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An Investigation of the Knowledge and
Opinions of British Men Regarding
Prostate Cancer
By
Jedrik Martinez
A Dissertation
Submitted to
Bishop Vaughan Catholic School
As An Extended Project
16 May 2014
Acknowledgement
I wish to express my sincere gratitude to Ms. Rebecca
Finch, Head of Year, for her expert and valuable guidance
extended to me.
I also thank my family and friends for their encouragement
and support.
I take this opportunity to thank all who, directly or
indirectly, have lent their helping hand in this study.
ii
ABSTRACT
Objectives.Prostate cancer is the most commoncancer in malesinthe UK. It is predictedthatone in
eight men across the UK will developthe disease. More than 10,000 die from prostate cancer every
year.This studyaims to investigate the knowledge andopinionsof Britishmenregardingthe causes,
age of onset and screening, treatment and counselling for prostate cancer and attitude towards
persons who have prostate cancer.
Methods. Questionnaireswere used to collect data for the study. All the respondents (n = 25) were
Britishmale withmeanage 36.5yearsandrange 16 – 69 years.Excludedfromthe studywerefemales;
personswithfamilyhistoryof prostatecancer;personswhohadbeenscreened,diagnosedortreated
forprostate cancer;medical studentsanddoctorsandpersonsinvolvedincancerresearch,awareness
or treatment.
Results. Results of the study revealedthat nineteen(76%) of the 25 respondents did not know the
causesof prostate cancer andonly6 (24%) were aware of them.Eleven(44%) respondentssuggested
that prostate cancer develops over the age of 50. Only 3 (12%) respondents knew there was no
screening programme for prostate cancer in the UK. Seventeen (68%) did not know the available
treatment options for prostate cancer while 8 (32%) were aware of them.Twenty(80%) of the total
respondents were willing to attend a screening programme for prostate cancer. Almost all of the
respondents (96%) felt comfortable talking about prostate cancer and nineteen (76%) felt it was
alrighttosee afemaleGPaboutit.Twenty-four(96%) respondentswillnottreatpersonswithprostate
cancer differently and 22 (88%) felt that persons with prostate cancer could continue working.
Conclusion.GenerallyBritishmenlackthe knowledge regardingthe causes,ageof onsetandscreening
and treatment for prostate cancer. However they show a positive attitude towards counselling and
towards persons who have prostate cancer.
iii
Table of Contents
Chapter Title Page
Title Page i
Acknowledgement ii
Abstract iii
Table of Contents iv
List of Tables & Figures v
1. Introduction 1
1.1. Background 1
2. Literature Review 2
3. Method 4
3.1 Questionnaire 4
3.2 Sampling 4
3.3 Ethical Issues 4
4. Results 5
5. Discussion 10
6. Conclusion 11
7. Evaluation and Recommendation 11
7.1 Evaluation 11
7.2Recommendation 12
8. References 13
9. Appendices 14
9.1 Appendix A 14
iv
Introduction
Background
Prostate canceristhe secondmostcommoncancer inmalesasstatedbyLongmore etal. (2010,
p. 646), and now, the most common cancer in men in the UK (Cancer Research UK 2014). World Cancer
ResearchFund(2013) reportsthat in 2011 there were 41,725 new cases of prostate diagnosedinthe
UK. Prostate Cancer UK (2013) predicts that one in eight men across the UK will develop prostate
cancer.It furtherreportsthateveryhouronemandiesfromprostatecancer,puttingitacrossasmore
than 10,000 every year.
Buckford et al. (2009, p. 7) suggest that there are several factors that increase the risk of
developingthe disease suchasage, familyhistory,ethnicity,anddietaryfactors.They furtheradded
that there are several treatment options for prostate cancer such as surgery, radiotherapy and
hormone therapy.
Chancesforsuccessful treatmentof cancer,accordingtothe WorldHealthOrganization(2014),
are greatly increased through early detection of the disease by way of education to promote early
diagnosis and screening. Increased awarenessthrough education like recognition of risk factors and
possible warningsignsandtakingpromptactionforearlydiagnosiscanhaveagreatimpactontreating
cancer.
The purpose of this dissertation is to investigate the knowledge and opinions of British men
regarding prostate cancer. The author believes knowledge promotes awareness leading to early
diagnosisandtreatment,which,inturn, can decrease morbidityandmortalityfromthe disease.The
study aims to answer the following questions:
1. The knowledge of British men regarding the causes of, age of onset and screening , and
available treatment for prostate cancer,
2. The opinions of British men regarding screening and counselling for prostate cancer, and
3. The opinions of British men regarding their behaviour towards persons who had been
diagnosed with or being treated for prostate cancer.
1
Literature Review
More than 40,000 cases of prostate cancer is diagnosed yearly accounting for almost a quarter of all
cancers in the UK (Cancer Research UK 2014). The World health Organization (2014) includes prostate
cancer as one among several types of cancer that cause the majority of cancer deaths. This type of cancer
develops in the prostate, a gland in the male reproductive system. NHS Choices (2012) describes the
prostate gland as one that produces a fluid that nourishes and protects sperm during sexual activity and
makes up a greater part of the ejaculatory volume. According to Muruve et al. (2013) the prostate gland is
“located posterior to the pubic symphysis, superior to the perineal membrane, inferior to the bladder, and
anterior to the rectum.”
The risks and causes of prostate cancer, according to Cancer Research UK (2014) include age, family
history, ethnicity and dietary factors. It further suggests bowel cancer, IGF-1 (Insulin-like Growth Factor)
and vasectomy as additional risk factors. Buckford et al. (2009, p. 7) stress that age is the strongest risk
factor with the average age during diagnosis at 70 – 74 years and average age at mortality 80 – 84 years.
Prostate cancer is less common below the age of 50, however, the risk increases as the age increases.
Another risk factor is family history. World Cancer Research Fund (2013) reports that around 5 – 9% of
prostate cancer arelinked to genes or family history. In addition, Prostate Cancer UK (2013) suggests that
a man is two and a half times more likely to develop the disease if his father or brother has the disease
compared to one who has no family history of prostate cancer. Regarding ethnicity as a risk factor, World
Cancer Research Fund (2013) further reports that men of African Caribbean or African descent have higher
risk of prostate cancer than white men. Lastly, Buckford et al. (2009, p. 8) suggest that research linking
prostate cancer and diet has been inconclusive but mentions lycopenes and selenium as having protective
effect while diet high in protein or calcium from dairy products may increase the risk of prostate cancer.
Benign and malignant growths in the prostate may present with similar symptoms which include
urinating more frequently than usual especially at night, needing to rush to the toilet to urinate, difficulty
in starting to (hesitancy) or taking a long time (straining) to urinate, and feeling the bladder is not
completely empty after passing urine (Cancer Research UK 2014). These symptoms, however, are not
evident until the cancer has grown large enough to put pressure on the urethra.
