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      Patterns of prostate-specific antigen (PSA) testing in Australian men: the influence of family history : INFLUENCE OF FAMILY HISTORY ON PATTERNS OF PSA TESTING IN AUSTRALIAN MEN

      ,   , ,
      BJU International
      Wiley

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          Abstract

          To describe how a family history of prostate cancer influences men's prostate cancer testing behaviours, information support preferences, and motives for testing. Men with a first-degree family history (239 men) and a comparison sample from the general population of Queensland, Australia (289) aged 40-65 years, and no prior history of cancer. Cross-sectional, retrospective survey assessing: prevalence of prostate-specific antigen (PSA) testing and digital rectal examination (DRE); discussion of prostate cancer risks and benefits with a physician; prostate cancer information needs and preferences; motivations for testing. Men with a family history were more likely to report: having ever had a PSA test (odds ratio [OR] 4.98; 95% confidence interval [CI] 3.16-7.85), more PSA tests in their lifetimes (b 1.04; se 0.40; 95% CI 0.26-1.82); to have had a DRE (OR 2.23; 95% CI 1.54-3.23); to have spoken to a doctor about prostate cancer (OR 3.72; 95% CI 2.30-6.02); and to have instigated these discussions (OR 1.74; 95%CI 1.13-2.70). Most men from both groups did not recall any discussion of the 'cons' of prostate cancer testing with a doctor. Men with a family history reported a greater desire for information about prostate cancer prevention than did men without a family history. Men with a family history are more concerned about getting prostate cancer and are tested more often; however, information needs, discussions about prostate cancer, and motivations for testing are similar to those of all men. There appears to be a disparity between public health approaches that promote informed decision-making and what is happening in practice. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

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          Most cited references10

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          American Cancer Society guideline for the early detection of prostate cancer: update 2010.

          In 2009, the American Cancer Society (ACS) Prostate Cancer Advisory Committee began the process of a complete update of recommendations for early prostate cancer detection. A series of systematic evidence reviews was conducted focusing on evidence related to the early detection of prostate cancer, test performance, harms of therapy for localized prostate cancer, and shared and informed decision making in prostate cancer screening. The results of the systematic reviews were evaluated by the ACS Prostate Cancer Advisory Committee, and deliberations about the evidence occurred at committee meetings and during conference calls. On the basis of the evidence and a consensus process, the Prostate Cancer Advisory Committee developed the guideline, and a writing committee drafted a guideline document that was circulated to the entire committee for review and revision. The document was then circulated to peer reviewers for feedback, and finally to the ACS Mission Outcomes Committee and the ACS Board of Directors for approval. The ACS recommends that asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after they receive information about the uncertainties, risks, and potential benefits associated with prostate cancer screening. Prostate cancer screening should not occur without an informed decision-making process. Men at average risk should receive this information beginning at age 50 years. Men in higher risk groups should receive this information before age 50 years. Men should either receive this information directly from their health care providers or be referred to reliable and culturally appropriate sources. Patient decision aids are helpful in preparing men to make a decision whether to be tested. Copyright 2010 American Cancer Society, Inc.
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            International epidemiology of prostate cancer: geographical distribution and secular trends.

            This review outlines current international patterns in prostate cancer incidence and mortality rates and survival, including recent trends and a discussion of the possible impact of prostate-specific antigen (PSA) testing on the observed data. Internationally, prostate cancer is the second most common cancer diagnosed among men (behind lung cancer), and is the sixth most common cause of cancer death among men. Prostate cancer is particularly prevalent in developed countries such as the United States and the Scandinavian countries, with about a six-fold difference between high-incidence and low-incidence countries. Interpretation of trends in incidence and survival are complicated by the increasing impact of PSA testing, particularly in more developed countries. As Western influences become more pronounced in less developed countries, prostate cancer incidence rates in those countries are tending to increase, even though the prevalence of PSA testing is relatively low. Larger proportions of younger men are being diagnosed with prostate cancer and living longer following diagnosis of prostate cancer, which has many implications for health systems. Decreasing mortality rates are becoming widespread among more developed countries, although it is not clear whether this is due to earlier diagnosis (PSA testing), improved treatment, or some combination of these or other factors.
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              Decision-making processes for breast, colorectal, and prostate cancer screening: the DECISIONS survey.

              Patients should understand the risks and benefits of cancer screening in order to make informed screening decisions. To evaluate the extent of informed decision making in patient-provider discussions for colorectal (CRC), breast (BrCa), and prostate (PCa) cancer screening. National sample of US adults identified by random-digit dialing. Cross-sectional survey conducted between November 2006 and May 2007. English-speaking US adults aged 50 y and older who had discussed cancer screening with a health care provider within the previous 2 y. Cancer screening survey modules that asked about demographic characteristics, cancer knowledge, the importance of various sources of information, and self-reported cancer screening decision-making processes. Overall, 1082 participants completed 1 or more of the 3 cancer modules. Although participants generally considered themselves well informed about screening tests, half or more could not correctly answer even 1 open-ended knowledge question for any given module. Participants consistently overestimated risks for being diagnosed with and dying from each cancer and overestimated the positive predictive values of prostate-specific antigen tests and mammography. Providers were the most highly rated information source, usually initiated screening discussions (64%-84%), and often recommended screening (73%-90%). However, participants reported that providers elicited their screening preferences in only 31% (CRC women) to 57% (PCa) of discussions. Although more than 90% of the discussions addressed the pros of screening, only 19% (BrCa) to 30% (PCa) addressed the cons of screening. Recall bias is possible because screening process reports were not independently validated. Cancer screening decisions reported by patients who discussed screening with their health care providers consistently failed to meet criteria for being informed. Given the high ratings for provider information and frequent recommendations for screening, providers have important opportunities to ensure that informed decision making occurs for cancer screening decisions.
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                Author and article information

                Journal
                BJU International
                Wiley
                14644096
                April 2012
                April 2012
                March 28 2012
                : 109
                : 64-70
                Article
                10.1111/j.1464-410X.2012.11050.x
                22458497
                5de231ba-3914-486d-b84b-156413312a01
                © 2012

                http://doi.wiley.com/10.1002/tdm_license_1.1

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