Communication message strategies for increasing knowledge about prostate cancer screening

Background. This community-based intervention study examined the effects of 2 different message strategies for presenting information about the prostate specific antigen (PSA) test. Methods. A quasi-experimental longitudinal design with 2 intervention and 1 control group. Results. Knowledge increased significantly among participants who received either version of the intervention message and remained elevated at 12 months. Presenting information in the context of other men’s health issues was associated with greater increases in knowledge relative to PSA only. Conclusions. Community-based interventions can increase knowledge about prostate cancer screening. Clinicians need to take careful account of what their patients understand and correct misperceptions.     

Psychological distress in spouses of men treated for early-stage prostate carcinoma

BACKGROUND: The authors examined levels and predictors of psychological distress in the wives of men treated for early-stage prostate carcinoma (PCa). METHODS: Patients with PCa (N = 165) and spouses were interviewed to assess general and cancer-specific distress. Social and intrapersonal factors of spouses as well as clinical characteristics and quality of life of patients were assessed as potential predictors of spouses' distress. RESULTS: Spouses reported more cancer-specific distress than did patients (P < 0.001), but did not differ from patients in general distress. Several spouse-reported factors predicted higher spouses' distress, including less education (P < 0.005), worse marriage quality and less social support (Ps < 0.005), more negative social interaction with the patient (Ps < 0.001), lower self-esteem (Ps < 0.001), less positive coping (Ps < 0.005), searching for meaning (P < 0.001), not finding meaning (P < 0.005), and greater illness uncertainty (Ps < 0.001). Patients' bowel function and mental health also predicted greater spouses' distress (Ps < 0.005). CONCLUSIONS: The findings indicated that overall distress in spouses of early-stage patients with PCa was modest, and it was more likely to be predicted by psychosocial than medical factors.     

Detection of ductal carcinoma in situ in women undergoing screening mammography

BACKGROUND: With the large number of women having mammography-an estimated 28.4 million U.S. women aged 40 years and older in 1998-the percentage of cancers detected as ductal carcinoma in situ (DCIS), which has an uncertain prognosis, has increased. We pooled data from seven regional mammography registries to determine the percentage of mammographically detected cancers that are DCIS and the rate of DCIS per 1000 mammograms. METHODS: We analyzed data on 653 833 mammograms from 540 738 women between 40 and 84 years of age who underwent screening mammography at facilities participating in the National Cancer Institute's Breast Cancer Surveillance Consortium (BCSC) throughout 1996 and 1997. Mammography results were linked to population-based cancer and pathology registries. We calculated the percentage of screen-detected breast cancers that were DCIS, the rate of screen-detected DCIS per 1000 mammograms by age and by previous mammography status, and the sensitivity of screening mammography. Statistical tests were two-sided. RESULTS: A total of 3266 cases of breast cancer were identified, 591 DCIS and 2675 invasive breast cancer. The percentage of screen-detected breast cancers that were DCIS decreased with age (from 28.2% [95% confidence interval (CI) = 23.9% to 32.5%] for women aged 40-49 years to 16.0% [95% CI = 13.3% to 18.7%] for women aged 70-84 years). However, the rate of screen-detected DCIS cases per 1000 mammograms increased with age (from 0.56 [95% CI = 0.41 to 0.70] for women aged 40-49 years to 1.07 [95% CI = 0.87 to 1.27] for women aged 70-84 years). Sensitivity of screening mammography in all age groups combined was higher for detecting DCIS (86.0% [95% CI = 83.2% to 88.8%]) than it was for detecting invasive breast cancer (75.1% [95% CI = 73.5% to 76.8%]). CONCLUSIONS: Overall, approximately 1 in every 1300 screening mammography examinations leads to a diagnosis of DCIS. Given uncertainty about the natural history of DCIS, the clinical significance of screen-detected DCIS needs further investigation.     

短期新辅助内分泌治疗对前列腺癌神经内分泌分化的影响

目的　探讨短期新辅助内分泌治疗对前列腺癌神经内分泌分化的影响 ,以及神经内分泌分化程度和肿瘤退化程度的关系。方法　采用嗜铬素A(ChA)和 5 羟色胺特异性免疫抗体作为神经内分泌细胞标记物 ,分析 18例前列腺癌患者内分泌治疗前后神经内分泌分化程度的差异。结果治疗前后 ,癌灶内神经内分泌肿瘤细胞数分别为 3.2× 10 5/ μm2 [(0～ 5 .7)× 10 5/ μm2 ]和 2 .3× 10 5/ μm2[(0～ 6 .6 )× 10 5/ μm2 ],差异无显著性 (P >0 .0 5 )。治疗前后神经内分泌肿瘤细胞百分比分别为7.0 % (0 %～ 14 .9% )和 4 .5 % (0 %～ 13.1% ) ,差异无显著性 (P >0 .0 5 )。 6例肿瘤中重度退化者与12例无退化或轻微退化者相比 ,癌灶内神经内分泌肿瘤细胞数差异无显著性 (P >0 .0 5 )。结论　短期新辅助内分泌治疗未导致明显前列腺癌神经内分泌细胞克隆增殖 ,治疗后肿瘤的退化程度和神经内分泌分化程度无明显相关性。     