Public Health England (2013) reports that there is no organized screening programme for prostate
cancer in the UK. However, it promotes an informed choice programme, the Prostate Cancer Risk
Management Programme. It is the aim of the programme to ensure that men who are concerned about
the risk of prostate cancer receive a clear understanding of the risks and benefits of PSA (Prostate Specific
Antigen) test for screening, other possible screening tests and the available treatment for prostate cancer.
Information packs are made available to help the primary care team in counselling men who require the
screening test. A number of uncertainties have been recognized surrounding the PSA test and currently,
there is no evidence that would prove a PSA-based screening programme beneficial over the risk of using
it.
The Prostate Cancer Risk Management Programme (Buckford, et al. 2009) explains that the PSA test is
currently the best method of identifying an increased risk of localized prostate cancer. However, the
antigen may be elevated in men with other types of prostate problems that are not malignant such as
benign prostatic hypertrophy. Although studies reveal reduction in rates of death from prostate cancer
after PSA based screening, Buckford et al. (2009, p.15) suggest that there was an associated high risk of
over-diagnosis and therefore over-treatment. There are other ways of determining the presence and/or
extent of prostate cancers that Buckford et al. (2009, p.9) mentioned like digital rectal examination (DRE);
transrectal ultrasound (TRUS); TRUS-guided prostate biopsy and histology; and imaging techniques
(magnetic resonance imaging [MRI], computerized tomography [CT] scan, x-ray, bone scan).
2
Buckford et al. (2009, p.13) provide several management options that are available for prostate cancer
which include watchful waiting with serial PSA monitoring; activesurveillance or active monitoring; radical
prostatectomy; radiotherapy or high intensity focused ultrasound (HIFU); cryotherapy; and adjuvant
hormonal therapy. It is recommended that treatment isconsidered individually for every manwith prostate
cancer.
According to Longmore et al. (2010, p.646), of men with prostate cancer, “10% die in six months and
that 10% live more than ten years.” Willey (2014), on the other hand, reported that the proportion of men
living ten years with prostate cancer has increased from 25% to around 80%. This has been attributed to
early diagnosis, more targeted treatment and better preventive measures.
3
Method
1. Questionnaire
The study made use of questionnairesincollectingdata.Aftersatisfyingthe inclusionand
exclusion criteria, the purpose of the study and the questionnaires was explained to the
respondents.The questionnairesconsistedof closedendeddichotomous questionsthatasked
respondents to answer in a yes or no with a number of these questions followed by open
formatquestionstogive the respondentsanopportunitytoexpresstheiropinions(Appendix
A).
2. Sampling
A stratified sampling of 25 British men from different age groups was used for the study.
The youngest age set for the study was 16 because at this age a child can give consent to
medical treatment(Library of Congress,2014). The oldest age group were respondentsover
the age of 50. No reference wasmade regardingethnicbackground.Excludedfromthe study
were:
 Females
 Men who have or would have prior knowledge about prostate cancer such as:
 those who had either been screened, diagnosed, treated or are undergoing
treatment for prostate cancer;
 those who have a family history of prostate cancer;
 medical doctors;
 medical students; and
 those who are or were directly or indirectly involved in any cancer research,
cancer awareness programme or cancer management, for example,
radiotherapists, most especially for prostate cancer.
3. Ethical Issues
For confidentiality and ethical issues the names, address and contact details of the
respondentwere notrequiredinformationinthe questionnaire.All dataobtainedwere kept
in confidentiality. The respondents were advised that they can withdraw from the study
anytime.
4
Results
All respondents (n = 25) completed the questionnaire. Respondents’ mean age was 36.5 years,
(median 37 years), and all were British male with no family history of prostate cancer (Table 1).
Resultsof the studyrevealedthatnineteen(76%) of the 25 respondentsdidnotknow the causes
of prostate cancer and only 6 (24%) were aware of them (Figure 1). Genes or family history as the
most answered cause followed by diet and age (Table 2). Eleven (44%) respondents suggested that
prostate cancerdevelopsoverthe age of 50, 1 didn’tknow when,and,13 (52%) thoughtitdeveloped
before the age of 50 (Table 3). Among the respondents, 10 (40%) thought that, in the UK, men over
50 yearsold are screenedforprostate cancer, 8 (32%) respondedthatit was before the age of 50, 4
(16%) didnot knowwhen,and, only3 (12%) repliedthere wasno screeningprogramme forprostate
cancerinthe UK (Table4). Seventeen(68%) didnotknow the available treatmentoptionsforprostate
cancer while 8 (32%) were aware of them (Figure 2). Twenty (80%) were willing to undergo
radiotherapyfortreatment,4 (16%) were not, and,1 (4%) saidit dependeduponthe successrate of
the treatment (Figure 3). Fifteen (60%) of the total respondents would prefer surgery over
radiotherapyeventhoughthiswouldtake several weekstorecover,8 (32%) wouldnot,while 2 (8%)
thought they would if it the only option left (Figure 4).
Figure 1. Knowledge Regarding the Causes of Prostate Cancer
Q1. Do you know what causes prostate cancer?
Figure 2. KnowledgeRegardingthe TreatmentOptionsAvailableforProstate Cancer
Q10. Do you know what treatment options are available for prostate cancer?
5
YES
24%
NO
76%
NO
68%
YES
32%
Figure 3. OpinionRegardingRadiotherapyasTreatment
Q11. One of the most popular treatments is radiotherapy. Would you feel comfortable undergoing this treatment with
the effects of radiation?
Figure 4. OpinionRegardingHavingSurgeryInsteadof RadiotherapyasTreatment
Q12. Would you prefer to have surgery rather than radiotherapy even though this would take several weeks to recover?
Table 1. StudyPopulation
N = 25 Mean or N (%) Range Median
Age (years) 36.5 16 - 69 37
Sex:M/F 25 (100%)/0
British 25 (100%)
Family history ofprostate
cancer
25 (100%)
6
YES
80%
NO16%
Depends
4%
YES
60%
NO
32%
Depends
8%
Table 2. Knowledge RegardingCausesof Prostate Cancer
Q1. Do you know what causes prostate cancer? If yes, please could you name the causes below.
Causes Total Percentage
Genes/Heredity/Familyhistory 5 35.7%
Diet 3 21.4%
Redmeat 1
Carcinogensinfood 1
Not specified 1
Age 3 21.4%
Race/Nationality 1 7.1%
Lifestyle (notspecified) 1 7.1%
Enlargementof prostate 1 7.1%
Table 3. Knowledge Regardingthe Age of Onsetof Prostate Cancer
Q3. What age do you think prostate cancer usually develops?
