Impact of prostate cancer testing: an evaluation of the emotional consequences of a negative biopsy result.
BACKGROUND
When testing for prostate cancer, as many as 75% of men with a raised prostate-specific antigen (PSA) have a benign biopsy result. Little is known about the psychological effect of this result for these men.


METHODS
In all, 330 men participating in the prostate testing for cancer and treatment (ProtecT) study were studied; aged 50-69 years with a PSA level of > or = 3 ng ml(-1) and a negative biopsy result. Distress and negative mood were measured at four time-points: two during diagnostic testing and two after a negative biopsy result.


RESULTS
The majority of men were not greatly affected by testing or a negative biopsy result. The impact on psychological health was highest at the time of the biopsy, with around 20% reporting high distress (33 out of 171) and tense/anxious moods (35 out of 180). Longitudinal analysis on 195 men showed a significant increase in distress at the time of the biopsy compared with levels at the PSA test (difference in Impact of Events Scale (IES) score: 9.47; 95% confidence interval (CI) (6.97, 12.12); P<0.001). These levels remained elevated immediately after the negative biopsy result (difference in score: 7.32; 95% CI (5.51, 9.52); P<0.001) and 12 weeks later (difference in score: 2.42; 95% CI (0.50, 1.15); P=0.009). Psychological mood at the time of PSA testing predicted high levels of distress and anxiety at subsequent time-points.


CONCLUSIONS
Most men coped well with the testing process, although a minority experienced elevated distress at the time of biopsy and after a negative result. Men should be informed of the risk of distress relating to diagnostic uncertainty before they consent to PSA testing.
Macefield
R C
RC
Department of Social Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
Metcalfe
C
C
Lane
J A
JA
Donovan
J L
JL
Avery
K N L
KN
Blazeby
J M
JM
Down
L
L
Neal
D E
DE
Hamdy
F C
FC
Vedhara
K
K
D000339:Affect; D000368:Aged; D000786:Anger; D001706:Biopsy; D003221:Confusion / Q000209:etiology; D003863:Depression / Q000209:etiology; D004644:Emotions; D005221:Fatigue / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology*; D018434:Sickness Impact Profile; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires; D016312:Treatment Refusal
D017430:Prostate-Specific Antigen