***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Professional societies recommend shared decision making ( SDM ) for prostate cancer screening , however , most efforts have promoted informed rather than shared decision making . The objective of this study is to 1 ) examine the effects of a prostate cancer screening intervention to promote SDM and 2 ) determine whether framing prostate information in the context of other clearly beneficial men ’s health services affects decisions . Methods We conducted two separate r and omized controlled trials of the same prostate cancer intervention ( with or without additional information on more clearly beneficial men ’s health services ) . For each trial , we enrolled a convenience sample of 2 internal medicine practice s , and their interested physicians and male patients with no prior history of prostate cancer ( for a total of 4 practice s , 28 physicians , and 128 men across trials ) . Within each practice site , we r and omized men to either 1 ) a video-based decision aid and research er-led coaching session or 2 ) a highway safety video . Physicians at each site received a 1-hour educational session on prostate cancer and SDM . To assess intervention effects , we measured key components of SDM , intent to be screened , and actual screening . After finding that results did not vary by trial , we combined data across sites , adjusting for the r and om effects of both practice and physician . Results Compared to an attention control , our prostate cancer screening intervention increased men ’s perceptions that screening is a decision ( absolute difference + 41 % ; 95 % CI 25 to 57 % ) and men ’s knowledge about prostate cancer screening ( absolute difference + 34 % ; 95 % CI 19 % to 50 % ) , but had no effect on men ’s self-reported participation in shared decisions or their participation at their preferred level . Overall , the intervention decreased screening intent ( absolute difference −34 % ; 95 % CI −50 % to −18 % ) and actual screening rates ( absolute difference −22 % ; 95 % CI −38 to −7 % ) with no difference in effect by frame . Conclusions SDM interventions can increase men ’s knowledge , alter their perceptions of prostate cancer screening , and reduce actual screening . However , they may not guarantee an increase in shared decisions . Trial registration # Background Men considering the prostate specific antigen ( PSA ) test for prostate cancer , an increasingly common male cancer , are encouraged to make informed decisions , as the test is limited in its accuracy and the natural history of the condition is poorly understood . The Web-based PSA decision aid , Prosdex , was developed as part of the UK Prostate Cancer Risk Management Programme in order to help men make such informed decisions . Objectives The aim of this study was to evaluate the effect of the Web-based PSA decision aid , Prosdex , on informed decision making . Methods A Web-based r and omized controlled trial was conducted in South Wales , United Kingdom . Men aged 50 to 75 who had not previously had a PSA test were r and omly allocated to two intervention and two control groups . Participants in the intervention groups either viewed Prosdex or were given a paper version of the text . The main outcome measures were the three components of informed decision making : ( 1 ) knowledge of prostate cancer and PSA , ( 2 ) attitude toward PSA testing , ( 3 ) behavior using a proxy measure , intention to undergo PSA testing . Decisional conflict and anxiety were also measured as was uptake of the PSA test . Outcomes were measured by means of an online question naire for the Prosdex group , the paper version group , and one of two control groups . Six months later , PSA test uptake was ascertained from general practitioners ’ records , and the online question naire was repeated . Results are reported in terms of the Mann-Whitney U-statistic divided by the product of the two sample sizes ( U/mm ) , line of no effect 0.50 . Results Participants were 514 men . Compared with the control group that completed the initial online question naire , men in the Prosdex group had increased knowledge about the PSA test and prostate cancer ( U/mn 0.70 ; 95 % CI 0.62 - 0.76 ) ; less favourable attitudes to PSA testing ( U/mn 0.39 , 95 % CI 0.31 - 0.47 ) ; were less likely to undergo PSA testing ( U/mn 0.40 , 95 % CI 0.32 - 0.48 ) ; and had less decisional conflict ( U/mn 0.32 , 95 % CI 0.25 - 0.40 ) ; while anxiety level did not differ ( U/mn 0.50 , 95 % CI 0.42 - 0.58 ) . For these outcomes there were no significant differences between men in the Prosdex group and the paper version group . However , in the Prosdex group , increased knowledge was associated with a less favourable attitude toward testing ( Spearman rank correlation [ ρ ] = -0.49 , P < .001 ) and lower intention to undergo testing ( ρ = -0.27 , P = .02 ) . After six months , PSA test uptake was lower in the Prosdex group than in the paper version and the question naire control group ( P = .014 ) . Test uptake was also lower in the control group that did not complete a question naire than in the control group that did , suggesting a possible Hawthorne effect of the question naire in favour of PSA testing . Conclusions Exposure to Prosdex was associated with improved knowledge about the PSA test and prostate cancer . Men who had a high level of knowledge had a less favourable attitude toward and were less likely to undergo PSA testing  . Prosdex appears to promote informed decision making regarding the PSA test . Trial Registration IS RCT N48473735 ; http://www.controlled-trials.com/IS RCT N48473735 ( Archived by WebCite at http://www.webcitation.org/5r1TLQ5nK Background Patient education material s can assist patient decision making on prostate cancer screening . Objective To explore the effectiveness of presenting health information on prostate cancer screening using video , internet , and written interventions on patient decision making , attitudes , knowledge , and screening interest . Design R and omized controlled trial . Participants A total of 161 men aged over 45 , who had never been screened for prostate cancer , were r and omized to receive information on prostate cancer screening . Measurements Participants were assessed at baseline and 1-week postintervention for decisional