Age of Onset
< 10 10 – 19 20 – 29 30 – 39 40 - 49 50 -59 60 & above Don’t Know
Sample
Population
< 20 0 1 2 1 1 0 0 0
20 - 29 0 0 1 2 2 0 0 0
30 - 39 0 0 0 1 1 3 0 0
40 - 49 0 0 0 1 0 1 2 1
50 & above 0 0 0 0 0 3 2 0
Table 4. Knowledge Regardingthe Age of ScreeningforProstate Cancerinthe UK
Q4. At what age are men screened in the UK for prostate cancer?
Age of Screening
< 10 10 – 19 20 – 29 30 – 39 40 - 49 50 -59 60 & above Not Screened Don’t
Know
Sample Population
< 20 0 1 1 1 1 1 0 0 0
20 - 29 0 0 2 0 1 1 0 0 1
30 - 39 0 0 0 0 0 2 2 0 1
40 - 49 0 0 0 0 1 0 1 2 1
50 & above 0 0 0 0 0 3 0 1 1
7
Twenty(80%) of the total respondentswere willingtoattenda screeningprogramme forprostate
cancerwhile only3(12%) wouldnotandthe remaining2(8%) maypossiblyattendit(Figure5).Almost
all of the respondents(96%) feltcomfortable talkingaboutprostate cancer(Table5).Nineteen(76%)
felt it was alright to see a female GP about it and the remaining 6 (24%) did not (Figure 6). Twenty-
four (96%) respondents will not treat persons with prostate cancer differently. Two (8%) felt that
personswithprostate cancercouldcontinue toworkdependingontheirwell-being,1(4%) disagreed
while the remaining 22 (88%) thought they could.
Figure 5. OpinionWhetherMenare WillingtoAttendaScreeningProgramme
Q5. Would you attend a screening programme?
Figure 6. Opinion Whether Men are Comfortable Going to a Female GP if Symptoms Develop
Q7. If your GP was female would you feel comfortable going to her when you first develop symptoms?
8
Yes 80%
No 12%
Maybe 8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Yes 76%
No 24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Table 5. OpinionWhetherMenFeel Comfortable TalkingAboutProstate Cancer
Q.6. Would you feel comfortable talking about prostate cancer if you thought you had this illness?
Sample Population
< 20 20 – 29 30 – 39 40 – 49 50 & above Total Percentage
YES 5 5 4 5 5 24 96%
NO 0 0 1 0 0 1 4%
Total 5 5 5 5 5 25
Table 6. Opinion Whether Men Will Treat a Person Differently if He Had Prostate Cancer
Q.8. Would you treat someone differently if you knew they had prostate cancer?
Sample Population
< 20 20 – 29 30 – 39 40 – 49 50 & above Total Percentage
YES 1 0 0 0 0 1 4%
NO 4 5 5 5 5 24 96%
Total 5 5 5 5 5 25
Table 7. OpinionWhetheraPersonwithProstate CancercouldContinue toWork
Q.9 Do you think someone could continue to work even if they have prostate cancer?
Sample Population
< 20 20 – 29 30 – 39 40 – 49 50 & above Total Percentage
YES 4 5 5 3 5 22 88%
NO 1 0 0 0 0 1 4%
Depends on
well-being
0 0 0 2 0 2 8%
Total 5 5 5 5 5 25
9
Discussion
Considering that prostate cancer is reported as the most common cancer in males in the UK, it is
distressingtoknowthatmajorityof menare stillunaware of the causesandriskfactorsof developing
the disease. A minorityof men, however, are aware that age, familyhistoryand diet are risk factors
for developingthe disease.Onlya feware aware that the risk of developingthe disease increasesat
age over 50 years and continues to increase as one grows older.
There is no organizedscreeningprogramme forprostate cancer. Thissituationdoesnot helpmen
who are at risk of developing the disease. Majority of men are willing to undergo the programme.
They feel that screening for the disease can for assure them that they don’t have it thus give them
peace of mind.Furthermore theybelieve thatascreeningprogramme canincrease awarenessof the
risks,the signsand symptomsand treatment.Theythinkthat screeningcanpromote earlydetection
of the disease resultingtopromptmanagement.However,somemenare notquite sure theywantto
be screenedbecause theyfeelitcanbe potentiallyembarrassing,andothersfeel thetests(PSA testing
and biopsy) might be painful and stressful.
Most men are comfortable talking about the disease as this can increase their awareness, help
them gain advice and understanding about treatment and outcome, and believe that this is serious
thus shouldnotbe ignored.Talkingaboutit can also helpthemgainsupport fromfamilyand friends
and in turn may help others, too. Onlyone of the respondents found it uncomfortable to talk about
the disease if he hadit because he feltitwasa seriousmatter.Generallytheyare comfortable seeing
a female GP when symptoms develop, however, some may still prefer seeing a male GP.
On the whole, men’s attitude or behaviour towards individualswith prostate cancer would not
change.Theyalsoagree thatdependingontheirgeneral well-being,thosewithprostate cancercould
continue to work.
A great numberof menare notaware of the availabletreatmentof prostatecancer.A few of them
knowthat surgery,radiotherapyandhormonal therapyare optionsavailable intreatingthe disease.
Most men agree to radiotherapy as a form of treatment. Their choice of treatment, however, was
dependentonsuccessrate of the treatmentandif itwasthe optionsuitable fortheircondition.Some
wouldagree tosurgeryonlyif othertreatmentshave failed and they are left with no other options.
10
Conclusion
Generally British men lack awareness of prostate cancer – the causes and risk factors, the age of onset,
the screening programme and the treatment available. Majority of men are willing to attend a screening
programme for prostate cancer as preventive health measure. They are generally comfortable talking
about the disease as well as consulting a GP about it. Basically they feel that their attitude towards
individuals with prostate cancer will not differ and most agree that these individuals could continue
working.
Evaluation and Recommendation
Evaluation
By doing the study and researching on the subject matter, the author had gained important insight
regarding prostate cancer. He believes that the awareness would encourage him to live a healthy life and
more importantly help others concerned about prostate cancer by sharing the knowledge he obtained
throughout the course of the study.
Method. The questionnaire made use of closed format questions to collect data. Some of these
questions were followed by qualitative questions like ‘why’ to allow the respondents to express their
opinion rather than confining their responses to a yes or no. There were only 12 questions utilized that
were short, simple and straight-forward. However the author agrees that the response options to the
questions were limited. The response lacked uniformity because some of the respondents provided
additional response options while others did not. The questionnaire failed to provide questions regarding
awareness of signs and symptoms of prostate cancer and the source of respondent’s knowledge of the
disease. Questions regarding adequacy or lack of awareness campaign on prostate cancer by authorities
dealing with prevention and management of the disease were not included. Finally it has also been
observed that hints or answers regarding the treatment of prostate cancer could be taken from the
questions in the questionnaire.
