Screening men for prostate cancer in general practice: experiences of men receiving an equivocal PSA (prostate specific antigen) test result

Abstract

Although there are often clear benefits from health screening strategies there is also evidence that some individuals experience emotional difficulties when participating, these reactions are often as a result of inconclusive or equivocal results from the screening tests. Most of the research literature explores this from a female perspective – there is less evidence of how men experience the uncertainties of screening. This article presents findings from a qualitative research study exploring the experiences of men who received equivocal results when participating in prostate specific antigen (PSA) testing. The men were drawn from a larger clinical trial to identify men with early signs of prostate cancer. In-depth interviews were conducted with seven men from one general practice in the North of England who had received an equivocal result from PSA testing and subsequent prostate biopsy. Phenomenological analysis revealed five inter-related themes in the men's experiences. The theme pre-conceptions centred around men's beliefs about the links between early diagnosis and was linked to their perceptions about responsibility towards their own health. However, men also reported feelings of uncertainty when receiving results that did not definitely indicate they did or did not have prostate cancer. This uncertainty generated reactions of stoicism towards the equivocal result and subsequent participation in further investigations. However, men also reported that participation in PSA screening did make them feel ‘looked after’. These findings are closely comparable with the literature on women's reactions to screening test uncertainty. This is possibly heightened by the lack of clear evidence about the accuracy of PSA testing to detect prostate cancer. These men participated in order to find out if they had prostate cancer or not and seemed unprepared for the possibility of an equivocal result.