112 • ORIGINAL ARTICLE TIMOTHY J. WILT, MD, MPH JEEVAN PAUL, MD MAUREEN MURDOCH, MD, MPH DAVID NELSON, PhD SEAN NUGENT, BS HANNA BLOOMFIELD RUBINS, MD, MPH Minneapolis VA Center for Chronic Disease Outcomes Research University of Minnesota Department of Medicine Minneapolis, Minn Eff Clin Pract. 2001;4:112-120. Edited by Lisa M. Schwartz, MD, MS This paper is available at ecp.acponline.org. Educating Men about Prostate Cancer Screening A Randomized Trial of a Mailed Pamphlet CONTEXT. Although evidence-based guidelines recommend that physicians inform men about prostate cancer screening, the most efficient way to do this is not known. OBJECTIVE. To evaluate whether a mailed educational pamphlet affected men’s knowledge about early detection of prostate cancer. DESIGN. Randomized, controlled trial. SETTING. Primary care clinic of the Minneapolis VA Medical Center. PATIENTS. 342 men at least 50 years of age who responded to a mailed survey (overall response rate, 68%) and did not report a history of prostate cancer. INTERVENTION. “Early Prostate Cancer” pamphlet mailed to patients in the interven- tion group 1 week before their scheduled clinic appointments. OUTCOME MEASURES. Patients’ responses to a survey mailed 1 week after their clinic appointments; prostate-specific antigen (PSA) testing determined from electronic medical records. RESULTS. Respondents were predominantly elderly white men (mean age, 71 years; 90% white) with chronic illnesses (48% described their health as “fair” or “poor”). Men who received the educational pamphlet were better informed than men in the usual care group, as measured by correct responses to the following three questions about prostate cancer screening: the natural history of prostate cancer (32% vs. 24%; P = 0.10), whether treatment lengthens lives of men with early prostate cancer (56% vs. 44%; P = 0.04), and accuracy of PSA testing (46% vs. 27%; P < 0.008). The over- all proportion of correctly answered questions was greater in the intervention group (45% vs. 32%; P < 0.001). Testing for PSA in the year after the index clinic appoint- ments did not differ significantly between the intervention group and the usual care group (31% vs. 37%; P > 0.2). CONCLUSIONS. Male veterans are poorly informed about the potential benefits and risks of prostate cancer screening. Although our mailed educational pamphlet enhanced knowledge only modestly, it was an inexpensive and easily implemented intervention. E arly detection and treatment of prostate cancer may reduce disease-specific morbidity and mortality. However, convincing evidence of benefit from this strategy is lacking. 1–5 Therefore, evidence-based practice guidelines recommend that “Rather than screening all men for prostate cancer as a matter of routine, physicians should describe the potential benefits and known harms of screening, diagnosis and treatment; listen to the patient’s concerns; and then individualize the decision to screen.” 6–8 © 2001 American College of Physicians–American Society of Internal Medicine •