123 The psychosocial effects of a planned prostate biopsy on men with increased prostate specific antigen and suspected prostate cancer

Abstract

Objectives Since the 1990’ties the incidence and prevalence of prostate cancer have increased across the higher-income countries of Northern, Western and Southern Europe, e.g., the incidence has increased from 3% to 10% per annum. At the same time the prostate cancer mortality has stayed stable or had a minor decrease, except for the Baltic States, where the mortality has increased steadily. There is still some contradiction in best available evidence if prostate antigen (PSA) screening and early identifying and treating prostate cancer can reduce prostate cancer mortality. On the other hand, PSA screening and early diagnosis could lead to overdiagnosis of prostate cancer and thereby overtreatment for those men treated for the cancer. This leaves undesirable effects on the men’s psychosocial and physical health. The aim of this study was to explore the potential psychosocial effects of prostate biopsy on men due to suspected cancer. Method A qualitative study was conducted at the outpatient clinic of Pauls Stradins Clinical University Hospital (Riga). We included men aged from 50 to 70 of various education levels, increased PSA levels and with no prior prostate biopsy. Specific PSA level and/or abnormal findings during digital rectal examination were not set as the pre-determinative inclusion criteria. Multi-morbid patients and those with prior biopsy were excluded. Semi-structured interviews were audio recorded, transcribed and subsequently analysed, using the Strauss and Corbin concepts: open, axial and selective coding, which identifies the main themes common to all interviews. Results Seven volunteers with an elevated PSA level and abnormal findings during a digital rectal examination were interviewed while awaiting prostate biopsy. The PSA test before referral to the biopsy was performed in interviewees with and without symptoms and was initiated by urologists, general practitioners or patients themselves. The majority of men felt anxiety and fear prior to the planned prostate biopsy. The men indicated that they had received an insufficient amount of information about the planned procedure. Some of interviewees had been seeking additional information about the procedure, while others had not. Psychosocial effects such as irritability, deterioration in relationships with relatives, denial, a feeling of hopelessness, despair, and pessimism about their future lives were identified. Knowledge of interviewees regarding PSA test was low and mostly related to prostate cancer. Conclusions Negative psychosocial experiences were identified in all patients before the expected prostate biopsy. The study implies that discomfort might be mitigated by providing detailed information about the planned procedure itself and its significance.