Study Measures

Distress was assessed using the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale (IES), the Cancer Worry Scale‐Revised (CWS‐R), and the Memorial Anxiety Scale for Prostate Cancer (MAX‐PC). The HADS contains two sub‐scales of seven items that measure the presence and severity of general anxiety and depression 29. Each subscale generates a score ranging from 0 to 21, and a score of >10 indicates clinically relevant levels of anxiety or depression.

The IES is a 15‐item scale measuring PCa‐specific distress through the frequency of intrusive or avoidant thoughts about PCa 30. Total scores on the intrusion and avoidance scales range from 0–35 to 0–40, respectively. A higher score indicates more frequent intrusive/avoidant thoughts about risk of cancer; a score of >8.5 indicates clinically relevant levels of distress.

The CWS‐R is a six‐item scale that measures worry about the risk of developing cancer and the frequency and impact of that worry on mood and daily functioning 31, 32. The CWS‐R uses a score of 1 (no worry) to 4 (maximum worry), giving a summative score between 4 and 24. A high score indicates greater worry, but no clinical thresholds for the scores are available.

The MAX‐PC includes three scales assessing PCa anxiety, PSA anxiety, and fear of recurrence. In the present study, we used the PCa anxiety (11 items) and PSA anxiety (3 items) scales 33. The PCa anxiety scale is scored from 0 to 33 and the PSA anxiety scale from 0 to 9, with a higher score indicating higher anxiety levels.

We assessed HRQoL using the 36‐item short‐form health survey (SF‐36) version 2.0 34, 35. This questionnaire consists of eight subscales: physical functioning; social functioning; role limitations attributable to physical problems; role limitations attributable to emotional problems; mental health; vitality; pain; and general health. Summary scores are calculated for two broad areas of subjective well‐being: physical health and mental health. All scales are linearly converted to a 0–100 scale, with a higher score representing better functioning.

Men were asked to rate their perceived risk of PCa compared with the average man's risk: lower; the same; slightly increased; moderately increased; or strongly increased 36.

We developed a ‘knowledge’ questionnaire based on a measure developed by Lerman et al. 37 and Wonderlick and Fine 38. The nine true/false items (Fig. 1) assessed knowledge of inheritance of BRCA1/BRCA2, the effect of having an altered gene, and risk of PCa. Knowledge scores were created by taking the sum of the correct responses to the nine items.

Knowledge questionnaire.

The internal consistency reliability, as assessed by Cronbach's coefficient α, was high for all measures used, ranging from 0.79 for the SF‐36 General Health scale to 0.96 for the SF‐36 Role Physical scale. Fourteen of the 15 scales had an α coefficient >0.80.