Karthikeyan, A (2007) A Survey on willingness for early detection of prostatic cancer and assessment of validity of digital rectal examination and prostate specific antigen. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Prostate cancer is a unique and controversial disease. The management of which is dominated by a series of unanswered questions. There is uncertainty as to the value of screening and the treatment of localised disease. The prevalence in the western world is rising. Epidemiology of cancer prostate is not known exactly in India but it certainly appears to be the most common malignancy of the male genital organs. ICMR statistics from National Cancer Registry (1997) reveals that prostate cancer is the fifth most common cancer in men in Bangalore, Chennai and in Bombay. Over the past two decades significant strides have been made in our understanding of the biology of the disease. Diagnosis of prostate cancer at an early stage, when the lesion is localized and curable, followed by effective, definitive therapy, is essential to reduce the number of deaths from this disease. Definitive studies to prove that early detection and treatment lower the mortality rate have been initiated. There is no direct evidence to suggest the effectiveness of such treatment. The tools used for early detection are prostate specific antigen (PSA) and digital rectal examination (DRE). Transrectal ultrasound (TRUS) guided biopsy is considered as the gold standard to diagnose malignancy, if the PSA or DRE is abnormal. The positive predictive value of PSA is between 30 and 42 %. Positive predictive value of DRE is between 11 and 26 %. The tools used for early detection are neither sensitive nor specific. Informed consent is mandatory for early detection for the above reasons. Those in favour of screening for prostate cancer, irrespective of symptoms, recommend an annual serum PSA test and DRE for men between the ages of 50 and 70 years. Because of the natural history of the disease, early detection is not recommended for men with a life expectancy less than 10 years. For men at high risk for prostate cancer, such as black North Americans and those with a family history of prostatic carcinoma, the age range during which testing is recommended is extended to 40 to 70 years. BACKGROUND: Patients should be aware of the potential benefits and risks related to testing for early detection of prostate cancer. Are Indian men willing for early detection of prostate cancer like men in the Western world? Are the tools used for early detection reliable? OBJECTIVES: 1. Patient’s perspective on early detection of prostate cancer after an informed consent. 2. To determine whether informed consent was obtained for PSA testing by their physicians prior to the test. 3. Positive predictive value of PSA and DRE in this study. MATERIALS & METHODS: The study was conducted in men between the age group of 50 and 69 years. The participants in the study group should have completed their undergraduate degree and should be able to make an independent decision regarding health related issues. Target population included were; 1. patients and relatives attending the Urology clinic 2. patients with normal DRE, who had their PSA tested earlier with an intention to detect early cancer of the prostate by their physicians. All the participants were given a brochure on prostate cancer which included methods for its early detection. The content, was developed from the available literature, determined to be important in shared decision making. The brochure was written in a question and answer format (appendix 1). The intervention stated the lifetime probability of developing and dying from prostate cancer, and the ability of the PSA test to detect early prostate cancer. It included the positive predictive value of PSA, and a brief description of the principal management options for early prostate cancer and their major complications. Those interested in filling up the questionnaire were enquired about their willingness to undergo tests for early detection of prostate cancer. The questionnaire was of the closed end format, and if they could’nt give a definitive answer they were given the privilege to answer ‘I am not sure’. Participants were given the freedom to express their opinion in addition to the choices mentioned in the questionnaire and they can make more than one choice. Men who had their PSA tested elsewhere earlier, were enquired about their opinion as to whether they would have undergone the test had they known the facts about early detection of prostate cancer. All men with LUTS had DRE. Men with normal DRE were included in this survey. They were enquired regarding their willingness for PSA testing. It was decided to survey three different groups of men; the reasons for it are 1. Is there a difference in their willingness to undergo tests for early detection in those with and without symptoms? 2. Will an informed consent alter their decision to undergo tests for early detection? Men in group 1 were asymptomatic. Men in group 2 had LUTS and normal DRE. None of the patients in group 2 had PSA testing in the past. Men in group 3 had LUTS and normal DRE, but had PSA testing in the past. There were thirty men in each group. RESULTS: Mean age of the participants in group1, group 2 and group 3 were 60, 59, 59 years respectively. Monthly income of men in three Groups. 30% of men in group 1, 20% in groups 2 &3 were aware of the fact that PSA is done to detect prostate cancer. 40%, 80%, 73% of men were willing to undergo tests for early detection of prostate cancer in groups 1, 2 and 3 respectively. Participants willing for early detection in group 1 were willing for prostatic biopsy if any one of the test was abnormal. Those willing for early detection in groups 2 and 3 were willing for prostatic biopsy if PSA was abnormal. 10% of men in group 1 had their PSA tested earlier with 33 an intention to detect early cancer of the prostate after an informed consent by their physician. Of the 30 men in group 3, benefits and risks relating to PSA testing was discussed by their physician in 30 % of patients. 70 % of the patients had their PSA tested without an informed consent. Of the 70 % who had a PSA without an informed consent 38% felt that they would not have undergone the test if the risks and benefits were explained to them prior to the test and 14 % were ‘not sure’ whether they would have undergone the test. The reason for willingness to undergo tests for early detection of prostate cancer is shown in table.3. Of those willing to undergo tests for early detection, 33%, 21% and 37% in groups 1, 2 and 3 respectively had more than one reason for their willingness to undergo tests to detect early cancer of the prostate. CONCLUSION: Based on this survey, providing educated men with balanced information gives them an opportunity to make decisions commensurate with their own values and will perhaps make them to be better equipped to deal with the consequences of early detection. Though informed consent is mandatory prior to PSA testing, informed consent was not obtained in majority of group 3 patients prior to the test. A brochure is a low cost method that can improve men’s knowledge about risks and benefits of early detection and treatment of prostate cancer. The information provided in the brochure can be used to counsel men who specifically ask their physician for a PSA test. DRE and PSA are not specific tools to detect prostatic malignancy. It seems that men with PSA between 4 and 10 ng./ml. are more likely to harbor benign disease unlike men in the western world.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | willingness ; early detection ; prostatic cancer ; assessment ; validity of digital rectal examination ; prostate specific antigen ; Survey. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:15 |
| Last Modified: | 12 Oct 2017 01:15 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3461 |
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