"Surprisingly, when asked, most men say they are doing something to protect themselves," says Ronald E. Myers, Ph.D., professor of medicine at Jefferson Medical College of Thomas Jefferson University in Philadelphia. "The presumption is, most men don't think about prostate cancer until they have problems, and if they do think about it, they don't do anything. These results indicate that this doesn't seem to be the case."
The researchers also found that men who said they had been screened were more likely to be more highly educated, better off financially, and believed that screening was an effective and convenient tool to prevent prostate cancer.
"This the first time anyone has reported what men do to protect themselves against prostate cancer," says senior author Elisabeth Kunkel, M.D., professor and vice chair for Clinical Affairs in the Department of Psychiatry and Human Behavior at Jefferson Medical College of Thomas Jefferson University. Drs. Kunkel, Myers and their co-workers at Jefferson's Kimmel Cancer Center report their findings in the current issue of the journal Cancer Epidemiology, Biomarkers and Prevention.
Prostate cancer screening is controversial. Prostate cancer tends to grow slowly, and debate centers on whether or not early detection and treatment do more harm than good. It is also unclear if so-called preventive methods such as diet, exercise and supplements such as selenium actually help prevent prostate cancer.
The researchers wanted to know what men do – if anything – to protect themselves from developing prostate cancer. The team surveyed two groups of men by either phone or mail and combined their data. In the study, 441 men were asked if they were taking any steps to protect themselves against prostate cancer, and what those steps were. In addition, they were asked if they had had screening – a prostate specific antigen, or PSA, test and/or a digital rectal exam – in the past year. Their responses were classified into three categories: conventional care, such as screening; self-care, which includes watching diet, getting regular exercise, taking nutritional supplements; and doing nothing regarding prevention.
According to the survey, says Dr. Myers, "Whether or not men take protective action seems to be influenced by socioeconomic status and their perceptions about screening – whether they think taking certain actions is worth it and is convenient. The decision to take protective action is also influenced by their perception of their risk.
"Most men we describe as engaging in conventional care are more educated, and they believe screening is effective and easy to do," Dr. Myers says. Conventional care users tend to be better off socioeconomically and look for ways to protect themselves from disease, he says. "Men who do self-care seem to be less advantaged socioeconomically, are not very concerned about prostate cancer and screening, and think less about protective behavior."
Twenty percent of those questioned said they didn't take any steps to prevent prostate cancer.
Men were more likely to do self-care if they were less worried and concerned about prostate cancer – a surprising result, says Dr. Kunkel. "Clinically, that hasn't been our experience," she says. "We've found that the more worried and concerned men are, the more likely they are to use non-conventional practices."
"It is the first time prostate cancer behaviors have been categorized in this way," says Dr. Kunkel. "People have looked at screening behavior, but no one has looked at the use of self-care to protect yourself against prostate cancer, whether that is really protective or not."
Dr. Myers agrees. This survey, he says, "is a more comprehensive look at protective behavior. It's the first paper to ask the question about how men protect themselves against disease and to put forward some ideas as to why men make different choices."
In one of the studies, the participants were African-American men between 40 and 69 who were seen in three primary care practices in Philadelphia. African-American men have a higher risk for prostate cancer than other groups. In the other study, the subjects included both white and non-white men between ages 50 and 69 who were seen at a university-based internal medicine practice in Philadelphia. In both surveys, participants saw their primary care doctor in the past two years and had no known problems with their prostate gland. They didn't have a history of cancer or benign prostate disease. They had never had a prostate biopsy or ultrasound.
Dr. Kunkel says, "we need to learn more in terms of both white and non-white men who decide to use different protection strategies, and what in terms of sociodemographic, cognitive and social support factors affect screening behaviors.
"We would like a better understanding of the behaviors in terms of teasing out whether they do these behaviors as part of a general lifestyle or whether these behaviors are specifically to protect themselves against prostate cancer," she says. Next, the researchers will investigate "how the role of the physician interfaces with this behavior in terms of what suggestions physicians make that influence decision-making."
Future studies should examine larger, more geographically diverse populations of men, she notes.
Phyllis Fisher
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