BMJ 2002;325:737 ( 5 October )

Papers

Why men with prostate cancer want wider access to prostate specific antigen testing: qualitative study

Papers p 737 Education and debate p 766

Alison Chapple, senior research fellow, ^a Sue Ziebland, senior research fellow, ^b Sasha Shepperd, university research lecturer, ^a Rachel Miller, honorary research fellow, ^a Andrew Herxheimer, emeritus fellow, UK Cochrane Centre, ^a Ann McPherson, research lecturer. ^a

^a DIPEx, Department of Primary Health Care, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF, ^b Cancer Research UK General Practice Research Group, Department of Primary Health Care, University of Oxford

Correspondence to: A Chapple
alison.chapple{at}dphpc.ox.ac.uk

Objectives: To explore the attitudes of men with confirmed or suspected prostate cancer to testing for prostate specific antigen.
Design: Qualitative interview study with a purposive sample.
Setting: Great Britain.
Participants: 52 men with suspected or confirmed prostate cancer, recruited through general practitioners, urologists, patient support groups, and charities.
Results: Almost all men remembered their prostate specific antigen test but recalled being given little information beforehand. Arguments in favour of increased access to testing included the belief that early diagnosis would reduce mortality, improve quality of life, and save the NHS money. Men also thought that a national screening programme should be available because symptoms can be ambiguous, screening for cancer is responsible health behaviour, and screening would encourage men to be tested. Four men who opposed a screening programme had gathered information alerting them to uncertainty about the benefits of treatment, and two regretted that they had been tested. Others thought that access to testing is restricted in the United Kingdom because of a lack of government backing, concerns about the accuracy of the test, and a lack of resources.
Conclusions: The few men in this study who subscribed to the argument that evidence of the benefits of treatment is a prerequisite for a screening programme did not want to see screening introduced. Men who proposed an alternative set of principles for testing gave reasons that did not all relate to overoptimism about the benefits of early diagnosis. People who plan services and people who respond to requests for testing need to understand men's perspectives and concerns.

What is already known on this topic The media report enthusiasm for both testing and screening for prostate specific antigen among men with prostate cancer Relatively little is known about men's experiences of such testing What this study adds The study helps to explain why most men with prostate cancer strongly advocate prostate specific antigen testing and screening It also shows that many men are ill prepared for test results and for the possible iatrogenic effects of treatment

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