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Effects of False-Positive Prostate Cancer Screening Results on Subsequent Prostate Cancer Screening Behavior

¹ Department of Medicine and Section of Health Services Research, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; ¹ Department of Biostatistics and Research Epidemiology and ³ Josephine Ford Cancer Center, Henry Ford Health Sciences Center, Detroit, Michigan; and ⁴ Department of Medicine, Michigan State University, East Lansing, Michigan

Requests for reprints: Marvella E. Ford, Department of Medicine and Section of Health Services Research, Baylor College of Medicine and Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030. Phone: 713-794-8666; Fax: 713-748-7359. E-mail: mford{at}bcm.tmc.edu

Objectives: Little is known about screening behavior following a false-positive prostate cancer screening result, which we have defined as a screening result with "abnormal/suspicious" labeling that did not result in a prostate cancer diagnosis within 14 months. The purpose of this analysis was to examine whether age, race, education, or previous false-positive prostate cancer screening results via prostate-specific antigen or digital rectal exam predict decision to obtain subsequent prostate cancer screening.

Methods: Data were drawn from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The study sample consisted of 2,290 older men (mean age, 62.8 years; range, 55-75 years) who had false-positive (n = 318) or negative (n = 1,972) prostate-specific antigen or digital rectal exam baseline prostate cancer screening results. Multivariable logistic regression was used to assess the effect of false-positive results on subsequent prostate cancer screening behavior, adjusting for all covariates.

Results: The multivariable model showed that being African American (P = 0.016), and having a high school education or less (P = 0.007), having a previous false-positive prostate cancer screening result (P < 0.001), were predictive of not returning for prostate cancer screening in the following screening trial year.

Conclusion: The study results highlight the importance of shared decision making between patients and their providers regarding the risks and benefits of prostate cancer screening, and follow-up options for abnormal prostate cancer screening results. Shared decision making may be especially important for African American men, whom prostate cancer disproportionately affects.

Key Words: Prostate Cancer Screening Behavior • False Positive Prostate Cancer Screening Results • Health Decision making • Men's Health • African Americans/Blacks

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