Men's preferences for prostate cancer screening: a discrete choice experiment.
BACKGROUND
Screening for prostate cancer (PC) may save lives, but overdiagnosis and overtreatment are serious drawbacks. We aimed to determine men's preferences for PC screening, and to elicit the trade-offs they make.


METHODS
A discrete choice experiment (DCE) was conducted among a population-based random sample of 1000 elderly men (55-75-years-old). Trade-offs were quantified with a panel latent class model between five PC screening aspects: risk reduction of PC-related death, screening interval, risk of unnecessary biopsies, risk of unnecessary treatments, and out-of-pocket costs.


RESULTS
The response rate was 46% (459/1000). Men were willing to trade-off 2.0% (CI: 1.6%-2.4%) or 1.8% (CI: 1.3%-2.3%) risk reduction of PC-related death to decrease their risk of unnecessary treatment or biopsy with 10%, respectively. They were willing to pay €188 per year (CI: €141-€258) to reduce their relative risk of PC-related death with 10%. Preference heterogeneity was substantial, with men with higher educational levels having a lower probability to opt for PC screening than men with lower educational levels.


CONCLUSIONS
Men were willing to trade-off some risk reduction of PC-related death to be relieved of the burden of biopsies or unnecessary treatments. Increasing knowledge on overdiagnosis and overtreatment, especially for men with lower educational levels, is warranted to prevent unrealistic expectations from PC screening.
Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. e.debekker@erasmusmc.nl
E W
EW
de Bekker-Grob
J M
JM
Rose
B
B
Donkers
M-L
ML
Essink-Bot
C H
CH
Bangma
E W
EW
Steyerberg
D000368:Aged; D002755:Choice Behavior; D055088:Early Detection of Cancer; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D012307:Risk Factors; D040242:Risk Reduction Behavior
D017430:Prostate-Specific Antigen