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Enhanced Counseling Could Help Prepare High-Risk Men for Prostate Screening Results

Men at high risk for prostate cancer are the most likely to undergo routine prostate cancer screening, and, now, scientists at Fox Chase Cancer Center in Philadelphia have developed a method of preparatory counseling that could better help to prepare these men for the psychological impact of their screening results.

“We talk a lot about precision medicine, which is tailored to the individual and their genetics,” explains Suzanne M. Miller, PhD, director of patient empowerment and health decision making at Fox Chase. “We are also interested in precision medicine at the psychological level, tailored to the individual’s own psychology and how they respond to information.”

Miller collaborated on the study with Elias Obeid, MD, MPH, director of the Prostate Risk Assessment Program (PRAP) at Fox Chase, and others from Fox Chase and other institutions.

When a man undergoes screening for prostate cancer, the results may trigger quite a few “decision points,” Miller says. Prostate cancer screening traditionally involves performing a blood test called the prostate specific antigen (PSA) test and a digital rectal exam (DRE) on the prostate gland. Treatment options are numerous and varied, and facing these important decisions can be profoundly disruptive to a man’s life, she says.

In this study, men were recruited from the PRAP. Eligible high-risk men were aged 35 to 69 and either white, with at least one first-degree relative or two second-degree relatives with prostate cancer, or African American. All participants took part in a group prostate cancer education session where they learned about hereditary risk for prostate cancer, screening options and procedures, treatment options, and preventive health options. Additionally, participants met individually with a genetic counselor and were shown a draft of their family pedigree. Participants were then randomly assigned to either a general health education group or a cognitive-affective preparation (CAP) group.

“The CAP group allowed men the opportunity to process the screening result information by doing role play, one of the oldest techniques in the clinical psychologist’s tool bag,” Miller says. “We asked them to imagine they had gone through testing and were getting the results.”

During the exercise, participants were asked to role-play their reactions to receipt of a combination of normal PSA and DRE results or to elevated PSA or abnormal DRE results. After participating in the CAP group, African American men reported having a higher perceived risk for prostate cancer than African American men who were assigned to the general health education arm. However, these men did not report an increased level of distress.

“Literature has shown that African American men tend to underplay their prostate cancer risk,” Miller says. “Our cognitive preparation increased their risk perception and made them more action oriented.”

The scientists also looked at whether participants were classified as high or low monitoring. High monitors are those who amplify ambiguous, potentially threatening health information and low monitors distract from and attenuate potentially threatening health information. Low monitors assigned to CAP had less prostate cancer knowledge than those who were assigned to general health education. These results indicate that low monitors may be actively blocking out information about risk when they are forced to focus too much on their potential disease outcome, according to Miller. Additionally, high monitors that participated in CAP were more likely to report negative expectancies of screening and distress than those who had general health education.

“High monitors are good patients who do what they are supposed to do, but do it at a psychological cost,” Miller says. “Since screening is done on a routine basis, this shows us that we have to find better ways to give messages to high monitors in a way that ‘tunes’ them down a bit.”

These results show that it is important to tailor preparation to the individuals’ coping style and cultural factors related to their racial/ethnic background. Oncologists and primary care physicians should be sensitized to these factors when interacting with their patients.

The paper, “Effects of a randomized trial comparing standard and enhanced counseling for men at high risk of prostate cancer as a function of race and monitoring style” was published in the Journal of Health Psychology.