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Kim IE, Kim DD, Kim S, Ma S, Jang TL, Singer EA, Ghodoussipour S, Kim IY. Changes in prostate cancer survival among insured patients in relation to USPSTF screening recommendations. BMC Urol 2022; 22:91. [PMID: 35752822 PMCID: PMC9233816 DOI: 10.1186/s12894-022-01045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the effects of the U.S. Preventive Services Task Force's (USPSTF) 2012 recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer on survival disparities based on insurance status. Prior to the USPSTF's 2012 screening recommendation, previous studies found that insured patients with prostate cancer had better outcomes than uninsured patients. METHODS Using the SEER 18 database, we examined prostate cancer-specific survival (PCSS) based on diagnostic time period and insurance status. Patients were designated as belonging to the pre-USPSTF era if diagnosed in 2010-2012 or post-USPSTF era if diagnosed in 2014-2016. PCSS was measured with the Kaplan-Meier method, while disparities were measured with the Cox proportional hazards model. RESULTS During the pre-USPSTF era, uninsured patients experienced worse PCSS compared to insured patients (adjusted HR 1.256, 95% CI 1.037-1.520, p = 0.020). This survival disparity was no longer observed during the post-USPSTF era as a result of decreased PCSS among insured patients combined with unchanged PCSS among uninsured patients (adjusted HR 0.946, 95% CI 0.642-1.394, p = 0.780). CONCLUSIONS Although the underlying reasons are not clear, the USPSTF's 2012 PSA screening recommendation may have hindered insured patients from being regularly screened for prostate cancer and selectively led to worse outcomes for insured patients without affecting the survival of uninsured patients.
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Affiliation(s)
- Isaac E Kim
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Daniel D Kim
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Sinae Kim
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, The State University of New Jersey, Piscataway, NJ, USA
| | - Shuangge Ma
- Department of Epidemiology and Public Health, Yale University, New Haven, CT, USA
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Division of Urology, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Isaac Yi Kim
- Department of Urology, Yale School of Medicine, 789 Howard Avenue, Fitkin 307, New Haven, CT, 06520, USA.
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Shahangian S, Sharma KP, Fan L, Siegel DA. Use of the prostate-specific antigen test in the U.S. for men age 30 to 64 in 2011 to 2017 using a large commercial claims database: Implications for practice interventions. Cancer Rep (Hoboken) 2021; 4:e1365. [PMID: 33934557 PMCID: PMC8388177 DOI: 10.1002/cnr2.1365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the public health relevance of PSA-based screening, various professional organizations have issued recommendations on the use of the PSA test to screen for prostate cancer in different age groups. AIM Using a large commercial claims database, we aimed to determine the most recent rates of PSA testing for privately insured men age 30 to 64 in the context of screening recommendations. METHODS AND RESULTS Data from employer plans were from MarketScan commercial claims database. Annual PSA testing rate was the proportion of men with ≥1 paid test(s) per 12 months of continuous enrollment. Men with diagnosis of any prostate-related condition were excluded. Annual percent change (APC) in PSA test use was estimated using joinpoint regression analysis. In 2011 to 2017, annual testing rate encompassing 5.02 to 5.53 million men was approximately 1.4%, age 30 to 34; 3.4% to 4.1%, age 35 to 39; 11% to 13%, age 40 to 44; 18% to 21%, age 45 to 49; 31% to 33%, age 50 to 54; 35% to 37%, age 55 to 59; and 38% to 41%, age 60 to 64. APC for 2011 to 2017 was -0.5% (P = .11), age 30 to 34; -3.0% (P = .001), age 35-39; -3.1% (P < .001), age 40 to 44; -2.4% (P = .001), age 45 to 49; -0.2% (P = .66), age 50 to 54; 0.0% (P = .997), age 55 to 59; and -3.3% (P = .054) from 2011 to 2013 and 1.2% (P = .045) from 2013 to 2017, age 60 to 64. PSA testing rate decreased from 2011 to 2017 for age groups between 35 and 49 by 13.4% to 16.9%. CONCLUSIONS Based on these data, PSA testing rate has modestly decreased from 2011 to 2017. These results, however, should be considered in view of the limitation that MarketScan claims data may not be equated to actual PSA testing practices in the entire U.S. population age 30 to 64. Future research should be directed to understand why clinicians continue ordering PSA test for men younger than 50.
