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Even Benign Prostate Biopsies Increase Fear of Cancer

Men with elevated PSA levels but benign pathology results were more likely to be worried about developing prostate cancer than were men who had never undergone biopsy.

One of the major concerns about using prostate specific antigen (PSA) assays for prostate cancer screening is the high rate of false-positive results that trigger unnecessary prostate biopsies. Boston investigators quantified the psychological effect of prostate biopsy, even with benign results. They compared 167 men who had suspicious PSA results but benign pathology results after prostate biopsies with 233 men who had normal PSA results (mean age of all respondents, 60). Subjects and controls were surveyed within 6 weeks of their biopsies or PSA results.

Compared with controls, men who had undergone biopsies were significantly more likely to have had histories of benign prostatic hyperplasia (13% vs. 34%) and prostatitis (9% vs. 23%); 73 biopsy subjects reported having undergone two or more biopsies. Compared with controls, biopsy subjects were more likely to report thinking "a lot" or "some" about prostate cancer (18% vs. 49%), being worried "a lot" or "some" that they might develop prostate cancer (8% vs. 40%), and thinking that their chances of developing prostate cancer were "much more" or "a little more" than average (18% vs. 36%).

Comment: A benign result on prostate biopsy apparently has little reassurance value and actually might increase a patient's anxiety about developing prostate cancer. Such psychological issues should be addressed in discussions with patients about prostate cancer screening.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine December 17, 2004

Citation(s):

McNaughton-Collins M et al. Psychological effects of a suspicious prostate cancer screening test followed by a benign biopsy result. Am J Med 2004 Nov 15; 117:719-25.

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