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Print, web aids help men decide on cancer screening

By Genevra Pittman

NEW YORK (Reuters Health) - Both print and online tools outlining the possible benefits and harms of prostate cancer screening can help men understand the disease and feel more confident in their screening-related decisions, a new study suggests.

Researchers found, however, that men who had access to those decision aids weren't any more or less likely to be screened in the following year than those who didn't receive extra information.

"We really wanted to develop something that clearly presented both sides of the issue so that men could make an informed decision with regards to whether they wanted to undergo screening," said Kathryn Taylor, who led the new study at Georgetown University in Washington, D.C.

Last year, the U.S. Preventive Services Task Force (USPSTF), a government-backed panel, recommended against prostate specific antigen (PSA) tests for average-risk men.

Other groups, including the American Urological Association, say men of certain ages should weigh the risks and benefits with their doctors and come to an individual decision about screening.

Data conflict about whether screening saves any lives. It's clearer that treatment after a positive test and biopsy can cause side effects, such as impotence and incontinence, and that some cancers picked up on screening would never have caused symptoms because they are so slow-growing.

Taylor and her colleagues randomly assigned close to 1,900 middle-aged men to receive print or Internet-based prostate cancer decision aids or no extra information.

Both tools contained information on the prostate gland, prostate cancer screening tests and treatment options, as well as prompts to help men define their screening-related values and encouragement to talk about screening with a doctor. The web version also included video testimonials and pop-up definitions of some terms.

Before receiving any information, men in each of the three groups scored an average of 10.4 on an 18-question exam about prostate cancer. One month later, men who had received either print or web decision aids scored a 13.5, versus 11.1 among those in the comparison group.

Those differences shrank slightly but remained a year later, the study team wrote in JAMA Internal Medicine.

One thing that didn't change was the proportion of men who decided to get screened: across study groups, between 45 and 48 percent of participants had a PSA test in the year following the study.

But after receiving decision aids, 60 percent of those in the print group and 52 percent in the web-based group reported a high satisfaction with their screening decisions, compared to 46 percent of the men who received usual care.

Taylor said lingering uncertainty about the PSA test and its potential benefits may have contributed to men continuing to get screened.

"The fact that it's easy to do, the fact that many doctors recommend it or perhaps don't discuss it and just do it, all make it easier to just undergo the test," she told Reuters Health.

Dr. Daniel Reuland from the University of North Carolina at Chapel Hill, who co-wrote a commentary published with the study, said it's not obvious the information men took away from the aids helped them make informed decisions about screening.

"I don't think it's clear from the study whether the knowledge that they gained and retained, how clinically important it is and whether it's sufficient to counteract known biases," he told Reuters Health.

"Men overestimate the likelihood that the PSA test is going to benefit them and underestimate the likelihood it's going to harm them."

In a separate study published in the American Journal of Preventive Medicine, researchers led by Linda Squiers at RTI International in Rockville, Maryland, surveyed 1,100 men about the new USPSTF recommendations while they were in draft form.

Although 62 percent of men agreed with the recommendation after reviewing it, only 13 percent intended to follow the new guidelines and not be screened.

Taylor said before going in to see their doctors, men can read up about screening on the USPSTF, National Cancer Institute and Centers for Disease Control and Prevention websites.

"Before undergoing screening, men really should educate themselves about the benefits and limitations," she said - including about all of the tests and procedures that could follow a positive PSA test.

"It's more than just thinking about, should I get this blood test or not?" she said.

SOURCES: http://bit.ly/1e8V1kP JAMA Internal Medicine, online July 29, 2013 and American Journal of Preventive Medicine, August 2013.

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