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Affiliation(s)
| | - Krishna P Sharma
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia, USA
| | - Lin Fan
- Division of Laboratory Systems, CDC, Atlanta, Georgia, USA
| | - David A Siegel
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia, USA
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3
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Shahangian S, Fan L, Sharma KP, Siegel DA. Use of the prostate-specific antigen (PSA) test in the United States for men age ≥65, 1999-2015: Implications for practice interventions. Cancer Rep (Hoboken) 2021; 4:e1352. [PMID: 33932150 PMCID: PMC8388175 DOI: 10.1002/cnr2.1352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/23/2021] [Accepted: 02/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Various professional organizations have issued recommendations on use of the PSA test to screen for prostate cancer in different age groups. AIMS Using Medicare claims databases, we aimed to determine rates of PSA testing in the context of screening recommendations during 1999-2015 for US men age ≥65, stratified by age group and census regions, after excluding claims relating to all prostate-related conditions. METHODS AND RESULTS Medicare claims databases encompassed 9.71-11.12 million men for the years under study. PSA testing rate was the proportion of men with ≥1 test(s) per 12 months of continuous enrollment. Men diagnosed with any prostate-related condition were excluded. Annual percent change (APC) in PSA test use was estimated using joinpoint regression analysis. In 1999-2015, annual testing rate was 10.1%-23.1%, age ≥85; 16.6%-31.0%, age 80-84; 23.8%-35.8%, age 75-79; 28.3%-36.9%, age 70-74; and 26.4%-33.6%, age 65-69. From 1999 to 2015, PSA testing rate decreased 40.7%, 29.9%, 13.9%, and 2.9%, respectively, for men age ≥85, 80-84, 75-79, and 70-74. For men age 65-69, test use increased by 0.3%. Significant APC trends were: APC1999-2002 = +8.1%, P = .029 and APC2008-2015 = -9.0%, P < .001 for men age ≥85; APC2008-2015 = -7.1%, P = .001 for men age 80-84; APC2001-2015 = -2.5%, P < .001 for men age 75-79; APC2008-2015 = -3.3%, P = .007 for men age 70-74; and APC2010-2015 = -5.2%, P = .014 for men age 65-69. COCLUSION Although decreased from 1999 to 2015, PSA testing rates remained high for men age ≥70. Further research could help understand why PSA testing continues inconsistent with recommendations.
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Affiliation(s)
| | - Lin Fan
- Division of Laboratory Systems, CDC, Atlanta, Georgia, USA
| | - Krishna P Sharma
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia, USA
| | - David A Siegel
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia, USA
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4
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Magnani CJ, Li K, Seto T, McDonald KM, Blayney DW, Brooks JD, Hernandez-Boussard T. PSA Testing Use and Prostate Cancer Diagnostic Stage After the 2012 U.S. Preventive Services Task Force Guideline Changes. J Natl Compr Canc Netw 2020; 17:795-803. [PMID: 31319390 DOI: 10.6004/jnccn.2018.7274] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 01/15/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most patients with prostate cancer are diagnosed with low-grade, localized disease and may not require definitive treatment. In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate cancer screening to address overdetection and overtreatment. This study sought to determine the effect of guideline changes on prostate-specific antigen (PSA) screening and initial diagnostic stage for prostate cancer. PATIENTS AND METHODS A difference-in-differences analysis was conducted to compare changes in PSA screening (exposure) relative to cholesterol testing (control) after the 2012 USPSTF guideline changes, and chi-square test was used to determine whether there was a subsequent decrease in early-stage, low-risk prostate cancer diagnoses. Data were derived from a tertiary academic medical center's electronic health records, a national commercial insurance database (OptumLabs), and the SEER database for men aged ≥35 years before (2008-2011) and after (2013-2016) the guideline changes. RESULTS In both the academic center and insurance databases, PSA testing significantly decreased for all men compared with the control. The greatest decrease was among men aged 55 to 74 years at the academic center and among those aged ≥75 years in the commercial database. The proportion of early-stage prostate cancer diagnoses (<T2) decreased across age groups at the academic center and in the SEER database. CONCLUSIONS In primary care, PSA testing decreased significantly and fewer prostate cancers were diagnosed at an early stage, suggesting provider adherence to the 2012 USPSTF guideline changes. Long-term follow-up is needed to understand the effect of decreased screening on prostate cancer survival.
