Objectives: To elicit the views of well informed community members on the ethical obligations of general practitioners regarding prostate-specific antigen (PSA) testing, and what should be required before a man undergoes a PSA test.
Design and setting: Three community juries held at the University of Sydney over 6 months in 2014.
Participants: Forty participants from New South Wales, of diverse social and cultural backgrounds and with no experience of prostate cancer, recruited through public advertising: two juries of mixed gender and ages; one all-male jury of PSA screening age.
Results: In contrast to Royal Australian College of General Practitioners guidelines, the three juries concluded that GPs should initiate discussions about PSA testing with asymptomatic men over 50 years of age. The mixed juries voted for GPs offering detailed information about all potential consequent benefits and harms before PSA testing, and favoured a cooling-off period before undertaking the test. The all-male jury recommended a staggered approach to providing information. They recommended that written information be available to those who wanted it, but eight of the 12 jurors thought that doctors should discuss the benefits and harms of biopsy and treatment only after a man had received an elevated PSA test result.
Conclusions: Informed jury participants preferred that GPs actively supported individual men in making decisions about PSA testing, and that they allowed a cooling-off period before testing. However, men of screening age argued that uncertain and detailed information should be communicated only after receiving an elevated PSA test result.
- 1. Barry MJ. Screening for prostate cancer — the controversy that refuses to die. N Engl J Med 2009; 360: 1351-1354.
- 2. Schröder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med 2012; 366: 981-990.
- 3. Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med 2011; 155: 762-771.
- 4. Ilic D, O’Connor D, Green S, Wilt TJ. Screening for prostate cancer: an updated Cochrane systematic review. BJU Int 2011; 107: 882-891.
- 5. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010; 102: 605-613.
- 6. Brett AS, Ablin RJ. Prostate-cancer screening — what the US Preventive Services Task Force left out. N Engl J Med 2011; 365: 1949-1951.
- 7. Moyer VA. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 157: 120-134.
- 8. Urological Society of Australia and New Zealand. PSA testing policy 2009. http://www.usanz.org.au/uploads/29168/ufiles/USANZ_2009_PSA_Testing_Policy_Final1.pdf (accessed Jul 2015).
- 9. Prostate Cancer Foundation of Australia and Cancer Council Australia; PSA Testing Guidelines Expert Advisory Panel. Draft clinical practice guidelines PSA testing and early management of test-detected prostate cancer. Sydney: Cancer Council Australia, 2014. http://wiki.cancer.org.au/australia/Guidelines: PSA_Testing/Guideline_development_process (accessed Jul 2015).
- 10. National Health and Medical Research Council. PSA testing for prostate cancer in asymptomatic men: information for health practitioners. 2014. http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/men4d_psa_testing_asymptomatic_men_140304.pdf (accessed Jul 2015).
- 11. Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 8th ed. Melbourne: RACGP, 2012. http://www.racgp.org.au/your-practice/guidelines/redbook/ (accessed Jul 2015).
- 12. Degeling C, Carter SM, Lychetnik L. Which public and why deliberate? — A scoping review of public deliberation in public health and health policy research. Soc Sci Med 2015; 131: 114-121.
- 13. Rychetnik L, Doust J, Thomas R, et al. Community Jury on PSA screening: what do well-informed men want the government to do about prostate cancer screening — a qualitative analysis. BMJ Open 2014; 4: e004682.
- 14. Paul C, Nicholls R, Priest P, McGee R. Making policy decisions about population screening for breast cancer: the role of citizens’ deliberation. Health Policy 2008; 85: 314-320.
- 15. Wollin D, Loeb S. Patient perceptions and shared decisions about PSA screening. Rev Urol 2013; 15: 206-207.
- 16. Knight SJ. Decision making and prostate cancer screening. Urol Clin North Am 2014; 41: 257-266.
- 17. Lenaghan J, New B, Mitchell E. Setting priorities: is there a role for citizens’ juries? BMJ 1996; 312: 1591.
- 18. Center for Values, Ethics and the Law in Medicine, University of Sydney. Project 5: Prostate screening from the perspective of citizens [website]. 2014. http://cancerscreeningethics.org/prostate-screening-projects/project-5-community-juries (accessed Jul 2015).
- 19. Entwistle VA, Carter SM, Trevena L, et al. Communicating about screening. BMJ 2008; 337: a1591-1593.
- 20. Howard K, Brenner AT, Lewis C, et al. A comparison of US and Australian men’s values and preferences for PSA screening. BMC Health Serv Res 2013; 13: 388.
- 21. Gattellari M, Ward JE. Will men attribute fault to their GP for adverse effects arising from controversial screening tests? An Australian study using scenarios about PSA screening. J Med Screen 2004; 11: 165-169.
- 22. Australian Bureau of Statistics. Australian Standard Classification of Cultural and Ethnic Groups (ASCCEG), 2011. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1249.0Main+Features12011?OpenDocument (accessed Jul 2015).
- 23. Australian Bureau of Statistics. SEIFA 2011. http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001 (accessed Jul 2015).
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.