title: Psychological impact of serial prostate-specific antigen tests in Japanese men waiting for prostate biopsy.
abstract: BACKGROUND
  It is common to repeat prostate-specific antigen (PSA) measurements for men with intermediate PSA elevation before prostate biopsy. In this scenario, men with persistently elevated PSA values may have considerable psychological distress. We attempted to determine whether elevated PSA values have psychological effects on these men in association with the timing of measurement, PSA kinetics, and biopsy results.
  
  
  METHODS
  In order to investigate the initial and late effects of PSA tests on psychological distress during serial measurements, two groups of men with screen-positive results (PSA ≥3 ng/ml) were studied-205 men whose first questionnaires regarding anxiety and depression were taken at initial screening (group A), and 103 men whose questionnaires were taken at repeated measurement for prior PSA elevation (group B).
  
  
  RESULTS
  The level of distress was generally low. There were no significant differences in distress between the two groups, suggesting a constant psychological effect by elevated PSA values over a long period of time. The distress of men in group A increased significantly as PSA levels rose and decreased when they fell to normal range. On the other hand, the distress of men in group B did not change regardless of PSA kinetics, indicating that their psychological condition seemed susceptible to subtle PSA change only in the initial phase of measurements. Unexpectedly, men with benign results showed insignificant but higher distress after prostate biopsy.
  
  
  CONCLUSIONS
  Although a small fraction of men have psychological distress caused by changes in PSA levels, the benefits, risks (psychological and physical), and limitations of PSA tests must be adequately explained to the patients before entering the screening program.
authors.affiliation: Department of Urology, Utsunomiya Memorial Hospital, 1-3-16, Ohdori, Utsunomiya, Tochigi, 320-0811, Japan. minorukoba@hotmail.com.
authors.forename: Minoru
authors.identifier: http://orcid.org/0000-0002-6859-7064
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Urology, Nasu Red Cross Hospital, Tochigi, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Nukui
authors.affiliation: Department of Urology, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Kamai
mesh_terms: D000368:Aged; D001007:Anxiety / Q000209:etiology*; D001706:Biopsy / Q000523:psychology; D003863:Depression / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000523:psychology*; D013315:Stress, Psychological / Q000175:diagnosis; D011795:Surveys and Questionnaires
chemical_list: D017430:Prostate-Specific Antigen
keywords: Anxiety; Depression; Prostate cancer; Prostate-specific antigen