Involving a Citizens' Jury in Decisions on Individual Screening for Prostate Cancer

PLoS One. 2016 Jan 11;11(1):e0143176. doi: 10.1371/journal.pone.0143176. eCollection 2016.


Aims: Most public health agencies and learned societies agree that the prostate-specific antigen (PSA) test in asymptomatic men should not be recommended, on account of its potential for harm. Yet PSA is still widely used as a screening test and is not being abandoned. This remains a significant public health issue, and citizens' engagement is needed. This study was designed to produce a deliberation on the PSA screening test by a citizens' jury.

Methods: Fifteen citizens were selected and balanced for sex, age, and education. They received an information booklet and participated in a two-day meeting with experts to reach a deliberation on the question "Should the National Health Service discourage or recommend PSA as an individual screening test for prostate cancer in men 55-69 years old?". A facilitator ran the jurors' discussion.

Results: All except three of the jurors decided that the National Health Service should discourage the use of PSA as an individual screening test for prostate cancer in 55-69 year-old men. The jury was particularly convinced by the uncertainty of the test outcomes, the utility of the test, and its cost/benefit ratio. Before the meeting 60% of jurors would have recommended the test to a relative, and all the male jurors would have done so. After the meeting these percentages fell to 15% and 12%.

Conclusions: This experience confirms the feasibility and effectiveness of delegating to a group of citizens the responsibility to decide on public health issues on behalf of the community. Public health authorities should invest in information campaigns aimed at the public and in educational initiatives for physicians. This also provided an opportunity to disseminate information on screening, over-diagnosis, and over-treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Community Participation / psychology
  • Community Participation / statistics & numerical data*
  • Cost-Benefit Analysis
  • Decision Making / ethics
  • Early Detection of Cancer / economics
  • Early Detection of Cancer / ethics
  • Early Detection of Cancer / statistics & numerical data*
  • Group Processes
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Middle Aged
  • Prostate-Specific Antigen / blood*
  • Prostatic Neoplasms / blood
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / economics
  • Prostatic Neoplasms / pathology
  • Public Opinion*


  • Prostate-Specific Antigen

Grant support

This work was funded by Agenzia Nazionale per i Servizi Sanitari Regionali Agenas, CIG 0536828C77, CUP I85J10000400005. The funder had no role in study design, data collection and analysis, but participated in all the phases of the project and during the preparation of the manuscript. Agenzia di Editoria Scientifica Zadig provided support in the form of a salary for author RS, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the ‘author contributions’ section.