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Affiliation(s)
| | - Kevin Li
- Stanford University School of Medicine
| | - Tina Seto
- Stanford School of Medicine, IRT Research Technology
| | | | - Douglas W Blayney
- Department of Medicine, Stanford University.,Stanford Cancer Institute; and
| | | | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University.,Department of Biomedical Data Science, Stanford University, Stanford, California
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Zechmann S, Di Gangi S, Kaplan V, Meier R, Rosemann T, Valeri F, Senn O. Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study. PLoS One 2019; 14:e0217879. [PMID: 31194773 PMCID: PMC6565361 DOI: 10.1371/journal.pone.0217879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Following years of controversy regarding screening for prostate cancer using prostate-specific antigen, evidence evolves towards a more restrained and preference-based use. This study reports the impact of landmark trials and updated recommendations on the incidence rate of prostate cancer screening by Swiss general practitioners. Methods We performed a retrospective analysis of primary care data, separated in 3 time periods based on dates of publications of important prostate-specific antigen screening recommendations. 1: 2010-mid 2012 including 2 updates; 2: mid 2012-mid 2014 including a Smarter Medicine recommendation; 3: mid-2014—mid-2017 maintenance period. Period 2 including the Smarter Medicine recommendation was defined as reference period. We further assessed the influence of patient’s age and the number of prostate-specific-antigen (PSA) tests, by the patient and within each time period, on the mean PSA concentration. Uni- and multivariable analyses were used as needed. Results 36,800 men aged 55 to 75 years were included. 14.6% had ≥ 2 chronic conditions, 11.7% had ≥ 1 prostate-specific antigen test, (mean 2.60 ng/ml [SD 12.3]). 113,921 patient-years were covered. Data derived from 221 general practitioners, 33.5% of GP were women, mean age was 49.4 years (SD 10.0), 67.9% used prostate-specific antigen testing. Adjusted incidence rate-ratio (95%-CI) dropped significantly over time periods: Reference Period 2: incidence rate-ratio 1.00; Period 1: incidence rate-ratio 1.74 (1.59–1.90); Period 3: incidence rate-ratio 0.61 (0.56–0.67). A higher number of chronic conditions and a patient age between 60–69 years were significantly associated with higher screening rate. Increasing numbers of PSA testing per patient, as well as increasing age, were independently and significantly associated with an increase in the PSA value. Conclusion Swiss general practitioners adapted screening behavior as early as evidence of a limited health benefit evolved, while using a risk-adapted approach whenever performing multiple testing. Updated recommendations might have helped to maintain this decrease. Further recommendations and campaigns should aimed at older patients with multimorbidity, to sustain a further decline in prostate-specific antigen screening practices.
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Affiliation(s)
- Stefan Zechmann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Vladimir Kaplan
- Department of Internal Medicine, Hospital Muri, Muri, Switzerland
| | - Rahel Meier
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding the United States Preventative Services Task Force recommendation against PSA screening. Urol Oncol 2018; 36:500.e21-500.e27. [DOI: 10.1016/j.urolonc.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/25/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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Zakaria AS, Dragomir A, Brimo F, Kassouf W, Tanguay S, Aprikian A. Changes in the outcome of prostate biopsies after preventive task force recommendation against prostate-specific antigen screening. BMC Urol 2018; 18:69. [PMID: 30126402 PMCID: PMC6102901 DOI: 10.1186/s12894-018-0384-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022] Open
Abstract
Background The benefits of PSA-based screening for prostate cancer (PCa) are controversial. The Canadian and American Task Forces on Preventive Health Care (CTFPHC & USPSTF) have released recommendations against the use of routine PSA-based screening for any men. We thought to assess the impact of these recommendations on the outcomes and trends of prostate needle biopsies. Methods A complete chart review was conducted for all men who received prostate needle biopsies at McGill University Health Center between 2010 and 2016. Of those, we included 1425 patients diagnosed with PCa for analysis. We Compared 2 groups of patients (pre and post recommendations’ release date) using Welch’s t-tests and Chi-square test. A multivariate logistic regression model was used to analyze variables predicting worse pathological outcomes. Results When the release date of the USPSTF draft (October 2011) was used as a cut-off, we found an average annual decrease of 10.6% in the total number of biopsies. The median (IQR) baseline PSA levels were higher in post-recommendations group (n = 977) when compared to pre-recommendations group (n = 448) [8 ng/ml (5.7–12.9) versus 6.4 ng/ml (4.9–10.1), respectively. P = 0.0007]. Also, post-recommendations group’s patients had higher Gleason score (G7: 35.4% versus 28.4% and G8-G10: 31.2% versus 18.1%, respectively. P < 0.0001). Moreover, they had higher intermediate and high-risk PCa classification (36.4% versus 32.8% and 35.5% versus 22.1%, respectively. P < 0.0001). The recommendations release date was an independent variable associated with higher Gleason score in prostate biopsies (OR: 2.006, 95%CI: 1.477–2.725). Using the CTFPHC recommendations release date (October 2014) as a cut-off in further analysis, revealed similar results. Conclusions Our results revealed a reduction in the number of prostate needle biopsies performed over time after the recommendations of the preventive task forces. Furthermore, it showed a significant relative increase in the higher risk PCa diagnosis. The oncological outcomes associated with this trend need to be examined in further studies.
