摘要：Objectives . This study examined knowledge about prostate-specific antigen (PSA) screening among African Americans and Whites. Because PSA screening for prostate cancer is controversial, professional organizations recommend informed consent for screening. Methods . Men (n = 304) attending outpatient clinics were surveyed for their knowledge about and experience with screening. Results . Most men did not know the key facts about screening with PSA. African Americans appeared less knowledgeable than Whites, but these differences were mediated by differences in educational level and experience with prostate cancer screening. Conclusions . Public health efforts to improve informed consent for prostate cancer screening should focus on highlighting the key facts and developing different approaches for men at different levels of formal education and prior experience with screening. Screening for prostate cancer with prostate-specific antigen (PSA) is controversial because it is not clear whether it reduces mortality and whether the potential benefits of screening and early detection outweigh the risks. 1– 5 These risks include unnecessary worry and the side effects of common treatments for prostate cancer (e.g., impotence and urinary leakage from surgery or radiation therapy) particulary if early, localized prostate cancer is found. 1– 5 Until randomized controlled trials determine whether regular screening with PSA reduces mortality, 5– 9 professional organizations have issued different guidelines 10– 15 for prostate cancer screening. Many, including the US Preventive Services Task Force, 11 recommend informing men about the known risks and potential benefits of screening. 10– 15 Despite professional recommendations 10– 15 to promote informed consent or “informed decisionmaking” 16– 18 for screening, knowledge about prostate cancer and screening is low. 19– 26 Because PSA testing has become widespread, 27– 30 highlighted in the mass media, 31– 33 and encouraged by mass screenings and advertised through a movement to create postage stamps, 35– 37 promoting informed consent has become an ethical issue in public health. Although African American men have a higher incidence of prostate cancer, are more likely to be diagnosed at an advanced stage, and have higher mortality rates compared with Whites, 38– 41 they are generally less knowledgeable about the disease. 24, 42, 43 The gap between what men know and what they ought to know in order to make an informed decision about screening has the potential to widen, particularly for African American men. In previous studies assessing knowledge, investigators determined whether men knew facts about prostate cancer, screening, and treatment. 19– 25, 42– 43 These studies were based on facts drawn from patient education material, 20, 22, 45 from what the investigators considered important, 21, 23, 24, 42, 43, 47 or from a literature review. 25, 42 We hypothesized that most men do not know the facts needed to provide informed consent for prostate cancer screening with PSA. In contrast to previous studies, 19– 25, 42– 47 we assessed knowledge relative to the reasonable-person standard of informed consent, using a survey based on results from a prior study by 1 of the authors. 48 That study identified facts that experts in prostate cancer and African American and White couples believed men ought to know to make an informed decision about screening. Those facts formed the proposed content of informed consent by the reasonable-person standard, a legal standard defined by what a hypothetical person would need to know in order to make an informed decision. 49– 51 We hypothesized that there would be differences in knowledge about prostate cancer, screening, and treatment by race/ethnicity. In contrast to previous studies, 23, 42, 43 we examined racial/ethnic differences in knowledge while controlling for educational level. Because a man’s experience with PSA screening might modify the association between race/ethnicity and knowledge, we also examined potential effect modifiers related to experience. As a result, we were more fully able to characterize differences in knowledge by race/ethnicity.
