Perceptions and misconceptions of PSA screening in Switzerland: A preference epidemiology study

PSA screening for prostate cancer remains controversial due to the trade-offs between potential benefits and harms, particularly overdiagnosis and overtreatment. This study applies a preference epidemiology approach to explore how individuals evaluate these trade-offs and identify thresholds at which screening is perceived as acceptable or burdensome. We examined both personal and societal perspectives on PSA screening to better understand the role of values, preferences, and psychosocial factors in health-related decision-making. A cross-sectional survey of 425 Swiss men aged 55+ assessed awareness, screening history, and willingness to participate in future screenings. Participants evaluated hypothetical scenarios presenting various trade-offs between overdiagnosis and lives saved by screening. Quantitative data were analyzed using Chi-square tests and MANOVA; qualitative responses underwent thematic analysis. Findings reveal that participants substantially overestimated PSA screening's life-saving potential, with a median estimate of 50 deaths prevented, compared to the actual figure of 3 per 1000 screened. Over half supported screening even in a scenario where no deaths were prevented. Personal and family cancer history significantly influenced screening support. Our results suggest that simply providing factual information is insufficient to support informed, autonomous decision-making. People's perceptions are shaped by experiential and psychosocial factors that affect how they interpret evidence. Policy decisions and health communication strategies should therefore go beyond information dissemination, incorporating systematic evidence on how individuals evaluate medical trade-offs. Preference epidemiology offers a valuable framework for developing more value-sensitive, patient-centered screening programs.