The fear of prostate cancer in men with lower urinary tract symptoms: should symptomatic men be screened?

Abstract

OBJECTIVETo explore the concerns and worries in men with uncomplicated lower urinary tract symptoms (LUTS, but no evidence of prostate cancer) relating to their symptoms. PATIENTS AND METHODSThere is no current prostate cancer screening programme in the UK. Evidence suggests that men with LUTS have the same risk of prostate cancer as aged-matched asymptomatic men. However, most men with LUTS are 'screened' with a digital rectal examination (DRE) and prostate specific antigen (PSA) testing as part of routine assessment. Whether this screening offers any benefit to patients and whether national screening for prostate cancer and subsequent early treatment offer any long-term survival or quality of life benefit is uncertain. Thus 30 men with uncomplicated LUTS were qualitatively interviewed to explore their concerns and worries about their symptoms. Interviews were transcribed verbatim and subjected to content analysis using validated techniques. RESULTSOf the 30 men, 22 (73%) expressed a fear of prostate cancer at the time of their initial presentation. This fear was independent of race, social class and symptom severity; older men were less worried. Of the 22, 15 (68%) stated that after reassurance their symptoms were less bothersome and easier to cope with. CONCLUSIONSThese findings suggest there is a considerable gain in health by explicitly addressing the concerns of prostate cancer in men with uncomplicated LUTS. Informing these men of their true risk of prostate cancer (before or after a DRE and PSA estimate) may alleviate much of the bother associated with their symptoms. Despite no evidence of any greater risk of prostate cancer than in asymptomatic men, symptomatic men should continue to be screened after appropriate counselling.

Lower urinary tract symptoms and risk of prostate cancer in Japanese men

“…These biopsy rates were not significantly different between the two groups. Of the 178 men who underwent biopsy, 117 (66%) had low symptom scores (0-7), 50 (28%) had moderate scores (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and 11 (6%) had severe scores (20-35). There was no significant intergroup difference in mean age in the men who underwent biopsy.…”

“…This might be because the number of men who had abnormally high IPSS scores of 20-35 was as low as 11 (6%) out of the total of 178 who were biopsied and, therefore, prostate volume did not differ appreciably between the 0-7 and 8-35 IPSS groups. In the report by Porter and Kim, 14 41, 32 and 27% of men had low (0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)) and severe (20-35) scores, respectively. There might also be a point of difference between races.…”

“…Several researchers have reported that symptomatic men perceive they are more predisposed to prostate cancer than asymptomatic men and, therefore, actively consult urology clinics. 4,16 However, there is no evidence that such men carry any greater risk of prostate cancer than asymptomatic men. The presence of LUTS does not differentiate men with and without prostate cancer.…”

An Object Lesson: Source Determines the Relations That Trait Anxiety, Prostate Cancer Worry, and Screening Fear Hold with Prostate Screening Frequency

“…African Americans report greater fear of prostate cancer and screening, particularly for DRE (17,18), although there are exceptions (19). One study of 180 men found that both African American and Jamaican men reported greater screening fear than European Americans (20).…”

The measurement of psychological distress in men being investigated for the presence of prostate cancer

“…6 Although men with lower urinary tract symptoms (LUTS) are not at a greater risk of prostate cancer as compared to asymptomatic men of the same age, 7 men presenting with LUTS in the United Kingdom do express anxiety about prostate cancer. 8 Various conditions inducing anxiety that relate to the measurement of prostate-specific antigen (PSA) have been described. These include PSA-itis (anxiety related to the knowledge of serum PSA) 9 and PSA-dynia (a state of emotional or physical distress due to an elevated PSA level).…”