Prostate cancer testing causes psychological stress in men in UK … Well, maybe (or maybe not)

Based on data from a study published recently in the British Journal of Cancer, media reports have suggested that men in the UK who undergo testing to detect prostate cancer suffer from significant psychological stress. For an example of the media “take” on this study, complete with multiple inaccuracies, just click here.

The actual study, by Macefield et al., which was published on line on April 6, actually shows nothing of the sort.

The authors report on data from a total of 330 men who took part in initial evaluation as part of the potential enrollment process for the ProtecT trial (a trial to compare outcomes of active treatment to expectant management in men diagnosed with localized prostate cancer). All the men were aged between 50 and 69 years; they had PSA levels of ≥ 3 ng /ml; and they all had a negative biopsy result.

The authors note that (in the UK) up to 75 percent of men with a raised PSA level have a benign prostate biopsy result. Their study was conducted because, “Little is known about the psychological effect of this [negative] result for these men.” So … during and after the prostate cancer risk evaluation process, the patients in this study were also assessed for risk of psychological distress and negative mood that might be associated with or caused by the various tests and their outcomes — twice during diagnostic testing and twice after their negative biopsy result. Because none of these patients were shown to actually have prostate cancer, it should be made clear that there is no reason to think that any psychological distress or negative mood could be associated with a diagnosis of prostate cancer.

The results of the study were as follows — and please note that we have used the precise words of the authors (given in quotation marks) whenever we could:

  • “The majority of men were not greatly affected by testing or a negative biopsy result.” [Bold italic type added for emphasis.]
  • “The impact on psychological health was highest at the time of the biopsy” (and therefore had little to do with PSA testing, which the media report referred to above seems to think is the crucial issue).
  • 33/171 men (19.3 percent) reported a high level of distress at the time of biopsy.
  • 35/180 men (19.4 percent) reported having a tense/anxious mood at the time of biopsy.
  • “Longitudinal analysis on 195 men showed a significant increase in distress at the time of the biopsy compared with levels at the PSA test” (but as noted above, this occurred in only about 20 percent of the men involved).
  • “These levels” of distress “remained elevated immediately after the negative biopsy result …  and 12 weeks later.”
  • “Psychological mood at the time of PSA testing predicted high levels of distress and anxiety at subsequent time-points.”

In their conclusion, the authors write that, “Most men coped well with the testing process, although a minority experienced elevated distress at the time of biopsy and after a negative result. Men should be informed of the risk of distress relating to diagnostic uncertainty before they consent to PSA testing.”

Given the fact that “psychological distress” was apparently evident in slightly less than 20 percent of the men in this study, it seems reasonable to draw these conclusions. Furthermore, the fact that 20 percent of men showed signs of “a significant increase in distress at the time of the biopsy” correlates well with what appears to be the normal personality profile range of  males in the UK. Since the 1990s, the prevalence of mental health problems in the UK has been rising significantly faster in men than in women. It may, therefore, be reasonable to conclude only that men who are already at risk for psychological stress and worry in their day to day lives were also stressed and worried by the idea that they might shortly find out they had cancer! The remaining 80 percent of the patients appear to have been able to handle the whole series of events with relative equanimity.

Is undergoing tests to learn whether you might have prostate cancer a potentially stressful series of events? Of course it is. Do most men actually “suffer distress” as a consequence of such testing? Different question and a different answer. Most apparently seem to cope with the stress quite well, thank you (at least in the UK)! It would also seem to be the case that the stress felt by those men who are already at risk for such an emotional response is fostered by inaccurate media reports.

2 Responses

  1. My brother — the macho one — says he thinks men have “gone soft” and abhors the site of sportsmen weeping when they lose a game of soccer, for example.

    Mind you he was a bit concerned about a PSA of 3.8 …

    “Hmmm,” I said, “talk about sauce for the goose ….”

    It has always seemed to me to be so difficult to measure psychological distress because it can only be measured by self-reporting and therefore is influenced by the person’s own paradigm. The macho man will find it very difficult to admit that he is stressed — but it doesn’t mean that he is not.

    The position becomes even more complex for the man’s partner or close friend who may not want to admit to stress in case it causes stress to the partner.

  2. Part of the problem is that we often fail to differentiate between stress (definition: “a physical, chemical, or emotional factor that causes bodily or mental tension”) and psychological distress (definition: “the end result of factors such as psychogenic pain, internal conflicts, and external stress that prevent a person from self-actualization and connecting with ‘significant others’ “).

    On a much too common basis, a phlebotomist sticks a needle in my arm and removes enough blood to run a variety of tests. I don’t enjoy this experience. There have been several occasions when less-skilled individuals have caused me significant discomfort and even pain. I find the experience stressful … but it does not cause me any degree of psychological distress (that I have ever been aware of).

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