conflict , screening interest , knowledge , anxiety , and decision-making preference . Results A total of 156 men were followed-up at 1-week postintervention . There was no statistical , or clinical , difference in mean change in decisional conflict scores between the 3 intervention groups ( video vs internet −0.06 [ 95 % CI −0.24 to 0.12 ] ; video vs pamphlet 0.04 [ 95%CI −0.15 to 0.22 ] ; internet vs pamphlet 0.10 [ 95%CI −0.09 to 0.28 ] ) . There was also no statistically significant difference in mean knowledge , anxiety , decision-making preference , and screening interest between the 3 intervention groups . Conclusion Results from this study indicate that there are no clinical ly significant differences in decisional conflict when men are presented health information on prostate cancer screening via video , written material s , or the internet . Given the equivalence of the 3 methods , other factors need to be considered in deciding which method to use . Health professionals should provide patient health education material s via a method that is most convenient to the patient and their preferred learning style BACKGROUND The European R and omised study of Screening for Prostate Cancer ( ERSPC ) has shown significant reductions in prostate cancer mortality after 9 years and 11 years of follow-up , but screening is controversial because of adverse events such as overdiagnosis . We provide up date d results of mortality from prostate cancer with follow-up to 2010 , with analyses truncated at 9 , 11 , and 13 years . METHODS ERSPC is a multicentre , r and omised trial with a predefined central ised data base , analysis plan , and core age group ( 55 - 69 years ) , which assesses prostate-specific antigen ( PSA ) testing in eight European countries . Eligible men aged 50 - 74 years were identified from population registries and r and omly assigned by computer generated r and om numbers to screening or no intervention ( control ) . Investigators were masked to group allocation . The primary outcome was prostate cancer mortality in the core age group . Analysis was by intention to treat . We did a secondary analysis that corrected for selection bias due to non-participation . Only incidence and no mortality data at 9 years ' follow-up are reported for the French centres . This study is registered with Current Controlled Trials , number IS RCT N49127736 . FINDINGS With data truncated at 13 years of follow-up , 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group .  The rate ratio of prostate cancer incidence between the intervention and control groups was 1·91 ( 95 % CI 1·83 - 1·99 ) after 9 years ( 1·64 [ 1·58 - 1·69 ] including France ) , 1·66 ( 1·60 - 1·73 ) after 11 years , and 1·57 ( 1·51 - 1·62 ) after 13 years . The rate ratio of prostate cancer mortality was 0·85 ( 0·70 - 1·03 ) after 9 years , 0·78 ( 0·66 - 0·91 ) after 11 years , and 0·79 ( 0·69 - 0·91 ) at 13 years . The absolute risk reduction of death from prostate cancer at 13 years was 0·11 per 1000 person-years or 1·28 per 1000 men r and omised , which is equivalent to one prostate cancer death averted per 781 ( 95 % CI 490 - 1929 ) men invited for screening or one per 27 ( 17 - 66 ) additional prostate cancer detected . After adjustment for non-participation , the rate ratio of prostate cancer mortality in men screened was 0·73 ( 95 % CI 0·61 - 0·88 ) . INTERPRETATION In this up date the ERSPC confirms a substantial reduction in prostate cancer mortality attributable to testing of PSA , with a substantially increased absolute effect at 13 years compared with findings after 9 and 11 years . Despite our findings , further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening . FUNDING Each centre had its own funding responsibility CONTEXT Three fourths of US men older than 50 years have been screened with prostate-specific antigen ( PSA ) for prostate cancer . OBJECTIVE To estimate the receiver operating characteristic ( ROC ) curve for PSA . DESIGN , SETTING , AND PARTICIPANTS Calculation of PSA ROC curves in the placebo group of the Prostate Cancer Prevention Trial , a r and omized , prospect i ve study conducted from 1993 to 2003 at 221 US centers . Participants were 18 882 healthy men aged 55 years or older without prostate cancer and with PSA levels less than or equal to 3.0 ng/mL and normal digital rectal examination results , followed up for 7 years with annual PSA measurement and digital rectal examination .  If PSA level exceeded 4.0 ng/mL or rectal examination result was abnormal , a prostate biopsy was recommended . After 7 years of study participation , an end-of- study prostate biopsy was recommended in all cancer-free men . MAIN OUTCOME MEASURES Operating characteristics of PSA for prostate cancer detection , including sensitivity , specificity , and ROC curve . RESULTS Of 8575 men in the placebo group with at least 1 PSA measurement and digital rectal examination in the same year , 5587 ( 65.2 % ) had had at least 1 biopsy ; of these , 1225 ( 21.9 % ) were diagnosed with prostate cancer . Of 1213 cancers with Gleason grade recorded , 250 ( 20.6 % ) were Gleason grade 7 or greater and 57 ( 4.7 % ) were Gleason grade 8 or greater . The areas under the ROC curve ( AUC ) for PSA to discriminate any prostate cancer vs no cancer , Gleason grade 7 or greater cancer vs no or lower- grade cancer , and Gleason grade 8 or greater cancer vs no or lower- grade cancer were 0.678 ( 95 % confidence interval [ CI ] , 0.666 - 0.689 ) , 0.782 ( 95 % CI , 0.748 - 0.816 ) , and 0.827 ( 95 % CI , 0.761 - 0.893 ) , respectively ( all P values < .001 for AUC vs 50 % ) . For detecting any prostate cancer , PSA cutoff values of 1.1 , 2.1 , 3.1 , and 4.1 ng/mL yielded sensitivities of 83.4 % , 52.6 % , 32.2 % , and 20.5 % , and specificities of 38.9 % , 72.5 % , 86.7 % , and 93.8 % , respectively . Age-stratified analyses showed slightly better performance of PSA in men younger than 70 years vs those 70 years or older with AUC values of 0.699 ( SD , 0.013 ) vs 0.663 ( SD , 0.013 ) ( P = .03 ) . CONCLUSION There is no cutpoint of PSA with simultaneous high sensitivity and high specificity for monitoring healthy men for prostate cancer , but rather a continuum of 
    Output:
    
Decision aids increase patient knowledge and confidence in decision making about prostate cancer testing .