Quality-of-life outcomes for men with prostate carcinoma detected by screening

BACKGROUND: There is limited information on outcomes of prostate carcinoma treatments given to screened patient populations for whom cancer is usually detected at an earlier stage. METHODS: The authors conducted a cross-sectional evaluation of quality-of-life outcomes for men with prostate carcinoma detected in screening studies at a university center. Of 2234 men diagnosed with prostate carcinoma between 1989 and 1997, 74% responded to the questionnaire. Primary management included radical prostatectomy (76%), radiotherapy (11%), observation (7%), hormonal therapy (4%), and cryoablation (2%). Main outcome measures included validated measurements of quality of life, urinary and sexual functioning, and bother (36-item RAND Health Survey, UCLA Prostate Cancer Index). RESULTS: After controlling for demographic factors, differences among treatment groups were found for all general quality-of-life outcomes, with increased impairment in men who underwent hormonal therapy (all P values <0.05). Urinary and sexual function and bother were also significantly related to treatment. However, among men followed for > or =12 months, only 9% reported a moderate or major problem with urinary control. Sexual functioning was a moderate or major problem following treatment for 58% treated with prostatectomy, 48% treated with radiotherapy, 64% treated with hormonal therapy, 45% treated with cryoablation, and 30% managed with observation. Approximately one-third of the men younger than 70 years who underwent radical prostatectomy maintained adequate sexual functioning posttreatment. CONCLUSIONS: Up to 6 years after diagnosis, the majority of men with prostate carcinoma detected by screening were bothered by their current sexual function, regardless of treatment. In contrast, most men were not bothered by their current urinary function.     

Use of complementary health practices by prostate carcinoma patients undergoing radiation therapy

BACKGROUND: There has been increasing interest in complementary health practices among patients, popular media, and even institutional health care providers. However, there is still surprisingly little information on the use of alternative medicine by patients undergoing treatment for prostate carcinoma. METHODS: A prospective study of 50 consecutive patients undergoing radiation treatment for prostate carcinoma at a tertiary care referral center was conducted. Patients were surveyed after the initiation of radiation therapy whether they had used complementary health practices at any time. RESULTS: The authors found that a surprisingly high proportion of patients (37%) relied on complementary health practices not prescribed by physicians. In contrast, according to a separate survey of the treating physicians, the physicians believed that on average only 4% of their patients resorted to such practices. The use of complementary health practices usually continued even after the initiation of definitive treatment for prostate carcinoma. Patients who used complementary health practices tended to have higher levels of education and income, whereas there were no differences in age, religion, perception of health status, stage of prostate carcinoma, or prostate specific antigen level. Herbal remedies were the most frequently utilized, by 60% of those using complementary health practices, followed by old-time remedies (47%), high dose vitamins (41%), chiropractic/massage therapy and relaxation techniques (18% each), and special diets (12%). CONCLUSIONS: Patients undergoing radiation therapy for prostate carcinoma frequently rely on complementary health practices not prescribed by their treating physicians. Patients who do so tend to have higher education and income levels and continue their complementary practices during the conventional treatment. As the health implications of these practices are unclear, further research is clearly needed.     

Demographics, family histories, and psychological characteristics of prostate carcinoma screening participants

BACKGROUND: The goals of this study were to 1) understand the reasons that men seek prostate carcinoma screening, in light of the ongoing medical controversy surrounding screening; and 2) assess the level of psychological distress and perceived risk among men seeking screening, and whether or not these variables were dependent on a man's family history of prostate carcinoma. METHODS: The subjects were 126 men (40% had a family history of prostate carcinoma) who participated in a free prostate carcinoma detection program. Questionnaires, which were completed prior to prostate carcinoma screening, included demographic and medical information, reasons for screening participation, general and cancer-related psychological distress, and perceived risk for prostate carcinoma. RESULTS: Among both family history groups, self-referral was the most common reason for attending the screening, compared with receiving a recommendation from a health professional or from a friend or family member. Men with a positive family history were not more distressed than those without a family history; but as the authors predicted, men with a positive family history of prostate carcinoma did report higher levels of perceived risk relative to those without a family history. In addition, an interaction revealed that psychological distress was greater among men with a family history only among those who also reported elevated perceived risk. CONCLUSIONS: Similar to other prostate carcinoma screening programs, men in the current sample largely elected to attend the screening on their own. Furthermore, although perceived risk was higher among men with a family history compared with those without a family history, psychological distress was greater among men with a family history only among those who also reported elevated perceived risk. Thus, among men with a family history of the disease, perceived risk may be a marker of elevated psychological distress. Screening programs should assess family history and perceived risk because of the potential psychological implications for screening participants.     

