Prostate-specific antigen testing and prostate biopsy: are self-reported lower urinary tract symptoms and health-related quality of life associated with the decision to undergo these investigations?

OBJECTIVE: To investigate whether men's self-reported health-related quality of life and lower urinary tract symptoms (LUTS) are associated with acceptance of prostate-specific antigen (PSA) testing and subsequent prostate biopsy. PATIENTS AND METHODS: In a prospective questionnaire study of men aged 50-69 years, nested within the primary-care-based Prostate testing for cancer and Treatment study in nine UK areas, the Hospital Anxiety and Depression Scale (HADS), 12-item Short Form Health Survey (SF-12) and a self-reported LUTS measure (ICSmaleSF) were completed immediately before having a PSA test or prostate biopsy, or after not responding to an invitation for a PSA test or refusing a biopsy. Analyses compared 348 men accepting or 232 not responding to invitations for PSA testing and 318 accepting or 48 refusing a prostate biopsy. RESULTS: Men accepting or not responding to the invitation for a PSA test had similar HADS, SF-12 and LUTS scores. Men accepting a biopsy had similar HADS and SF-12 scores to those refusing biopsy, but significantly more LUTS (P < 0.01 for hesitancy, reduced stream, intermittency, incomplete emptying, frequency during the day). CONCLUSION: Depressed or anxious mood, comorbidity and LUTS were not associated with the decision to respond to invitations for a PSA test. Men agreeing to a biopsy were more likely to have LUTS than those refusing, suggesting that men believe that LUTS are a symptom of prostate cancer. Men needing a prostate biopsy require more information about LUTS so that they can make informed choices about testing for prostate cancer.