Men in the United States have a roughly 15 percent lifetime risk of developing prostate cancer, and there are an estimated 233,000 new cases reported every year. The primary method to screen for prostate cancer is the prostate-specific antigen (PSA) test, which measures PSA levels in blood. Since PSA levels can be affected by other non-cancerous factors, such as infection, the PSA test alone cannot confirm cancer. A prostate biopsy is necessary to confirm cancer following a positive PSA test.

Deciding whether to have a PSA screening test is a choice many men between the ages of 55 and 69 will face. And although the options seem straightforward, choosing to have a PSA test may not be so clear-cut. A PSA test could potentially detect cancer early on, but carries the risk of stress from a false positive result, or complications that could arise from a prostate biopsy.

Studies of decision aids indicate that these tools can help patients learn more about their options and reduce their decisional conflict when it comes to PSA testing. But not as much is known about the impact of decision aids on people who choose to use an online tool, independent of any recruitment.  A recent study examined how an online Option Grid™ decision aid influenced shifts in preference for this type of spontaneous user. The study analyzed data from 164 men who searched for and used the online “Prostate-specific antigen (PSA) test: Yes or no?” Option Grid™ decision aid during 2016 and 2017. This decision aid is designed to help patients compare the risks and benefits associated with either having or not having a PSA test to screen for prostate cancer. The decision aid used in the study has since been updated with the most recent evidence-based information. 

The online decision aid shifted user preference toward not having the PSA screening test, increased user knowledge, and reduced decisional conflict.

Users in the study declared their initial preference from three options (have a PSA test, do not have a PSA test, and unsure), and indicated the strength of their preference, level of decisional conflict and level of knowledge. Users were then presented with ten frequently asked questions (FAQs) with evidence-based answers about the PSA test, and then reported their final preference along with the strength of those preferences after completing the “interactive journey.”

The study found that the use of the decision aid shifted user preference toward not having the PSA screening test: 26.2% of users initially chose not to have the test, while 71.3% chose to not have the test as their final preference. The decision aid also increased user knowledge and reduced decisional conflict. The researchers also found that specific components of the decision aid influenced preference shifts. While the description of the test shifted user preferences toward having the PSA test, the following information in the decision aid shifted preferences away from the PSA test:

  • A patient’s chances of having prostate cancer, if testing finds high PSA levels.
  • The risks associated with having a PSA test.

It is important that patients are aware that evidence-based information is available to help them make informed decisions that align with their preferences when it comes to PSA testing.

For more clinical evidence, visit the prostate cancer screening topic in DynaMed®.

Visit the Option Grid™ product page, where you can request a free trial to use the “Prostate-specific antigen (PSA) test: Yes or no?” decision aid, and other decision aids for a variety of conditions.