Open Access Research article

A preliminary exploration of the feasibility of offering men information about potential prostate cancer treatment options before they know their biopsy results

Steven B Zeliadt12*, Peggy A Hannon2, Ranak B Trivedi12, Laura M Bonner1, Thuy T Vu2, Carol Simons1, Crystal A Kimmie35, Elaine Y Hu1, Chris Zipperer4 and Daniel W Lin56

Author affiliations

1 Northwest HSR&D Center of Excellence, VA Puget Sound Health Care System, Metropolitan Park West, 1100 Olive Way #1400, Seattle, WA 98101, USA

2 Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA

3 Seattle Institute for Biomedical and Clinical Research, Seattle, WA, USA

4 Washington State Department of Health, Cancer Prevention and Control Unit, Olympia, WA, USA

5 Department of Veterans Affairs Medical Center, Urology Service, Seattle, WA, USA

6 Department of Urology, University of Washington School of Medicine, Seattle, WA, USA

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Citation and License

BMC Medical Informatics and Decision Making 2013, 13:19  doi:10.1186/1472-6947-13-19

Published: 6 February 2013



A small pre-test study was conducted to ascertain potential harm and anxiety associated with distributing information about possible cancer treatment options at the time of biopsy, prior to knowledge about a definitive cancer diagnosis. Priming men about the availability of multiple options before they have a confirmed diagnosis may be an opportunity to engage patients in more informed decision-making.


Men with an elevated PSA test or suspicious Digital Rectal Examination (DRE) who were referred to a urology clinic for a biopsy were randomized to receive either the clinic’s usual care (UC) biopsy instruction sheet (n = 11) or a pre-biopsy educational (ED) packet containing the biopsy instruction sheet along with a booklet about the biopsy procedure and a prostate cancer treatment decision aid originally written for newly diagnosed men that described in detail possible treatment options (n = 18).


A total of 62% of men who were approached agreed to be randomized, and 83% of the ED group confirmed they used the materials. Anxiety scores were similar for both groups while awaiting the biopsy procedure, with anxiety scores trending lower in the ED group: 41.2 on a prostate-specific anxiety instrument compared to 51.7 in the UC group (p = 0.13). ED participants reported better overall quality of life while awaiting biopsy compared to the UC group (76.4 vs. 48.5, p = 0.01). The small number of men in the ED group who went on to be diagnosed with cancer reported being better informed about the risks and side effects of each option compared to men diagnosed with cancer in the UC group (p = 0.07). In qualitative discussions, men generally reported they found the pre-biopsy materials to be helpful and indicated having information about possible treatment options reduced their anxiety. However, 2 of 18 men reported they did not want to think about treatment options until after they knew their biopsy results.


In this small sample offering pre-biopsy education about potential treatment options was generally well received by patients, appeared to be beneficial to men who went on to be diagnosed, and did not appear to increase anxiety unnecessarily among those who had a negative biopsy.

Prostate cancer; Biopsy; Decision aid; Prostate biopsy; Treatment decision making