Table 3

Results of the studies reporting direct choice related to PSA screening acceptability

StudyOutcome/presentationResults
Cantor et al 24 Preference for PSA screening or no screening, based on individualised decision-analytic model.

  • 28.6% of men preferred screening to no screening.

  • 34.5% of couples (men and their wives) preferred screening to no screening.

de Bekker-Grob et al 25 Willingness to trade per cent decrease in screening-related mortality risk reduction (from 3.5% to 3.2%, 10% RRR; 2.8%, 20% RRR; 2.5%, 30% RRR; 1.8%, 50% RRR), per cent decrease in burden from unnecessary biopsies (20%, 40%, 60%, 80%) and unnecessary treatments (0%, 20%, 50%, 80%).

  • 2.0% decrease in screening-related mortality risk reduction (95% CI 1.6 to 2.4) for 10% less risk of unnecessary treatment.

  • 1.8% decrease in screening-related mortality risk reduction (95% CI 1.3 to 2.3) for 10% less risk of unnecessary biopsies.

Howard et al 26 and Pignone et al 29 Preference for a PSA screening option compared with a no screening option, based on a discrete choice experiment*, and balance sheet task (unlabelled description of benefits and harms)†, over 10 years.

  • Balance sheet: 43.7% prefer the PSA screening option.

  • Discrete choice experiment: 20.2% prefer the PSA screening option.

Howard et al 27 Preference for the number of men who would experience screening-related harms (unnecessary biopsies, incontinence/bowel problems) to avoid one prostate cancer death in 10 000 men screened. Men aged 40–49 years:

  • 65 in 10 000 (95% CI 59 to 70) extra men with unnecessary biopsies.

  • 31 in 10 000 (95% CI 28 to 34) extra men with incontinence/bowel problems.

Men aged 50–59 years:

  • 233 in 10 000 (95% CI 224 to 242) extra men with unnecessary biopsies.

  • 72 in 10 000 (95% CI 69 to 75) extra men with incontinence/bowel problems.

Men aged 60–69 years:

  • 153 in 10 000 (95% CI 149 to 158) extra men with unnecessary biopsies.

  • 54 in 10 000 (95% CI 52 to 55) extra men with incontinence/bowel problems.

van den Bruel et al 28 Willingness to accept overdetection to trade off reduction in prostate cancer-specific mortality.10% prostate cancer-specific reduction in mortality, 126 cases (95% CI 100 to 150) of overdetection per 1000 people screened:

  • 5.5% (95% CI 3.7 to 7.9) accepts no overdetection at all.

  • 7.1% (95% CI 5.0 to 9.8) accepts overdetection in the complete population

50% prostate cancer-specific reduction in mortality, 231 cases (95% CI 200 to 250) of overdetection per 1000 people screened:

  • 4.5% (95% CI 2.8 to 6.7) accepts no overdetection at all.

  • 9.2% (95% CI 6.8 to 12.1) accepts overdetection in the complete population.

  • *Discrete choice experiment, levels of attributes, over 10 years: chance of prostate cancer diagnosis 40 in 1000, 60 in 1000 or 80 in 1000 with screening, vs 40 in 1000 with no screening; chance of dying from prostate cancer 2 in 1000, 3 in 1000 or 4 in 1000 with screening, vs 4 in 1000 with no screening; chance of having a prostate biopsy as a result of screening 0 in 1000, 240 in 1000 or 330 in 1000 with screening, vs 0 in 1000 with no screening; chance of becoming impotent or incontinent as a result of screening 0 in 1000, 10 in 1000 or 20 in 1000 with screening, vs 0 in 1000 with no screening.

  • †Balance sheet task, features of options, over 10 years: chance of prostate cancer diagnosis for 40 out of 1000 men with no screening, vs 80 out of 1000 men with screening; chance of dying from prostate cancer for 4 out of 1000 men with no screening, vs 3 out of 1000 men with screening; chance of having a prostate biopsy as a result of screening for 0 out of 1000 men with no screening, vs 240 out of 1000 men with screening; chance of becoming impotent or incontinent as a result of screening for 0 out of 1000 men with no screening, vs 20 out of 1000 men with screening.

  • PSA, prostate-specific antigen; RRR, relative risk reduction.