Sample. The sample covered a wide range of age population, with respondents ranging from ages
16 – 69. The inclusion and exclusion criteria were specific to avoid exposure or acquired knowledge on the
disease thus minimising bias in answering the questions. The race and educational level of the respondents
were, however, not recorded. The author agrees that the sample size was too small to support a claim
affecting the study’s reliability and statistical significance. He believes that his target population should
have been an age group that were at risk of developing the disease for this would involve men who are
likely to need such information in the future.
Ethics. For confidentiality and ethical issues the names, address and contact details of the
respondent were not recorded in the questionnaire. For sensitivity issues, persons who had been
screened, diagnosed, treated or being treated for prostate cancer were not included in the study.
Although there was no writteninformedconsent,personswho consented verbally were included in
the study.
Practical Issues.The questionnaireswere easytoprintoff andeconomical.The sample sizewas
small and respondents were well within the author’s vicinity of daily activity, e. g. school and
neighbourhood so it was not difficult and time-consuming to collect data.
11
Previous research on the topic. An investigation on knowledge and attitudes of Australianmen
about prostate cancer by Arnold-Reed, et al. (2008, p. 312) revealed a similar lack of knowledge
regarding the disease. However Arnold-Reed, et al. (2008) had a large sample size (n=503) and
targeted men aged 40 – 80 who were highly at risk of developing the disease which this author
believes,if done similarly,wouldhave givenmore supporttothe significance of hisowninvestigation.
Recommendation
For further study to be conducted on thematter, the author recommends increasing the sample size
and improving the questionnaire by
 providing different possible response options (e.g. Yes _ No _ Maybe _ );
 including questions about awareness of signs and symptoms of the disease;
 asking the respondents the source of their awareness of the disease to help explain the extent of
their knowledge (e.g. What is the source of your knowledge regarding prostate cancer?
Newspaper _ Television _ Radio _ Internet _ Posters/Flyers _ School _ Individuals with prostate
cancer _ Family _ Friends _ Others _ ) ;
 including a measure of the adequacy or lack of awareness campaign on prostate cancer (e.g. How
often do you see advertsor campaigns regarding prostatecancer? Very often _Often _Sometimes
_ Not at all _ ); and
 avoiding giving obvious hints or answers by carefully structuring the questions.
12
References
Arnold-Reed, D., Hince, D., Bulsara,M., Ngo H., Eaton, M., Wright,A., Jones, F., Kaczmarczyk,W., Marangou,A.
and Brett, T. (2008) ‘Knowledge and attitudes of men about prostate cancer’, The Medical Journal of Australia,
186 (6), pp. 312–314.[Online]. Availableat:https://www.mja.com.au/journal/2008/189/6/knowledge-and-
attitudes-men-about-prostate-cancer (Accessed: 01/05/14)
Buckford , D., Kirby,M. and Austoker, J. (2009) Prostate cancer risk management programme: information for
primary care. NHS Cancer Screening Programmes.
Cancer Research UK (2014) Prostate cancer risk and causes. Availableat:
http://www.cancerresearchuk.org/cancer-help/type/prostate-cancer/about/prostate-cancer-risks-and-causes
(Accessed: 21/04/14 ).
Cancer Research UK (2014) Prostate cancer symptoms. Availableat:http://www.cancerresearchuk.org/cancer-
help/type/prostate-cancer/about/prostate-cancer-symptoms (Accessed: 21/04/14).
Library of Congress (2014) Child health and social welfare. Availableat:http://loc.gov/law/help/child-
rights/uk.php#ChildHealthandSocialWelfare (Accessed:01/05/14)
Longmore M., Wilkinson I.,Davidson,E., Foulkes, A. and Mafi,A. (2010) Oxford handbook of clinical medicine.
8th edition. New York: Oxford University Press Inc.
Muruve, N. and Gest, T. (2013) Prostate anatomy. Availableat:
http://emedicine.medscape.com/article/1923122-overview#aw2aab6b3 (Accessed: 16/11/13)
NHS Choices (2012) Know your prostate. Availableat:
http://nhs.uk/Livewell/Prostatehealth/Pages/knowyourprostate.aspx (Accessed: 16/11/13)
Prostate Cancer UK (2013) Prostate cancer facts and figures. Availableat:
http://prostatecanceruk.org/information/prostate-cancer-facts-and-figures (Accessed:08/01/14)
Prostate Cancer UK (2013) What is my risk of prostate cancer? Availableat:
http://prostatecanceruk.org/information/who-is-at-risk/infographic-what-is-my-risk (Accessed:08/01/14)
Public Health England (2013) Prostate cancer risk management programme. Availableat:http://
cancerscreening.nhs.uk/prostate/ (Accessed: 18/11/13)
Willey,J. (2014) ‘Tippingpoint in war againstcancer in survival rates soar’, Daily Express, 29 April,p.8.
World Health Organization (2014) Cancermortality and morbidity. Availableat:
http://www.who.int/gho/ncd/mortality_morbidity/cancer_text/en/ (Accessed: 28/04/14)
World Health Organization (2014) Early detection of cancer. Availableat:http://who.int/cancer/detection/en/
(Accessed: 28/04/14)
World Cancer Research Fund (2013) Prostate cancer – at a glance. Availableat:http:// http://www.wcrf-
uk.org/cancer_prevention/types_of_cancer/prostate_cancer.php (Accessed: 18/11/13)
13
Appendices
Appendix A.Questionnaire
A Questionnaire to Investigate the Knowledge and Opinions on Prostate Cancer
You have the right to withdraw at any time. All data collected will be kept confidential. Thank you for
taking part. All data will be used for research and study purposes.
Age:
1. Do you know what causes prostate cancer? Yes / No
If yes, please could you name the causes below?
2. Do you have a family history of prostate cancer? Yes / No
3. What age do you think prostate cancer usually develops?
4. At what age are men screened in the UK for prostate cancer?
5. Would you attend a screening program for prostate cancer? Yes / No
Why?
6. Would you feel comfortable talking about prostate cancer if you thought that you had this
illness? Yes / No
Why?
