Men's preferences and trade-offs for prostate cancer screening: a discrete choice experiment.
OBJECTIVE
Prostate cancer screening using prostate-specific antigen (PSA) remains controversial. In deciding about screening, men must weigh the benefits and harms: little is known about benefit: harm trade-offs men are willing to accept. The objective of this study was to assess men's preferences for PSA screening, and the trade-offs between benefits and harms men are willing to accept when deciding about screening.


METHODS
Preferences of 662 men aged 40-69 were assessed using a discrete choice experiment. PSA screening was described by six attributes: prostate cancer deaths, prostate cancer diagnoses, unnecessary biopsies from false-positive PSA tests, impotence, urinary incontinence/bowel problems and cost. A mixed logit model was used to examine the influence of attributes on men's preferences for PSA testing; benefit: harm trade-offs were also calculated.


RESULTS
Men's preferences were significantly influenced by test characteristics, particularly potential mortality benefit, unnecessary biopsies and likelihood of urinary incontinence or bowel problems; preferences were also influenced by age, prior PSA testing experience and perceived risk of prostate cancer. Men were willing to accept between 65 and 233 of 10 000 extra men with unnecessary biopsies, and between 31 and 72 of 10 000 extra men with incontinence/bowel problems to avoid one prostate cancer death.


CONCLUSIONS
Differences in valuations of attributes and trade-offs acceptable to men of different ages suggest a one size fits all approach to PSA testing, regardless of age, may not reflect men's preferences. Our results can be used by policymakers to ensure screening programmes are in line with men's preferences and by clinicians and patients to facilitate informed discussions of the most relevant benefits and downsides of PSA screening for an individual man.
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Kirsten
K
Howard
Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Glenn P
GP
Salkeld
Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
Manish I
MI
Patel
Westmead Clinical School, University of Sydney at Westmead Millennium Institute for Medical Research, Westmead, NSW, Australia.
Graham J
GJ
Mann
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Michael P
MP
Pignone
D000328:Adult; D000368:Aged; D002755:Choice Behavior; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D011795:Surveys and Questionnaires
D017430:Prostate-Specific Antigen
PSA; discrete choice experiment; preferences; prostate-specific antigen screening