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Affiliation(s)
- Ahmed S Zakaria
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Alice Dragomir
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Simon Tanguay
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Armen Aprikian
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada.
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Hall IJ, Tangka FKL, Sabatino SA, Thompson TD, Graubard BI, Breen N. Patterns and Trends in Cancer Screening in the United States. Prev Chronic Dis 2018; 15:E97. [PMID: 30048233 PMCID: PMC6093265 DOI: 10.5888/pcd15.170465] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction We examined the prevalence of cancer screening reported in 2015 among US adults, adjusted for important sociodemographic and access-to-care variables. By using data from the National Health Interview Survey (NHIS) for 2000 through 2015, we examined trends in prevalence of cancer screening that adhered to US Preventive Services Task Force screening recommendations in order to monitor screening progress among traditionally underserved population subgroups. Methods We analyzed NHIS data from surveys from 2000 through 2015 to estimate prevalence and trends in use of recommended screening tests for breast, cervical, colorectal, and prostate cancers. We used logistic regression and report predictive margins for population subgroups adjusted for various socioeconomic and demographic variables. Results Colorectal cancer screening was the only test that increased during the study period. We found disparities in prevalence of test use among subgroups for all tests examined. Factors that reduced the use of screening tests included no contact with a doctor in the past year, no usual source of health care, and no insurance coverage. Conclusion Understanding use of cancer screening tests among different population subgroups is vital for planning public health interventions with potential to increase screening uptake and reduce disparities in cancer morbidity and mortality. Overarching goals of Healthy People 2020 are to “achieve health equity, eliminate disparities, and improve the health of all groups.” Adjusted findings for 2015, compared with previous years, show persistent screening disparities, particularly among the uninsured, and progress for colorectal cancer screening only.
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Affiliation(s)
- Ingrid J Hall
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Centers for Disease Control and Prevention, DCPC, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341.
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Nancy Breen
- Office of Science Policy, Strategic Planning, Assessment, Analyses, Resources, Reporting and Data, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
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Karunasinghe N, Ambs S, Wang A, Tang W, Zhu S, Dorsey TH, Goudie M, Masters JG, Ferguson LR. Influence of lifestyle and genetic variants in the aldo-keto reductase 1C3 rs12529 polymorphism in high-risk prostate cancer detection variability assessed between US and New Zealand cohorts. PLoS One 2018; 13:e0199122. [PMID: 29920533 PMCID: PMC6007906 DOI: 10.1371/journal.pone.0199122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/03/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction The prostate-specific antigen (PSA) based prostate cancer (PC) screening is currently being debated. The current assessment is to understand the variability of detecting high-risk PC in a NZ cohort in comparison to a US cohort with better PSA screening facilities. Aldo-keto reductase 1C3 (AKR1C3) is known for multiple functions with a potential to regulate subsequent PSA levels. Therefore, we wish to understand the influence of tobacco smoking and the AKR1C3 rs12529 gene polymorphism in this variability. Method NZ cohort (n = 376) consisted of 94% Caucasians while the US cohort consisted of African Americans (AA), n = 202, and European Americans (EA), n = 232. PSA level, PC grade and stage at diagnosis were collected from hospital databases for assigning high-risk PC status. Tobacco smoking status and the AKR1C3 rs12529 SNP genotype were considered as confounding variables. Variation of the cumulative % high-risk PC (outcome variable) with increasing PSA intervals (exposure factor) was compared between the cohorts using the Kolmogorov-Smirnov test. Comparisons were carried out with and without stratifications made using confounding variables. Results NZ cohort has been diagnosed at a significantly higher mean age (66.67± (8.08) y) compared to both AA (62.65±8.17y) and EA (64.83+8.56y); median PSA (NZ 8.90ng/ml compared to AA 6.86ng/ml and EA 5.80ng/ml); and Gleason sum (NZ (7) compared EA (6)) (p<0.05). The cumulative % high-risk PC detection shows NZ cohort with a significantly lower diagnosis rates at PSA levels between >6 - <10ng/ml compared to both US groups (p<0.05). These were further compounded significantly by smoking status and genetics. Conclusions High-risk PCs recorded at higher PSA levels in NZ could be due to factors including lower levels of PSA screening and subsequent specialist referrals for biopsies. These consequences could be pronounced among NZ ever smokers carrying the AKR1C3 rs12529 G alleles making them a group that requires increased PSA screening attention.
