BERKELEY, CA (UroToday.com) - Prostate cancer screening outcomes have recently caused some controversy since there is a possibility for over-diagnosis and over-treatment of prostate cancer.[1,2] With the recently revised national guidelines discouraging the practice of population/community-based mass prostate cancer screening events, informed decision-making for prostate cancer screening is now being recommended.[3]
The purpose of this article was to describe how the Men’s Health Forum (MHF), a community health promotion event, transitioned from mass, on-site prostate cancer screenings to a voucher system promoting informed decision-making. The MHF is a community health promotion event in Tampa, Florida that provides medical screenings and health education to men who are uninsured, underinsured, or do not have a regular health care provider.[4] The overall purpose of the MHF is to empower men with the resources, knowledge, and information to manage their health effectively and ultimately, to reduce the risk of chronic diseases and improve the overall quality of life for men. The programs, services, and exhibits at the MHF are designed to address the specific needs and interests of men of all ages.
The Men’s Health Forum has been offering mass, on-site prostate cancer screenings since its inception in 2000. However, because of the recently revised national guidelines for prostate cancer screening, the community-based screening approach was no longer offered on-site at the MHF starting in 2011. It was recommended that men talk with a doctor or nurse about the risks and benefits of prostate cancer screening before having a prostate exam in order to make an informed decision about having the screening or not.[5] In order to accommodate this change, vouchers were made available at the MHF for men to receive a free prostate cancer screening within 90 days after the MHF at Moffitt Cancer Center’s Screening and Prevention Center. There were seven criteria the men had to meet in order to be eligible for a voucher. The criteria included:
- men reaching age 40–75 years on the day of the MHF;
- no insurance or without insurance for prostate testing;
- no history of prostate cancer;
- no PSA blood test within the last 12 months;
- not being treated by a doctor for urinary symptoms (such as blood in the urine); and
- living in the state of Florida; and
- attend a prostate cancer education workshop facilitated by physicians.
The change in prostate cancer screening vouchers at the Men’s Health Forum ensured men would be making an informed decision about being screened. This helps to reduce bioethical concerns related to prostate cancer screening.[6, 7] In several cancer screening scenarios, informed consent is not employed, especially in community-based settings.[8] Additionally, there is still uncertainty that screening for prostate cancer offers more benefit than harm since it may or may not decrease mortality, often detects cancer of questionable significance, and may even lead to unnecessary treatments accompanied by debilitating side effects and ultimately a decrease in quality of life.[6] Therefore, it is imperative that men who are age-appropriate for screening or who are at-risk for prostate cancer make an informed decision about whether they should be screened or not. Commensurate with the requirements of the informed consent process for participating in a research study or prior to receiving clinical services in a medical setting, men must be informed of the benefits and risks of prostate cancer screening. Utilizing community-based approaches to conduct prostate cancer screening offers little privacy and hardly any opportunity to engage in a meaningful and balanced dialogue with the provider. The prostate cancer screening vouchers provide many benefits, including one-on-one time to talk with a doctor or nurse to facilitate informed decision-making, the opportunity to be accompanied by a family member to assist with the decision-making process, more confidentiality and privacy for the men while being examined, and the opportunity for men to track how their prostate specific antigen blood test changes over time.
In conclusion, it is vitally important for community-based health events that offer prostate cancer screenings to also provide a process for informed decision-making. As health professionals and researchers, it is our bioethical responsibility to ensure individuals fully understand the risks and benefits of medical procedures and to empower patients to knowledgably make their own decisions about their health.
References:
- Andriole GL, Grubb RL, Buys SS, et al. Mortality results from a randomized prostatecancer screening trial. New Engl J Med. 2009;360(13):1310–1319.
- Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. New Engl J Med. 2009;360(13):1320–1328.
- Barry MJ. Screening for prostate cancer—the controversy that refuses to die. New Engl J Med. 2009;360(13):1351–1354.
- Grant CG, Davis JL, Rivers BM, et al. The Men’s Health Forum: an initiative to address health disparities in the community. J Community Health. 2012;37:773-780.
- American Cancer Society. Cancer prevention and early detection facts and figures. Atlanta, GA: American Cancer Society, 2011.
- Justman S. Uninformed consent: mass screening for prostate cancer. Bioethics. 2012;26(3):143–148.
- Ustun C, Ceber E. Ethical issues for cancer screenings: five countries—four types of cancer. Prev Med. 2004;39(2):223–229.
- Barratt A, Davey HM, McCaffery K, et al. Use of decision aids to support informed choices about screening. BMJ. 2004;329(7464):507–510.
Written by:
Jenna L. Davis, MPH, Brian M. Rivers, PhD, MPH, and B. Lee Green, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Moffitt Cancer Center, Tampa, FL, USA
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