Effects of false-positive prostate cancer screening results on subsequent prostate cancer screening behavior.

OBJECTIVES: Little is known about screening behavior following a false-positive prostate cancer screening result, which we have defined as a screening result with "abnormal/suspicious" labeling that did not result in a prostate cancer diagnosis within 14 months. The purpose of this analysis was to examine whether age, race, education, or previous false-positive prostate cancer screening results via prostate-specific antigen or digital rectal exam predict decision to obtain subsequent prostate cancer screening.METHODS: Data were drawn from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The study sample consisted of 2,290 older men (mean age, 62.8 years; range, 55-75 years) who had false-positive (n = 318) or negative (n = 1,972) prostate-specific antigen or digital rectal exam baseline prostate cancer screening results. Multivariable logistic regression was used to assess the effect of false-positive results on subsequent prostate cancer screening behavior, adjusting for all covariates.RESULTS: The multivariable model showed that being African American (P = 0.016), and having a high school education or less (P = 0.007), having a previous false-positive prostate cancer screening result (P < 0.001), were predictive of not returning for prostate cancer screening in the following screening trial year.CONCLUSION: The study results highlight the importance of shared decision making between patients and their providers regarding the risks and benefits of prostate cancer screening, and follow-up options for abnormal prostate cancer screening results. Shared decision making may be especially important for African American men, whom prostate cancer disproportionately affects.     

Hidden barriers between knowledge and behavior: the North Carolina prostate cancer screening and treatment experience

BACKGROUND: Prostate cancer (PC) mortality is much greater for African American than for Caucasian men. To identify patient factors that might account for some of this disparity, men within 6 months of diagnosis were surveyed about health attitudes and behavior. METHODS: Using Rapid Identification in the North Carolina Cancer Registry, 207 African American and 348 Caucasian recently diagnosed PC patients were identified and surveyed. RESULTS: African American men were younger and less often currently married, and had lesser education, job status, and income than Caucasian men (all P < .001). African American men were at no greater distance to medical care, but had less access: poorer medical insurance coverage, more use of public clinics and emergency wards, less continuity with a primary physician, and more often omitted physician visits they felt they needed. They also expressed less trust in physicians. African American men acknowledged their greater risk of PC, accepted greater responsibility for their health, and reported more personal failures that delayed diagnosis. African American men more often requested the tests that diagnosed their cancers, which resulted more often from routinely ordered screening tests for Caucasian men. African American men expressed less interest in nontraditional treatments. CONCLUSIONS: Despite lesser education, African American men in North Carolina are aware of their increased risk of cancer, the importance of treatment, and their responsibility for their health. Obstacles to timely diagnosis and appropriate care, including greater physician distrust, appear more likely to arise from reduced access and continuity of medical care arising from their worse socioeconomic position.     

Improvements in pathologic staging for African-American men undergoing radical retropubic prostatectomy during the prostate specific antigen era: implications for screening a high-risk group for prostate carcinoma.

BACKGROUND: The objective was to compare the changes in pathologic and clinical data over time for African-American (AA) and white men with prostate carcinoma undergoing radical prostatectomy in an attempt to determine the early impact of prostate specific antigen (PSA). METHODS: Data from 195 AA and 587 white men who underwent radical prostatectomy from 1988 to 1999 in an equal access, tertiary, military medical facility were collected. Statistical analysis was used to determine the significance of the changes in the rates of extracapsular extension (ECE), positive margins, pretreatment PSA levels, and age at the time of surgery for each race over time. RESULTS: Comparing 1988-99 results, the authors found that the percentage of AA men with ECE decreased from 100% to 34.8% (P = 0.007), and for white men from 56.9% to 43.2% (P = 0.269). The percentage of AA men with positive margins decreased from 100% to 26.1% (P < 0.0001), and for white men from 41.2% to 27.0% (P = 0.021). Mean age at surgery decreased from 66.6 to 59.9 years for AA men (P < 0.001) and from 65.9 to 61.1 years for white men (P < 0.001). Also, PSA levels decreased from 10.1 to 6.6 ng/dL for white men (P < 0.001) and from 16.5 to 6.5 ng/dL for AA men (P < 0.001). CONCLUSIONS: The authors believe that the decrease in ECE and positive margins in AA men is primarily because of PSA testing, coupled with improved public awareness and equal access to care. It appears reasonable to recommend PSA testing in AA men, who have historically experienced poor outcomes from prostate carcinoma.     