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Affiliation(s)
- Nishi Karunasinghe
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
- * E-mail:
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, National Cancer Institute/NIH, 37 Convent Drive Bethesda, MD, United States of America
| | - Alice Wang
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
| | - Wei Tang
- Laboratory of Human Carcinogenesis, National Cancer Institute/NIH, 37 Convent Drive Bethesda, MD, United States of America
| | - Shuotun Zhu
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
| | - Tiffany H. Dorsey
- Laboratory of Human Carcinogenesis, National Cancer Institute/NIH, 37 Convent Drive Bethesda, MD, United States of America
| | - Megan Goudie
- Urology Department, Auckland City Hospital, Auckland, New Zealand
| | | | - Lynnette R. Ferguson
- Auckland Cancer Society Research Centre (ACSRC), Faculty of Medical and Health Sciences (FM&HS), The University of Auckland, Auckland, New Zealand
- Discipline of Nutrition and Dietetics, FM&HS, The University of Auckland, Auckland, New Zealand
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10
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Impact of the United States Preventive Services Task Force 'D' recommendation on prostate cancer screening and staging. Curr Opin Urol 2018; 27:205-209. [PMID: 28221220 DOI: 10.1097/mou.0000000000000383] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW In 2012, the United States Preventive Services Task Force (USPSTF) issued a grade 'D' recommendation against the use of routine prostate-specific antigen (PSA)-based screening for any men. This recommendation reflects critical misinterpretations of the available evidence base regarding benefits and harms of PSA screening and has influenced the nationwide landscape of prostate cancer screening, diagnosis, and treatment. RECENT FINDINGS Following the USPSTF recommendation, a substantial decline in PSA screening was noted for all age groups. Similarly, overall rates of prostate biopsy and prostate cancer incidence have significantly decreased with a shift toward higher grade and stage disease upon diagnosis. Concurrently, the incidence of metastatic prostate cancer has significantly risen in the United States. These trends are concerning particularly for the younger men with occult high-grade disease who are expected to benefit the most from early detection and definitive prostate cancer treatment. SUMMARY These emerging trends in PSA screening and prostate cancer incidence following the USPSTF recommendation may have significant public health implications. Due to the long natural history of the disease, a long-term follow-up is needed to provide a better understanding on the implications of such recommendations on disease progression and mortality rates in prostate cancer patients. The future of US screening policy should reflect a targeted 'smarter' screening strategy rather than dichotomizing the decision between 'screen all' or 'screen none'.
