OBJECTIVE: To evaluate the psychosocial impact of participation in a 
population-based prostate-specific antigen (PSA) testing programme, akin to 
screening, and to explore the relationship between urinary symptoms reported 
before PSA testing and the response to the subsequent PSA result.
PATIENTS AND METHODS: This prospective questionnaire study was nested within the 
case-finding component of the ProtecT (prostate testing for cancer and 
treatment) feasibility study (ISRCTN20141297). Men aged 50-69 years from 18 
general practices in three cities in the UK completed the Hospital Anxiety and 
Depression Scale (HADS), the Short Form-12 (SF-12) Health Survey, and the 
International Continence Society 'male' (ICSmale) questionnaires before giving 
consent for a PSA test in a community clinic (baseline). Men with an 'abnormal' 
PSA result returned for further investigation (including biopsy) and repeated 
these questionnaires before biopsy.
RESULTS: At baseline, study participants had similar levels of anxiety and 
depression to the general male population. There was no increase in the HADS 
scores, or reduction in the SF-12 mental health component summary score, on 
attendance at the biopsy clinic after receiving an 'abnormal' PSA result. 
Urinary symptoms were associated with levels of anxiety and depression before 
receiving a PSA result (baseline), but were not associated with anxiety and 
depression at biopsy independently of baseline scores. Therefore changes in 
anxiety or depression at biopsy did not appear to differ between those with and 
without urinary symptoms.
CONCLUSIONS: This study confirms the findings of other studies that the 
deleterious effects of receiving an abnormal PSA result during population 
screening are not identified by generic health-status questionnaires. 
Comparisons with outcomes of studies measuring cancer-specific distress and 
using qualitative research methods raise the question of whether a prostate 
cancer screening-specific instrument is required. However, a standardized 
measure of anxiety identified differences at baseline between those who did and 
did not report urinary symptoms. These findings suggest that it might be 
advisable to better inform men undergoing PSA testing about the uncertain 
relationship between urinary symptoms and prostate cancer, to minimize baseline 
levels of psychological distress.