Psychosocial screening for patients with prostate cancer: The development and validation of the psychosocial distress questionnaire-prostate cancer

ABSTRACT

We describe the psychosocial distress questionnaire-prostate cancer (PDQ-PC), a psychosocial screening list developed and validated specifically for prostate cancer patients. An existing screening list, the psychosocial distress questionnaire-breast cancer (PDQ-BC), was used as a starting point. Two focus groups were then implemented to investigate which items of the PDQ-BC were relevant for the PDQ-PC and which new items were needed. Validity and reliability of the questionnaire were assessed on 278 prostate cancer patients. Factor analysis showed that the 36-item PDQ-PC comprises eight subscales, for which the internal consistency ranged from α = 0.48–0.88. Moreover, moderate to high convergent validity was found.     

Prevalence of distress in cancer patients undergoing chemotherapy

Aim: Feeling distressed is often a normal reaction to the diagnosis of cancer and cancer treatment. However, if excessive, distress may lead to more disabling conditions such as depression and anxiety. The aims of the study were to determine the prevalence and level of distress in patients with cancer who were undergoing chemotherapy and to examine the associated factors related to psychological distress in these patients. Methods: Adult patients with confirmed cancer who were undergoing out‐patient chemotherapy at the Clinical Oncology Unit, Universiti Malaya Medical Centre were invited to participate in the study. They were assessed on their sociodemographic profiles, clinical history, distress level as measured using the ‘Distress Thermometer’, and problems checklist on practical, family, emotional and physical symptoms. The Hospital Anxiety Depression Scale (HADS) was used by patients to report anxiety and depression. Results: One hundred and sixty‐eight patients with mean age of 50 years participated in the study. The prevalence of psychological distress determined by the ‘Distress Thermometer’ was 51%. HADS found the prevalence of depression/anxiety to be 32%. There was no significant association between distress and the primary site of cancer, the phase of chemotherapy and the sociodemographic profiles except for age (r = ?0.21, P = 0.007). Distress was significantly associated with practical, family and emotional problems. Some of the physical problems such as appearance, breathing, changes in urination, constipation, eating, fatigue, getting around, memory/concentration, nausea, pain and sleep were also significantly associated with distress. Conclusion: Cancer patients undergoing chemotherapy experienced high level of distress. This finding should alert oncologists that some patients exhibiting these signs of distress may need referral to the mental health team.     

Primary treatment choices for men with clinically localized prostate carcinoma detected by screening

BACKGROUND: Increasingly, prostate carcinoma is diagnosed through screening. However, little is known regarding factors that influence a patient's decision concerning the treatment choices presented to him. METHODS: Subjects were prostate carcinoma patients detected through the Washington University PSA Prostate Cancer Screening Program between September 1989 and June 1998. The sources of data were the prostate specific antigen (PSA) screening database and follow-up questionnaire. RESULTS: Among 1809 study subjects, 79.2% chose radical prostatectomy (RP), 12.4% chose radiation therapy, and 8.4% chose watchful waiting (WW) as their decision regarding primary treatment. In bivariate analyses, education, income, age, indication for prostate biopsy, comorbidity score, serum PSA level, clinical stage, and pretreatment urinary and sexual function were associated significantly with treatment choice, but race, marital status, and Gleason grade were not. In a multivariate analysis, age, race, clinical stage, PSA level, and pretreatment urinary and sexual function were found to be associated significantly with treatment choice. For every 5-year decrease in age, the odds for choosing RP versus WW increased by 276%; for every 1-ng increase in PSA, the odds for choosing RP versus WW increased by 12%. Non-African-American patients were greater than four times more likely to select RP versus WW. Patients with T2 tumors and those with normal pretreatment urinary function were three times more likely and twice more likely to choose RP versus WW, respectively. CONCLUSIONS: In the current study, RP was the most widely used treatment in patients with screen-detected prostate carcinoma. Age, race, PSA level, clinical stage, and pretreatment urinary and sexual function were significant factors influencing treatment selection.     

Appalachian knowledge of cancer and screening intentions

Background. This cross-sectional study was designed to assess levels of knowledge about cancer and behavioral intentions regarding cancer screening from a representative sample of adults residing in 51 Appalachian counties in Kentucky. Methods. A random-digit-dialed telephone survey obtained 696 interviews and provided a 4% margin of error. Results. Findings showed that knowledge of cancer screening was generally low and uniform by age and educational attainment. Logistic regression models demonstrated that possessing insurance was an important predictor of those likely to obtain cancer screening. Conclusions. Having a family history of breast cancer or a family history of prostate cancer were not significant predictors for obtaining mammograms or prostate-specific antigen (PSA) tests.