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Kearns JT, Holt SK, Wright JL, Lin DW, Lange PH, Gore JL. PSA screening, prostate biopsy, and treatment of prostate cancer in the years surrounding the USPSTF recommendation against prostate cancer screening. Cancer 2018; 124:2733-2739. [PMID: 29781117 DOI: 10.1002/cncr.31337] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/25/2017] [Accepted: 12/06/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The 2012 United States Preventive Services Task Force recommendation against screening for prostate cancer has impacted rates of prostate-specific antigen (PSA) screening and appears to be associated with declining prostate cancer incidence. Our objective was to characterize health care utilization that may explain these observed trends. METHODS MarketScan claims, which capture >30 million privately insured patients in the United States, were queried for all men aged 40-64 years for the years 2008-2014. PSA testing, prostate biopsy, prostate cancer diagnosis, and definitive local treatment were determined using associated International Classification of Diseases, Ninth Revision and Current Procedural Terminology, Fourth Edition codes. RESULTS There were approximately 6 million qualifying men with a full year of data. PSA testing, prostate biopsy, and prostate cancer detection declined significantly between 2009 and 2014, most notably after 2011. The prostate biopsy rate per 100 patients with a PSA test decreased over the study period from 1.95 (95% confidence interval [CI], 1.92-1.97) to 1.52 (95% CI, 1.50-1.54). Prostate cancer incidence per prostate biopsy increased over the study period from 0.36 (95% CI, 0.35-0.36) to 0.39 (95% CI, 0.39-0.40). Of new prostate cancer diagnoses, the proportion managed with definitive local treatment decreased from 69% (95% CI, 69%-70%) to 54% (95% CI, 53%-55%). Both PSA testing and prostate cancer incidence decreased significantly after 2011 (P < .001). CONCLUSION In a large cohort of privately insured men, PSA testing, prostate biopsy, prostate cancer incidence, and local definitive treatment for prostate cancer decreased between 2008 and 2014, most notably after 2011. This decrease may be driven by differential referral patterns from primary care providers to urologists. Cancer 2018;124:2733-2739. © 2018 American Cancer Society.
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Affiliation(s)
- James T Kearns
- University of Washington Medical Center, Seattle, Washington
| | - Sarah K Holt
- University of Washington Medical Center, Seattle, Washington
| | | | - Daniel W Lin
- University of Washington Medical Center, Seattle, Washington
| | - Paul H Lange
- University of Washington Medical Center, Seattle, Washington
| | - John L Gore
- University of Washington Medical Center, Seattle, Washington
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Patel NH, Bloom J, Hillelsohn J, Fullerton S, Allman D, Matthews G, Eshghi M, Phillips JL. Prostate Cancer Screening Trends After United States Preventative Services Task Force Guidelines in an Underserved Population. Health Equity 2018; 2:55-61. [PMID: 29806045 PMCID: PMC5963250 DOI: 10.1089/heq.2018.0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Prostate cancer screening is a controversial topic. We examined trends in Prostate Specific Antigen (PSA) testing in an underserved population before and after the United States Preventative Services Task Force (USPSTF) recommendation against screening. Methods: Data were collected on all PSA and cholesterol screening tests from 2008 to 2014. We examined the trend of these tests and prostate biopsies while comparing this data to lipid panel data to adjust for changes in patient population. Results: A decrease in PSA screening was observed from 2010 through 2014, with the greatest decline in 2012. The age group most affected was patients aged 55–69 years. The amount of prostate biopsies during this period decreased as well. Conclusions: Decreased rates of PSA screening were observed in our urban hospital population that preceded the publication of the USPSTF guidelines. The incidence of prostate biopsies decreased in this timeframe. It now remains to be demonstrated whether decreased PSA screening rates impact the diagnosis of and ultimately the survival from prostate cancer.
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Affiliation(s)
- Neel H Patel
- Department of Urology, New York Medical College, Valhalla, New York
| | - Jonathan Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Joel Hillelsohn
- Department of Urology, New York Medical College, Valhalla, New York
| | - Sean Fullerton
- Department of Urology, New York Medical College, Valhalla, New York
| | - Denton Allman
- Department of Urology, New York Medical College, Valhalla, New York
| | - Gerald Matthews
- Department of Urology, New York Medical College, Valhalla, New York
| | - Majid Eshghi
- Department of Urology, New York Medical College, Valhalla, New York
| | - John L Phillips
- Department of Urology, New York Medical College, Valhalla, New York
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Morrow M, Abrahamse P, Katz SJ. Trend Analysis on Reoperation After Lumpectomy for Breast Cancer-Reply. JAMA Oncol 2018; 4:747. [PMID: 29423506 DOI: 10.1001/jamaoncol.2017.5261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Abrahamse
- School of Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Steven J Katz
- School of Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
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14
