the benefits (and lack of risks) of prostate cancer screening. However, there is also a strong social stigma attached to the exams and cancer screening in general, so this may cause conflict. It is therefore a challenge to communicate the controversy surrounding screening. To date, much information about men's understanding of the controversy and the development of effective methods for communicating the controversy have been developed using samples of primarily White men. It is important to develop effective messages that readily reach African-American men, conveying information from trusted experts regarding the pros and cons of prostate cancer screening and encouraging discussion within social networks. This approach can facilitate informed decisions regarding the appropriateness of screening for the individual.

In the Prostate Health Awareness Project, an educational intervention, participants are mailed packets of materials designed specifically for African-American men presenting balanced information on the risks and benefits of prostate cancer screening. The materials do not provide recommendations for or against screening, and they do not include information about local prostate cancer screening locations. Rather, they encourage men to reach their own decisions in collaboration with their physicians and family members. 

The materials include a printed 16-page booklet and a video. The booklet includes information on prostate cancer symptoms, anatomy and function of the prostate, prostate cancer risk factors, risks and benefits of screening, sample questions for men to ask their doctors, and a glossary of terms. The 25-minute video features a story about a middle-aged African-American man as he discusses prostate cancer screening with his friends, family, and physician. The story portrays his journey to understand the pros and cons of screening through his discussions. In the doctor's office, he is shown diagrams of the prostate and given rationale for and against screening. In addition, both the booklet and video feature Frank Robinson - not only a National Baseball Hall of Fame ballplayer and the first African-American manager of a major league baseball team, but a prostate cancer survivor as well. 

To administer the Prostate Health Awareness Project, time is required for:

 - Program coordinator to send materials (i.e., creating a packet by putting the booklet or DVD in an envelope, addressing it, adding postage, and mailing it); approximately 5 minutes per packet

 - Participants to read the 16-page printed participant guide, 15-30 minutes, depending on the individual reader

 - Participants to watch the DVD, 25 minutes

The primary audience for the Prostate Health Awareness Project is adult African-American men aged 40-70 years.

The Prostate Health Awareness Project is designed to be administered to participants in their homes, community-based, or clinical settings. 

The Prostate Health Awareness Project toolkit includes the following materials:

 - Participant guide-"The Right Decision Is Yours: A Guide to Prostate Cancer Checkups"
 - Participant DVD- "The Right Decision Is Yours: A Guide to Prostate Cancer Checkups"

Participants included 238 African-American men, aged 40-70, who were members of the Most Worshipful Prince Hall Grand Lodge in Washington, DC, which consists of 27 lodges, each with 100 or more members. To be eligible, the men could not have participated in the focus groups when intervention materials were developed, and they could not have a history of prostate cancer. Participants were recruited between January 2001 and August 2002. Within each lodge, a coordinator (who was paid $50 for his assistance in recruiting participants) helped to identify potential participants. A research assistant followed up to enroll the eligible men and conduct the baseline interview. 

Following completion of a baseline interview, participants were randomly assigned to one of three study arms: (a) video-based information, (b) print-based information, or (c) wait-list control. Participants in the print and videotape arms of the study were mailed a cover letter, the intervention materials, and the written consent form. The cover letter included a statement about the rationale for the study, length of time needed to watch the video and read the booklet, instructions for returning the consent form, a reminder about the 1-month follow-up interview, a request to not share the intervention materials with other Masons (to prevent contamination of the control group), and phone numbers to call for more information. 

At 1 month after the baseline interview, the video and print arm participants completed the first follow-up telephone assessment. Participants who reported they had not had a chance to read and watch the materials were given an additional week and were called again to complete their follow-up telephone assessment. Participants in the wait-list control group were called 1 month following study enrollment to complete their baseline interviews, were randomly assigned to either the print or videotape arm of the study, and 1 month later, received their follow-up telephone assessments. All participants received $25 after completion of their 1-month follow-up telephone assessment. At 1-year post-intervention, all participants completed a brief mailed questionnaire to assess whether they had undergone prostate cancer screening.  All follow-up interviews were completed by July 2003. 

• At the 1-month follow-up, both the print and video arms had a significant increase in knowledge about prostate cancer screening compared to baselines (p<.0001 for both groups). There were significant differences across groups, with knowledge about prostate cancer screening significantly higher in the print and video arms compared to the wait-list control group (p<.0001). 

• At the 1-month follow-up, the percentage of participants reporting high decisional conflict decreased significantly in those receiving the print arm (p<.0001). After adjusting for relevant covariates (i.e., demographics, previous prostate cancer screening), logistic regression revealed that relative to the wait-list control arm, the print and video arms both resulted in significantly reduced decision conflict (p<.01).

Additional Findings
Prostate cancer screening

• At the 1-year follow-up, there were no significant differences across groups with regard to rate of prostate cancer screening.