7. If your GP was female would you feel comfortable going to her when you first develop
symptoms? Yes / No
8. Would you treat someone differently if you knew that they had prostate cancer? Yes / No
9. Do you think someone could continue to work even if they have prostate cancer? Yes / No
10. Do you know what treatment options are available for prostate cancer? Yes / No
If yes please list below:
11. One of the most popular treatments is radiotherapy. Would you feel comfortable undergoing
this treatment with the effects of radiation? Yes / No
12. Would you prefer to have surgery rather than radiotherapy even though this would take several
weeks to recover? Yes / No
14

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An Investigation of the Knowledge and Opinions of British Men Regarding Prostate Cancer[91]

  • 1. An Investigation of the Knowledge and Opinions of British Men Regarding Prostate Cancer By Jedrik Martinez A Dissertation Submitted to Bishop Vaughan Catholic School As An Extended Project 16 May 2014
  • 2. Acknowledgement I wish to express my sincere gratitude to Ms. Rebecca Finch, Head of Year, for her expert and valuable guidance extended to me. I also thank my family and friends for their encouragement and support. I take this opportunity to thank all who, directly or indirectly, have lent their helping hand in this study. ii
  • 3. ABSTRACT Objectives.Prostate cancer is the most commoncancer in malesinthe UK. It is predictedthatone in eight men across the UK will developthe disease. More than 10,000 die from prostate cancer every year.This studyaims to investigate the knowledge andopinionsof Britishmenregardingthe causes, age of onset and screening, treatment and counselling for prostate cancer and attitude towards persons who have prostate cancer. Methods. Questionnaireswere used to collect data for the study. All the respondents (n = 25) were Britishmale withmeanage 36.5yearsandrange 16 – 69 years.Excludedfromthe studywerefemales; personswithfamilyhistoryof prostatecancer;personswhohadbeenscreened,diagnosedortreated forprostate cancer;medical studentsanddoctorsandpersonsinvolvedincancerresearch,awareness or treatment. Results. Results of the study revealedthat nineteen(76%) of the 25 respondents did not know the causesof prostate cancer andonly6 (24%) were aware of them.Eleven(44%) respondentssuggested that prostate cancer develops over the age of 50. Only 3 (12%) respondents knew there was no screening programme for prostate cancer in the UK. Seventeen (68%) did not know the available treatment options for prostate cancer while 8 (32%) were aware of them.Twenty(80%) of the total respondents were willing to attend a screening programme for prostate cancer. Almost all of the respondents (96%) felt comfortable talking about prostate cancer and nineteen (76%) felt it was alrighttosee afemaleGPaboutit.Twenty-four(96%) respondentswillnottreatpersonswithprostate cancer differently and 22 (88%) felt that persons with prostate cancer could continue working. Conclusion.GenerallyBritishmenlackthe knowledge regardingthe causes,ageof onsetandscreening and treatment for prostate cancer. However they show a positive attitude towards counselling and towards persons who have prostate cancer. iii
  • 4. Table of Contents Chapter Title Page Title Page i Acknowledgement ii Abstract iii Table of Contents iv List of Tables & Figures v 1. Introduction 1 1.1. Background 1 2. Literature Review 2 3. Method 4 3.1 Questionnaire 4 3.2 Sampling 4 3.3 Ethical Issues 4 4. Results 5 5. Discussion 10 6. Conclusion 11 7. Evaluation and Recommendation 11 7.1 Evaluation 11 7.2Recommendation 12 8. References 13 9. Appendices 14 9.1 Appendix A 14 iv
  • 5. Introduction Background Prostate canceristhe secondmostcommoncancer inmalesasstatedbyLongmore etal. (2010, p. 646), and now, the most common cancer in men in the UK (Cancer Research UK 2014). World Cancer ResearchFund(2013) reportsthat in 2011 there were 41,725 new cases of prostate diagnosedinthe UK. Prostate Cancer UK (2013) predicts that one in eight men across the UK will develop prostate cancer.It furtherreportsthateveryhouronemandiesfromprostatecancer,puttingitacrossasmore than 10,000 every year. Buckford et al. (2009, p. 7) suggest that there are several factors that increase the risk of developingthe disease suchasage, familyhistory,ethnicity,anddietaryfactors.They furtheradded that there are several treatment options for prostate cancer such as surgery, radiotherapy and hormone therapy. Chancesforsuccessful treatmentof cancer,accordingtothe WorldHealthOrganization(2014), are greatly increased through early detection of the disease by way of education to promote early diagnosis and screening. Increased awarenessthrough education like recognition of risk factors and possible warningsignsandtakingpromptactionforearlydiagnosiscanhaveagreatimpactontreating cancer. The purpose of this dissertation is to investigate the knowledge and opinions of British men regarding prostate cancer. The author believes knowledge promotes awareness leading to early diagnosisandtreatment,which,inturn, can decrease morbidityandmortalityfromthe disease.The study aims to answer the following questions: 1. The knowledge of British men regarding the causes of, age of onset and screening , and available treatment for prostate cancer, 2. The opinions of British men regarding screening and counselling for prostate cancer, and 3. The opinions of British men regarding their behaviour towards persons who had been diagnosed with or being treated for prostate cancer. 1
  • 6. Literature Review More than 40,000 cases of prostate cancer is diagnosed yearly accounting for almost a quarter of all cancers in the UK (Cancer Research UK 2014). The World health Organization (2014) includes prostate cancer as one among several types of cancer that cause the majority of cancer deaths. This type of cancer develops in the prostate, a gland in the male reproductive system. NHS Choices (2012) describes the prostate gland as one that produces a fluid that nourishes and protects sperm during sexual activity and makes up a greater part of the ejaculatory volume. According to Muruve et al. (2013) the prostate gland is “located posterior to the pubic symphysis, superior to the perineal membrane, inferior to the bladder, and anterior to the rectum.” The risks and causes of prostate cancer, according to Cancer Research UK (2014) include age, family history, ethnicity and dietary factors. It further suggests bowel cancer, IGF-1 (Insulin-like Growth Factor) and vasectomy as additional risk factors. Buckford et al. (2009, p. 7) stress that age is the strongest risk factor with the average age during diagnosis at 70 – 74 years and average age at mortality 80 – 84 years. Prostate cancer is less common below the age of 50, however, the risk increases as the age increases. Another risk factor is family history. World Cancer Research Fund (2013) reports that around 5 – 9% of prostate cancer arelinked to genes or family history. In addition, Prostate Cancer UK (2013) suggests that a man is two and a half times more likely to develop the disease if his father or brother has the disease