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Knowledge and attitudes of men about prostate cancer

Diane E Arnold-Reed, Dana A Hince, Max K Bulsara, Hanh Ngo, Michael Eaton, Alan R Wright, Frank R Jones, Walter Kaczmarczyk, Andreas G Marangou and Thomas D Brett
Med J Aust 2008; 189 (6): 312-314. || doi: 10.5694/j.1326-5377.2008.tb02047.x
Published online: 15 September 2008

Prostate cancer remains the most commonly diagnosed non-cutaneous cancer and the second most common cause of cancer mortality in Australian men.1 Incidence rates increase dramatically over the age of 65 years, with mortality rates increasing more rapidly over the age of 70.

When discussing prostate cancer with at-risk patients, general practitioners often find themselves having to balance the demands and expectations of individuals — who are often influenced by personal experience of having a family member or friend with the disease2 — with screening guidelines that are predominantly non-interventionist.3 We aimed to ascertain the current level of understanding about prostate cancer, the treatment options available and their potential side effects among an age group of men who are likely to need such information in the near future.

Methods

The study was undertaken between January and August 2006 in five general practices: three in metropolitan Perth and two in regional areas of Western Australia. The target population was a convenience sample of men aged 40–80 years, with or without prostate cancer, presenting to their GP for routine consultations. A total of 516 men were invited to participate. Only patients who provided written informed consent were included in the survey.

The questionnaire (based on that used by Brett4) was administered verbally by the GP during the consultation. It comprised 17 multiple-choice questions designed to ascertain patients’ prior experience with prostate cancer (personal, family or close friends), prior investigations for prostate cancer, and knowledge of prostate function, prostate cancer symptoms and treatment options. Several questions assessed attitudes to treatment side effects and decision making. Patients were provided with various options to choose from and, in some questions, could nominate more than one option. Age, occupation, race and education level were also recorded.

The study received approval from the University of Notre Dame Australia Human Research Ethics Committee.

Results

The study cohort comprised 503 men (participation rate, 97%), with a median age of 62 years (interquartile range, 18 years). Ninety-seven per cent (95% CI, 95%–98%) identified themselves as Caucasian. Fifty-three per cent (95% CI, 49%–58%) had received an education to high school level, and 40% (95% CI, 36%–44%) had a higher qualification. Just over half the cohort had some previous exposure to prostate cancer; 30% (95% CI, 26%–34%) had a friend with the disease and 6% (95% CI, 4%–8%) had the disease themselves. Of the 82 men (16%; 95% CI, 13%–20%) with a family history of prostate cancer, 61% (95% CI, 50%–72%) said their father had the disease, 6% (95% CI, 2%–14%) said their grandfather had it, and 18% (95% CI, 11%–28%) and 15% (95% CI, 7%–24%) said their brother or uncle, respectively, had prostate cancer.

Three quarters (95% CI, 71%–79%) of the cohort had undergone one or more previous prostate-related examinations. The most common tests undertaken were prostate-specific antigen (PSA) (59%; 95% CI, 54%–63%) or digital rectal examination (56%; 95% CI, 51%–60%). Only 5% had undergone transrectal ultrasound (95% CI, 4%–7%) and/or biopsy (95% CI, 4%–8%).

Discussion

Approximately half of the men completing our survey had previous exposure to prostate cancer, either through a relative or friend or, less commonly, by having the disease themselves. Knowledge concerning prostate cancer was generally poor, but previous exposure increased knowledge of treatment options and side effects.

There was a high and erroneous expectation among the study population that prostate cancer would be somewhat or very likely to cause impotence. The expectation of pain and problems with urination confirms a lack of knowledge that could lead to fear of how this cancer might progress. Generally, men were accepting of the potential side effects of treatment. Half the cohort did not know that impotence and incontinence were side effects of treatment; however, when specifically asked if they would refuse treatment given that these were possibilities, only a minority said they would. Interestingly, acceptance of these side effects was not related to age, potency or previous exposure to prostate cancer.

The prevalence of prostate examinations in our study was 20% higher than previously reported for any prostate cancer test in Australia and New Zealand.5-8 However, two of these prior studies6,8 did not clarify if “any test” included transrectal ultrasound and biopsy, as was the case in our study. PSA tests were more common in our study (59%) compared with a reported prevalence of 43% in WA.8 While this may be seen as a pitfall of dealing with a clinical cohort rather than a population-based cohort, it is useful in that it provides a natural cohort to assess if previous exposure to tests for prostate cancer has any impact on knowledge of and attitudes to the disease.

Unlike indices of knowledge, having previous exposure to prostate cancer or having had a previous examination for it had no effect on patients’ attitudes to treatment side effects. This is not unusual, as previous research has shown that there is no difference in the attitudes of men considering a hypothetical diagnosis of prostate cancer and those already diagnosed with the disease.9

Younger men are more likely to want to be involved in treatment decision making.10,11 Our study showed that men in the 40–49-years age group, though no more knowledgeable than older men (aged ≥ 70 years) about treatment options and side effects, were more likely to wish to make independent decisions about treatment options. Overall, the cohort preferred some GP or specialist involvement in treatment decision making.

Patients are generally receptive to information and assimilate information correctly. A brief patient decision aid on PSA testing for prostate cancer has been shown to increase knowledge of benefits and risks associated with undertaking tests.12 Patients, though aware of their own lack of knowledge and despite believing that their specialist or GP would be the preferred source of information on prostate cancer,13 are often reticent about asking for more information.14 It is often up to the doctor (usually the GP) to proffer this information in a suitable manner.15-17 Better knowledge has been shown to facilitate patient participation in decision making.11

This study confirms significant deficits in knowledge about prostate cancer and the available treatment options. Despite the availability of good factual information for patients,18 GPs still play a central role in the provision of information to at-risk ageing men about the high-technology tests and treatment options that many will inevitably face.

Received 5 December 2007, accepted 11 June 2008

  • Diane E Arnold-Reed1
  • Dana A Hince1
  • Max K Bulsara1,2
  • Hanh Ngo1
  • Michael Eaton1
  • Alan R Wright1
  • Frank R Jones1
  • Walter Kaczmarczyk1
  • Andreas G Marangou1
  • Thomas D Brett1

  • 1 General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA.
  • 2 School of Population Health, University of Western Australia, Perth, WA.


Correspondence: darnold-reed@nd.edu.au

Acknowledgements: 

Costs of this study were funded by donations from P Burns, J Pitt and G Sadlier. The GPs involved were supported by Researcher Development Program (RDP) Fellowships or clinical bursaries offered under the Australian Government Primary Health Care Research, Evaluation and Development (PHCRED) Strategy Phase II. Diane Arnold-Reed, Thomas Brett and Dana Hince were funded by PHCRED.

Competing interests:

None identified.

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