Prostate Restored
Prostate Restored
Photo: cottonbro studio
Prostate biopsy can be difficult for men to tolerate, and commonly results in physical side effects [3, 4] including bleeding, pain, urinary retention and infection.
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Read More »This study found that overall levels of regret were low (5%) among men following prostate biopsy. A higher level of regret following prostate cancer treatment decisions (11–12%) has been reported in a number of published studies [8, 10, 12] suggesting the possibility of differences in how men view the decisions around biopsy and treatment. Further suggestion of the difference between biopsy and treatment regret is reflected in the different predictor variables significantly associated with regret in this study compared with the existing literature on regret following prostate cancer treatment. One theory to explain this difference and supported by our results is that these men may have received better pre-procedure counselling for prostate biopsy. This is based on more than 80% of men reporting that they received enough information before the biopsy, and less than one fifth of men had side effects worse than expected. Also, at this point more than one-third of these men did not have cancer, a fact for which they may be grateful that they had the biopsy. Further research is needed to clarify if and how predictors of regret in biopsy and treatment differ with the aim of ensuring men are appropriately prepared and counselled at each point in the prostate cancer diagnosis and treatment pathway. The evidence base for PSA testing as a screening tool for prostate cancer – the route by which many men are referred for a prostate biopsy - includes conflicting results which has not as yet made a clear case for widespread PSA testing. However its use in Ireland [13] and elsewhere is widespread. Ransohoff and McNaughton Collins argue that this widespread use is because the system acts to make PSA attractive through positive feedback mechanisms [14]. A patient will be grateful for a negative PSA result or suspicious result followed by a negative biopsy; furthermore a positive PSA result followed by a cancer diagnosis makes the patient grateful for early detection. The clinician is also affected by positive feedback resulting from PSA testing and subsequent biopsy; we have previously shown that GPs who detect an asymptomatic prostate cancer via PSA testing were 3-times more likely to PSA test other asymptomatic men [15]. Additionally, litigation will usually only follow a cancer detected too late, not the one detected too early or which would never have caused harm. This theory may explain why the level of regret reported by respondents in this survey was generally low; a negative biopsy result provides reassurance, and a positive result provides positive feedback that the test was worth it as the cancer has been detected. Health anxiety was the only variable significantly associated with regret. Health anxiety can be thought of as a continuum, with hypochondriasis at the extreme. It is characterised by attentional biases towards illness-related information and cognitive biases leading to the misinterpretation of information as personally threatening and catastrophic [16]. Miles et al. [16] examined health anxiety in the context of screening for colorectal cancer and found that people with high health anxiety were less reassured following screening. In this study we found that men with higher health anxiety report higher levels of regret and, following from Miles et al. [16], it may be that men with high health anxiety were less reassured following prostate biopsy, and therefore were more likely to regret the procedure.
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Learn More »This study does have some limitations. The questionnaire designed to collect this data was in effect a new instrument. However it was tested for face validity and comprehension with 24 men in the RoI, and available validated tools were used within the questionnaire such as the Health Anxiety Questionnaire by Lucock and Morley, 1996. The limited sample size coupled with the low level of regret may explain in part why so few variables were associated with regret. The response rate is another limitation and we do not have any information on the characteristics of responders and non-responders, so we cannot assess participation bias. Respondents who answered the question on regret were more likely to be married or in a partnership and to have third level education than those who did not. The literature cited previously on regret after treatment decisions indicates that being married or in a partnership, and higher levels of educational attainment are associated with lower levels of regret. This suggests we may have somewhat underestimated regret in the current study. The major strength of the study is that we were able to test a wide variety of variables for an association with regret. The inclusion of men from two jurisdictions with differing health systems increases generalizability. The study overall can be viewed as a pilot study into regret among men following prostate biopsy and associated factors. This should raise the profile of this issue among researchers and the health community which may in turn lead to further research to explore this in other populations.
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