Clinical Health Updates

False-positive PSA associated with increased worry, fears

Clinical Question:
Do men who receive a positive prostate specific antigen (PSA) test result subsequently shown to be wrong worry more about prostate cancer than men who receive a negative result?

Bottom Line:
False positive results of screening tests are not benign but carry with them a psychological cost. As with women receiving false-positive mammogram results, men receiving false-positive prostate specific antigen (PSA) test results report having thought and worried more about prostate cancer despite receiving a negative follow-up test (prostate biopsy) result. They also think, like women, that the false-positive result makes them more likely to develop prostate cancer. Screening can be bad for our patients’ mental health.

Reference:
McNaughton -Collins M, Fowler FJ, Caubet JF, et al. Psychological effects of a suspicious prostate cancer screening test followed by a benign biopsy result. Am J Med 2004;117:719-25.

Study Design:
Cohort (prospective)

Synopsis:
The authors evaluated the psychological implications of an apparently false-positive screening result for prostate cancer. The sample comprised 167 men with a benign biopsy result in response to a suspicious screening test result (biopsy group) and 233 men with a normal prostate-specific antigen (PSA) test result (control group). The men responded to a questionnaire within about 6 weeks of their biopsy or PSA results. They were asked about demographic characteristics, medical history, psychological effects, biopsy experience, and prostate cancer knowledge. The survey response rate was 85% (400/471). The mean (+/- SD) age of respondents was 60 +/- 9 years (range, 40 to 88 years); 88% (n = 350) were white. Forty-nine percent (81/167) of men in the biopsy group reported having thought about prostate cancer either “a lot” or “some of the time”, compared with 18% (42/230) in the control group (P < 0.001). In addition, 40% (67/167) in the biopsy group reported having worried “a lot” or “some of the time” that they may develop prostate cancer, compared with 8% (18/231) in the control group (P < 0.001).