Clinical Question: Do men who receive a false-positive result on prostate-specific antigen (PSA) testing worry more about prostate cancer than men who receive a negative result?

Setting: Outpatient (primary care)

Study Design: Cohort (prospective)

Synopsis: In this study, investigators identified 167 men from a group of consecutive men who had a negative result on biopsy following a suspicious PSA test (i.e., these men had a false-positive PSA result). For comparison, they also identified 233 men who had a normal PSA result. The men were mailed a brief questionnaire approximately six weeks after their biopsy or normal PSA test result. Overall, 85 percent of the men completed the survey.

Of the men who had a false-positive result, 49 percent reported having thought about prostate cancer “a lot” or “some of the time” compared with 18 percent of patients in the control group (P < .001). Compared with 8 percent of patients in the control group, 40 percent of the men in the false-positive group also worried “a lot” (7 percent) or “some of the time” (33 percent) about the possibility of developing prostate cancer. The false-positive group did not worry more than the control group about dying soon. Sixty-two percent of the men with a negative biopsy reported being reassured “a lot” by the result, despite the 10 percent false-negative rate associated with biopsy.

As with women who receive a false-positive mammography result, instead of being angry at the erroneous test result, men with a false-positive PSA test felt they “dodged a bullet.” Significantly more men in this group reported their lives changed for the better (31 versus 13 percent in the control group; P < .001). Also similar to women who receive false-positive results on mammography, the men in the false-positive PSA group were more likely to think their chances of getting prostate cancer were “much more” or “a little more” than average (36 versus 18 percent in the control group; P < .001).

Bottom Line: False-positive results of screening tests are not benign; they have a psychologic cost. In this study, men who received false-positive PSA test results reported having thought and worried more about prostate cancer despite receiving a negative biopsy result on follow-up. They also thought that the false-positive result made them more likely to develop prostate cancer. Screening can be detrimental to the mental health of our patients. (Level of Evidence: 1b)