Open Access Research article

A comparison of US and Australian men’s values and preferences for PSA screening

Kirsten Howard1*, Alison T Brenner2, Carmen Lewis345, Stacey Sheridan345, Trisha Crutchfield45, Sarah Hawley67, Matthew E Nielsen8 and Michael P Pignone345

Author Affiliations

1 Sydney School of Public Health, University of Sydney, Edward Ford Bldg (A27), Sydney, NSW 2006, Australia

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

3 Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

4 Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

5 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

6 Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

7 Ann Arbor VA Health System, Ann Arbor, MI, USA

8 Department of Urology, University of North Carolina, Chapel Hill, NC, USA

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BMC Health Services Research 2013, 13:388  doi:10.1186/1472-6963-13-388

Published: 5 October 2013



Patient preferences derived from an assessment of values can help inform the design of screening programs, but how best to do so, and whether such preferences differ cross-nationally, has not been well-examined. The objective of this study was to compare the values and preferences of Australian and US men for PSA (prostate specific antigen) screening.


We used an internet based survey of men aged 50–75 with no personal or family history of prostate cancer recruited from on-line panels of a survey research organization in the US and Australia. Participants viewed information on prostate cancer and prostate cancer screening with PSA testing then completed a values clarification task that included information on 4 key attributes: chance of 1) being diagnosed with prostate cancer, 2) dying from prostate cancer, 3) requiring a biopsy as a result of screening, and 4) developing impotence or incontinence as a result of screening. The outcome measures were self reported most important attribute, unlabelled screening test choice, and labelled screening intent, assessed on post-task questionnaires.


We enrolled 911 participants (US:456; AU:455), mean age was 59.7; 88.0% were white; 36.4% had completed at least a Bachelors’ degree; 42.0% reported a PSA test in the past 12 months. Australian men were more likely to be white and to have had recent screening. For both US and Australian men, the most important attribute was the chance of dying from prostate cancer. Unlabelled post-task preference for the PSA screening-like option was greater for Australian (39.1%) compared to US (26.3%) participants (adjusted OR 1.68 (1.28-2.22)). Labelled intent for screening was high for both countries: US:73.7%, AUS:78.0% (p = 0.308).


There was high intent for PSA screening in both US and Australian men; fewer men in each country chose the PSA-like option on the unlabelled question. Australian men were somewhat more likely to prefer PSA screening. Men in both countries did not view the increased risk of diagnosis as a negative aspect, suggesting more work needs to be done on communicating the concept of overdiagnosis to men facing a PSA screening decision.

Trial registration

This trial was registered at (NCT01558583).