compared to one who has no family history of prostate cancer. Regarding ethnicity as a risk factor, World Cancer Research Fund (2013) further reports that men of African Caribbean or African descent have higher risk of prostate cancer than white men. Lastly, Buckford et al. (2009, p. 8) suggest that research linking prostate cancer and diet has been inconclusive but mentions lycopenes and selenium as having protective effect while diet high in protein or calcium from dairy products may increase the risk of prostate cancer. Benign and malignant growths in the prostate may present with similar symptoms which include urinating more frequently than usual especially at night, needing to rush to the toilet to urinate, difficulty in starting to (hesitancy) or taking a long time (straining) to urinate, and feeling the bladder is not completely empty after passing urine (Cancer Research UK 2014). These symptoms, however, are not evident until the cancer has grown large enough to put pressure on the urethra. Public Health England (2013) reports that there is no organized screening programme for prostate cancer in the UK. However, it promotes an informed choice programme, the Prostate Cancer Risk Management Programme. It is the aim of the programme to ensure that men who are concerned about the risk of prostate cancer receive a clear understanding of the risks and benefits of PSA (Prostate Specific Antigen) test for screening, other possible screening tests and the available treatment for prostate cancer. Information packs are made available to help the primary care team in counselling men who require the screening test. A number of uncertainties have been recognized surrounding the PSA test and currently, there is no evidence that would prove a PSA-based screening programme beneficial over the risk of using it. The Prostate Cancer Risk Management Programme (Buckford, et al. 2009) explains that the PSA test is currently the best method of identifying an increased risk of localized prostate cancer. However, the antigen may be elevated in men with other types of prostate problems that are not malignant such as benign prostatic hypertrophy. Although studies reveal reduction in rates of death from prostate cancer after PSA based screening, Buckford et al. (2009, p.15) suggest that there was an associated high risk of over-diagnosis and therefore over-treatment. There are other ways of determining the presence and/or extent of prostate cancers that Buckford et al. (2009, p.9) mentioned like digital rectal examination (DRE); transrectal ultrasound (TRUS); TRUS-guided prostate biopsy and histology; and imaging techniques (magnetic resonance imaging [MRI], computerized tomography [CT] scan, x-ray, bone scan). 2
  • 7. Buckford et al. (2009, p.13) provide several management options that are available for prostate cancer which include watchful waiting with serial PSA monitoring; activesurveillance or active monitoring; radical prostatectomy; radiotherapy or high intensity focused ultrasound (HIFU); cryotherapy; and adjuvant hormonal therapy. It is recommended that treatment isconsidered individually for every manwith prostate cancer. According to Longmore et al. (2010, p.646), of men with prostate cancer, “10% die in six months and that 10% live more than ten years.” Willey (2014), on the other hand, reported that the proportion of men living ten years with prostate cancer has increased from 25% to around 80%. This has been attributed to early diagnosis, more targeted treatment and better preventive measures. 3
  • 8. Method 1. Questionnaire The study made use of questionnairesincollectingdata.Aftersatisfyingthe inclusionand exclusion criteria, the purpose of the study and the questionnaires was explained to the respondents.The questionnairesconsistedof closedendeddichotomous questionsthatasked respondents to answer in a yes or no with a number of these questions followed by open formatquestionstogive the respondentsanopportunitytoexpresstheiropinions(Appendix A). 2. Sampling A stratified sampling of 25 British men from different age groups was used for the study. The youngest age set for the study was 16 because at this age a child can give consent to medical treatment(Library of Congress,2014). The oldest age group were respondentsover the age of 50. No reference wasmade regardingethnicbackground.Excludedfromthe study were:  Females  Men who have or would have prior knowledge about prostate cancer such as:  those who had either been screened, diagnosed, treated or are undergoing treatment for prostate cancer;  those who have a family history of prostate cancer;  medical doctors;  medical students; and  those who are or were directly or indirectly involved in any cancer research, cancer awareness programme or cancer management, for example, radiotherapists, most especially for prostate cancer. 3. Ethical Issues For confidentiality and ethical issues the names, address and contact details of the respondentwere notrequiredinformationinthe questionnaire.All dataobtainedwere kept in confidentiality. The respondents were advised that they can withdraw from the study anytime. 4
  • 9. Results All respondents (n = 25) completed the questionnaire. Respondents’ mean age was 36.5 years, (median 37 years), and all were British male with no family history of prostate cancer (Table 1). Resultsof the studyrevealedthatnineteen(76%) of the 25 respondentsdidnotknow the causes of prostate cancer and only 6 (24%) were aware of them (Figure 1). Genes or family history as the most answered cause followed by diet and age (Table 2). Eleven (44%) respondents suggested that prostate cancerdevelopsoverthe age of 50, 1 didn’tknow when,and,13 (52%) thoughtitdeveloped before the age of 50 (Table 3). Among the respondents, 10 (40%) thought that, in the UK, men over 50 yearsold are screenedforprostate cancer, 8 (32%) respondedthatit was before the age of 50, 4 (16%) didnot knowwhen,and, only3 (12%) repliedthere wasno screeningprogramme forprostate cancerinthe UK (Table4). Seventeen(68%) didnotknow the available treatmentoptionsforprostate cancer while 8 (32%) were aware of them (Figure 2). Twenty (80%) were willing to undergo radiotherapyfortreatment,4 (16%) were not, and,1 (4%) saidit dependeduponthe successrate of the treatment (Figure 3). Fifteen (60%) of the total respondents would prefer surgery over radiotherapyeventhoughthiswouldtake several weekstorecover,8 (32%) wouldnot,while 2 (8%) thought they would if it the only option left (Figure 4). Figure 1. Knowledge Regarding the Causes of Prostate Cancer Q1. Do you know what causes prostate cancer? Figure 2. KnowledgeRegardingthe TreatmentOptionsAvailableforProstate Cancer Q10. Do you know what treatment options are available for prostate cancer? 5 YES 24% NO 76% NO 68% YES 32%
  • 10. Figure 3. OpinionRegardingRadiotherapyasTreatment Q11. One of the most popular treatments is radiotherapy. Would you feel comfortable undergoing this treatment with the effects of radiation? Figure 4. OpinionRegardingHavingSurgeryInsteadof RadiotherapyasTreatment Q12. Would you prefer to have surgery rather than radiotherapy even though this would take several weeks to recover? Table 1. StudyPopulation N = 25 Mean or N (%) Range Median Age (years) 36.5 16 - 69 37 Sex:M/F 25 (100%)/0 British 25 (100%) Family history ofprostate cancer 25 (100%) 6 YES 80% NO16% Depends 4% YES 60% NO 32% Depends 8%
