Prostate cancer: To screen or not to screen

Men with a family history of prostate cancer who are confused about whether to undergo controversial screening could soon have access to an online resource to have their questions answered.

A world-first education tool for high risk men has been developed by researchers at the University of New South Wales (UNSW). The web-based tool has shown positive results in early trials in providing men with the information they need to make screening decisions.

Results of the trial are published this month in the journal Patient Education and Counselling.

“Research suggests that men with a family history of prostate cancer have a significant unmet need when it comes to information and strong desire for more information about their personal risk and treatment options,” said study co-author Associate Professor Bettina Meiser, from UNSW’s Prince of Wales Clinical School.

In Australia, screening is offered in the form of a serum Prostate Specific Antigen (PSA), which is often combined with a digital rectal examination. Yet there is considerable controversy surrounding the pros and cons of screening and men with a family history of prostate cancer often face a difficult decision.

While studies show regular testing can lead to a reduction in the risk of death, screening is also associated with a high risk of false positive results and unnecessary treatment.

Study co-author Dr Claire Wakefield, from UNSW’s School of Women’s and Children’s Health, said: “In light of the trade-off between potential benefits and harms, it is all the more important that men make their decisions based on all the information available. “Using our tool, men can better understand the chances of being diagnosed with, and dying from, prostate cancer over the next 10 years if they choose to have an annual PSA test, compared to no screening,” she said.

All participants in the trial said the tool was easy to use, with seven out of 10 reporting the web as their preferred mode of receiving prostate cancer screening information.

While not designed to be replacement for face-to-face advice, the resource will be made available via high-quality Australian cancer-related websites, such as the Cancer Council and could be a valuable adjunct to traditional counselling.

A larger trial of the web-based tool is now underway and men aged between 40 and 79 years who have never had prostate cancer themselves but have a family history of prostate cancer are invited to take part. For eligible men who enrol in the study, $20 will be donated to the Cancer Council of NSW for prostate cancer research.

Potential study participants should go to the secure study website: www.prostatescreening.org.au and follow the instructions.