Emotional Consequences of Persistently Elevated PSA with Negative Prostate Biopsies

摘要

False positive results are among the most common adverse outcomes of cancer screening tests. Up to 75% of men with an elevated prostate specific antigen (PSA) have had a negative prostate biopsy. Adverse emotional effects of false positive prostate cancer screening have been documented using surveys, but there is nothing in this literature describing the lived experience of having a false positive PSA. In a qualitative interview study of sixteen men who had false positive PSAs, we found that all subjects experienced transient anxiety while waiting for the results of their prostate biopsies. In addition there were three persistent emotional responses: (1) increased fear of cancer; (2) relief with increased vigilance; (3) relief with less worry about elevated PSA. The attitude and recommendations of urologists influenced the emotional responses. Some men expressed frustration with the PSA as a screening test. Many men had multiple negative prostate biopsies. These data suggest that there should be more effort to develop guidelines for subsequent prostate biopsies after an initial negative biopsy, and more effort to encourage primary care clinicians and urologists to discuss emotional risks of PSA testing with their patients.