  • 11. Table 2. Knowledge RegardingCausesof Prostate Cancer Q1. Do you know what causes prostate cancer? If yes, please could you name the causes below. Causes Total Percentage Genes/Heredity/Familyhistory 5 35.7% Diet 3 21.4% Redmeat 1 Carcinogensinfood 1 Not specified 1 Age 3 21.4% Race/Nationality 1 7.1% Lifestyle (notspecified) 1 7.1% Enlargementof prostate 1 7.1% Table 3. Knowledge Regardingthe Age of Onsetof Prostate Cancer Q3. What age do you think prostate cancer usually develops? Age of Onset < 10 10 – 19 20 – 29 30 – 39 40 - 49 50 -59 60 & above Don’t Know Sample Population < 20 0 1 2 1 1 0 0 0 20 - 29 0 0 1 2 2 0 0 0 30 - 39 0 0 0 1 1 3 0 0 40 - 49 0 0 0 1 0 1 2 1 50 & above 0 0 0 0 0 3 2 0 Table 4. Knowledge Regardingthe Age of ScreeningforProstate Cancerinthe UK Q4. At what age are men screened in the UK for prostate cancer? Age of Screening < 10 10 – 19 20 – 29 30 – 39 40 - 49 50 -59 60 & above Not Screened Don’t Know Sample Population < 20 0 1 1 1 1 1 0 0 0 20 - 29 0 0 2 0 1 1 0 0 1 30 - 39 0 0 0 0 0 2 2 0 1 40 - 49 0 0 0 0 1 0 1 2 1 50 & above 0 0 0 0 0 3 0 1 1 7
  • 12. Twenty(80%) of the total respondentswere willingtoattenda screeningprogramme forprostate cancerwhile only3(12%) wouldnotandthe remaining2(8%) maypossiblyattendit(Figure5).Almost all of the respondents(96%) feltcomfortable talkingaboutprostate cancer(Table5).Nineteen(76%) felt it was alright to see a female GP about it and the remaining 6 (24%) did not (Figure 6). Twenty- four (96%) respondents will not treat persons with prostate cancer differently. Two (8%) felt that personswithprostate cancercouldcontinue toworkdependingontheirwell-being,1(4%) disagreed while the remaining 22 (88%) thought they could. Figure 5. OpinionWhetherMenare WillingtoAttendaScreeningProgramme Q5. Would you attend a screening programme? Figure 6. Opinion Whether Men are Comfortable Going to a Female GP if Symptoms Develop Q7. If your GP was female would you feel comfortable going to her when you first develop symptoms? 8 Yes 80% No 12% Maybe 8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Yes 76% No 24% 0% 10% 20% 30% 40% 50% 60% 70% 80%
  • 13. Table 5. OpinionWhetherMenFeel Comfortable TalkingAboutProstate Cancer Q.6. Would you feel comfortable talking about prostate cancer if you thought you had this illness? Sample Population < 20 20 – 29 30 – 39 40 – 49 50 & above Total Percentage YES 5 5 4 5 5 24 96% NO 0 0 1 0 0 1 4% Total 5 5 5 5 5 25 Table 6. Opinion Whether Men Will Treat a Person Differently if He Had Prostate Cancer Q.8. Would you treat someone differently if you knew they had prostate cancer? Sample Population < 20 20 – 29 30 – 39 40 – 49 50 & above Total Percentage YES 1 0 0 0 0 1 4% NO 4 5 5 5 5 24 96% Total 5 5 5 5 5 25 Table 7. OpinionWhetheraPersonwithProstate CancercouldContinue toWork Q.9 Do you think someone could continue to work even if they have prostate cancer? Sample Population < 20 20 – 29 30 – 39 40 – 49 50 & above Total Percentage YES 4 5 5 3 5 22 88% NO 1 0 0 0 0 1 4% Depends on well-being 0 0 0 2 0 2 8% Total 5 5 5 5 5 25 9
  • 14. Discussion Considering that prostate cancer is reported as the most common cancer in males in the UK, it is distressingtoknowthatmajorityof menare stillunaware of the causesandriskfactorsof developing the disease. A minorityof men, however, are aware that age, familyhistoryand diet are risk factors for developingthe disease.Onlya feware aware that the risk of developingthe disease increasesat age over 50 years and continues to increase as one grows older. There is no organizedscreeningprogramme forprostate cancer. Thissituationdoesnot helpmen who are at risk of developing the disease. Majority of men are willing to undergo the programme. They feel that screening for the disease can for assure them that they don’t have it thus give them peace of mind.Furthermore theybelieve thatascreeningprogramme canincrease awarenessof the risks,the signsand symptomsand treatment.Theythinkthat screeningcanpromote earlydetection of the disease resultingtopromptmanagement.However,somemenare notquite sure theywantto be screenedbecause theyfeelitcanbe potentiallyembarrassing,andothersfeel thetests(PSA testing and biopsy) might be painful and stressful. Most men are comfortable talking about the disease as this can increase their awareness, help them gain advice and understanding about treatment and outcome, and believe that this is serious thus shouldnotbe ignored.Talkingaboutit can also helpthemgainsupport fromfamilyand friends and in turn may help others, too. Onlyone of the respondents found it uncomfortable to talk about the disease if he hadit because he feltitwasa seriousmatter.Generallytheyare comfortable seeing a female GP when symptoms develop, however, some may still prefer seeing a male GP. On the whole, men’s attitude or behaviour towards individualswith prostate cancer would not change.Theyalsoagree thatdependingontheirgeneral well-being,thosewithprostate cancercould continue to work. A great numberof menare notaware of the availabletreatmentof prostatecancer.A few of them knowthat surgery,radiotherapyandhormonal therapyare optionsavailable intreatingthe disease. Most men agree to radiotherapy as a form of treatment. Their choice of treatment, however, was dependentonsuccessrate of the treatmentandif itwasthe optionsuitable fortheircondition.Some wouldagree tosurgeryonlyif othertreatmentshave failed and they are left with no other options. 10 Conclusion
  • 15. Generally British men lack awareness of prostate cancer – the causes and risk factors, the age of onset, the screening programme and the treatment available. Majority of men are willing to attend a screening programme for prostate cancer as preventive health measure. They are generally comfortable talking about the disease as well as consulting a GP about it. Basically they feel that their attitude towards individuals with prostate cancer will not differ and most agree that these individuals could continue working. Evaluation and Recommendation Evaluation By doing the study and researching on the subject matter, the author had gained important insight regarding prostate cancer. He believes that the awareness would encourage him to live a healthy life and more importantly help others concerned about prostate cancer by sharing the knowledge he obtained throughout the course of the study. Method. The questionnaire made use of closed format questions to collect data. Some of these questions were followed by qualitative questions like ‘why’ to allow the respondents to express their opinion rather than confining their responses to a yes or no. There were only 12 questions utilized that were short, simple and straight-forward. However the author agrees that the response options to the questions were limited. The response lacked uniformity because some of the respondents provided additional response options while others did not. The questionnaire failed to provide questions regarding awareness of signs and symptoms of prostate cancer and the source of respondent’s knowledge of the disease. Questions regarding adequacy or lack of awareness campaign on prostate cancer by authorities dealing with prevention and management of the disease were not included. Finally it has also been observed that hints or answers regarding the treatment of prostate cancer could be taken from the questions in the questionnaire. Sample. The sample covered a wide range of age population, with respondents ranging from ages 16 – 69. The inclusion and exclusion criteria were specific to avoid exposure or acquired knowledge on the disease thus minimising bias in answering the questions. The race and educational level of the respondents were, however, not recorded. The author agrees that the sample size was too small to support a claim affecting the study’s reliability and statistical significance. He believes that his target population should have been an age group that were at risk of developing the disease for this would involve men who are likely to need such information in the future. Ethics. For confidentiality and ethical issues the names, address and contact details of the respondent were not recorded in the questionnaire. For sensitivity issues, persons who had been screened, diagnosed, treated or being treated for prostate cancer were not included in the study. Although there was no writteninformedconsent,personswho consented verbally were included in the study. Practical Issues.The questionnaireswere easytoprintoff andeconomical.The sample sizewas small and respondents were well within the author’s vicinity of daily activity, e. g. school and neighbourhood so it was not difficult and time-consuming to collect data. 11 Previous research on the topic. An investigation on knowledge and attitudes of Australianmen about prostate cancer by Arnold-Reed, et al. (2008, p. 312) revealed a similar lack of knowledge
  • 16. regarding the disease. However Arnold-Reed, et al. (2008) had a large sample size (n=503) and targeted men aged 40 – 80 who were highly at risk of developing the disease which this author believes,if done similarly,wouldhave givenmore supporttothe significance of hisowninvestigation. Recommendation For further study to be conducted on thematter, the author recommends increasing the sample size and improving the questionnaire by  providing different possible response options (e.g. Yes _ No _ Maybe _ );  including questions about awareness of signs and symptoms of the disease;  asking the respondents the source of their awareness of the disease to help explain the extent of their knowledge (e.g. What is the source of your knowledge regarding prostate cancer? Newspaper _ Television _ Radio _ Internet _ Posters/Flyers _ School _ Individuals with prostate cancer _ Family _ Friends _ Others _ ) ;  including a measure of the adequacy or lack of awareness campaign on prostate cancer (e.g. How often do you see advertsor campaigns regarding prostatecancer? Very often _Often _Sometimes _ Not at all _ ); and  avoiding giving obvious hints or answers by carefully structuring the questions. 12 References
  • 17. Arnold-Reed, D., Hince, D., Bulsara,M., Ngo H., Eaton, M., Wright,A., Jones, F., Kaczmarczyk,W., Marangou,A. and Brett, T. (2008) ‘Knowledge and attitudes of men about prostate cancer’, The Medical Journal of Australia, 186 (6), pp. 312–314.[Online]. Availableat:https://www.mja.com.au/journal/2008/189/6/knowledge-and- attitudes-men-about-prostate-cancer (Accessed: 01/05/14) Buckford , D., Kirby,M. and Austoker, J. (2009) Prostate cancer risk management programme: information for primary care. NHS Cancer Screening Programmes. Cancer Research UK (2014) Prostate cancer risk and causes. Availableat: http://www.cancerresearchuk.org/cancer-help/type/prostate-cancer/about/prostate-cancer-risks-and-causes (Accessed: 21/04/14 ). Cancer Research UK (2014) Prostate cancer symptoms. Availableat:http://www.cancerresearchuk.org/cancer- help/type/prostate-cancer/about/prostate-cancer-symptoms (Accessed: 21/04/14). Library of Congress (2014) Child health and social welfare. Availableat:http://loc.gov/law/help/child- rights/uk.php#ChildHealthandSocialWelfare (Accessed:01/05/14) Longmore M., Wilkinson I.,Davidson,E., Foulkes, A. and Mafi,A. (2010) Oxford handbook of clinical medicine. 8th edition. New York: Oxford University Press Inc. Muruve, N. and Gest, T. (2013) Prostate anatomy. Availableat: http://emedicine.medscape.com/article/1923122-overview#aw2aab6b3 (Accessed: 16/11/13) NHS Choices (2012) Know your prostate. Availableat: http://nhs.uk/Livewell/Prostatehealth/Pages/knowyourprostate.aspx (Accessed: 16/11/13) Prostate Cancer UK (2013) Prostate cancer facts and figures. Availableat: http://prostatecanceruk.org/information/prostate-cancer-facts-and-figures (Accessed:08/01/14) Prostate Cancer UK (2013) What is my risk of prostate cancer? Availableat: http://prostatecanceruk.org/information/who-is-at-risk/infographic-what-is-my-risk (Accessed:08/01/14) Public Health England (2013) Prostate cancer risk management programme. Availableat:http:// cancerscreening.nhs.uk/prostate/ (Accessed: 18/11/13) Willey,J. (2014) ‘Tippingpoint in war againstcancer in survival rates soar’, Daily Express, 29 April,p.8. World Health Organization (2014) Cancermortality and morbidity. Availableat: http://www.who.int/gho/ncd/mortality_morbidity/cancer_text/en/ (Accessed: 28/04/14) World Health Organization (2014) Early detection of cancer. Availableat:http://who.int/cancer/detection/en/ (Accessed: 28/04/14) World Cancer Research Fund (2013) Prostate cancer – at a glance. Availableat:http:// http://www.wcrf- uk.org/cancer_prevention/types_of_cancer/prostate_cancer.php (Accessed: 18/11/13) 13 Appendices
  • 18. Appendix A.Questionnaire A Questionnaire to Investigate the Knowledge and Opinions on Prostate Cancer You have the right to withdraw at any time. All data collected will be kept confidential. Thank you for taking part. All data will be used for research and study purposes. Age: 1. Do you know what causes prostate cancer? Yes / No If yes, please could you name the causes below? 2. Do you have a family history of prostate cancer? Yes / No 3. What age do you think prostate cancer usually develops? 4. At what age are men screened in the UK for prostate cancer? 5. Would you attend a screening program for prostate cancer? Yes / No Why? 6. Would you feel comfortable talking about prostate cancer if you thought that you had this illness? Yes / No Why? 7. If your GP was female would you feel comfortable going to her when you first develop symptoms? Yes / No 8. Would you treat someone differently if you knew that they had prostate cancer? Yes / No 9. Do you think someone could continue to work even if they have prostate cancer? Yes / No 10. Do you know what treatment options are available for prostate cancer? Yes / No If yes please list below: 11. One of the most popular treatments is radiotherapy. Would you feel comfortable undergoing this treatment with the effects of radiation? Yes / No 12. Would you prefer to have surgery rather than radiotherapy even though this would take several weeks to recover? Yes / No 14