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Smith S, Wolanski P. Metastatic prostate cancer incidence in Australia after amendment to prostate-specific antigen screening guidelines. ANZ J Surg 2017; 88:E589-E593. [PMID: 29194902 DOI: 10.1111/ans.14275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/10/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND To compare the incidence of newly diagnosed metastatic prostate cancer at an Australian facility pre- and post-publication of the United States Preventive Services Task Force (USPSTF) guidelines and subsequent amendment of the Royal Australian College of General Practitioners Preventive Activities in General Practice guidelines. METHODS A retrospective analysis was undertaken by patients with newly diagnosed prostate cancer following transrectal ultrasound-guided biopsy between 2009 and 2014. Patients were divided into two even groups based on whether they had undergone their transrectal ultrasound biopsy pre- (2009-2011) or post- (2013-2014) publication of USPSTF guidelines. Metastatic disease was determined by computed tomography chest, abdomen, pelvis as well as nuclear medicine bone scan. A comparison in the incidence of newly diagnosed metastatic prostate cancer was made. RESULTS A total of 130 patients were allocated into each group. In the pre-USPSTF group, 23 out of 130 patients had newly diagnosed metastatic prostatic cancer (17.7%). In the post-USPSTF group, 41 out of 130 (31.5%) had newly diagnosed metastatic prostate cancer (P < 0.05). The mean and median prostate-specific antigen was 15.9 and 9.4 (pre-guideline group) and 33.0 and 9.8 (post-guideline group), respectively (P = 0.02). The post-guidelines group had a higher incidence of low-grade disease (Gleason <7), a decreased incidence of intermediate grade disease (Gleason 7) and a relatively unchanged incidence in high-risk disease (Gleason >7). CONCLUSION The incidence of newly diagnosed metastatic prostate cancer nearly doubled in patients referred to our Urology Department post-release of the USPSTF guidelines.
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Affiliation(s)
- Sabin Smith
- Department of Urology, Townsville Hospital, Douglas, Queensland, Australia
| | - Philippe Wolanski
- Department of Urology, Townsville Hospital, Douglas, Queensland, Australia
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15
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Hehemann MC, Baldea KG, Quek ML. Prostate Cancer in the Elderly Male: Diagnostic and Management Considerations. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0213-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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16
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Lee DJ, Mallin K, Graves AJ, Chang SS, Penson DF, Resnick MJ, Barocas DA. Recent Changes in Prostate Cancer Screening Practices and Epidemiology. J Urol 2017; 198:1230-1240. [PMID: 28552708 DOI: 10.1016/j.juro.2017.05.074] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Prostate specific antigen based screening for prostate cancer has had a significant impact on the epidemiology of the disease. Its use has been associated with a significant decrease in prostate cancer mortality but has also resulted in the over diagnosis and overtreatment of indolent prostate cancer, exposing many men to the harms of treatment without benefit. The USPSTF (U.S. Preventive Services Task Force) in 2008 issued a recommendation against screening men older than 75 years, and in 2012 against routine screening for all men, indicating that in its interpretation the harms of screening outweigh the benefits. We review changes in the use of prostate specific antigen testing, performance of prostate biopsy, incidence of prostate cancer and stage of disease at presentation since 2012. MATERIALS AND METHODS An English language literature search was performed for terms that included "prostate specific antigen," "screening" and "United States Preventive Services Task Force" in various combinations. A total of 26 original studies had been published on the effects of the USPSTF recommendations on prostate specific antigen based screening or prostate cancer incidence in the United States as of December 1, 2016. RESULTS Review of the literature from 2012 through the end of 2016 indicates that there has been a decrease in prostate specific antigen testing and prostate biopsy. As a result, there has been a decline in the incidence of localized prostate cancer, including low, intermediate and high risk disease. The data regarding stage at presentation have yet to mature but there are some early signs of a shift toward higher burden of disease at presentation. CONCLUSIONS These findings raise concern about a reversal of the observed improvement in prostate cancer specific mortality during preceding decades. Alternative screening strategies would 1) incorporate patient preferences by allowing shared decision-making, 2) preserve the survival benefits associated with screening, 3) improve the specificity of screening to reduce unnecessary biopsies and detection of low risk disease, and 4) promote the use of active surveillance for low risk cancers if they are detected.
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Affiliation(s)
- Daniel J Lee
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Amy J Graves
- Center for Surgical Quality and Outcomes Research, Nashville, Tennessee
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Surgical Quality and Outcomes Research, Nashville, Tennessee; Geriatric Research, Education and Clinical Center, VA Tennessee Valley Health Care System, Nashville, Tennessee
| | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Surgical Quality and Outcomes Research, Nashville, Tennessee; Geriatric Research, Education and Clinical Center, VA Tennessee Valley Health Care System, Nashville, Tennessee
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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17
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Paller CJ, Cole AP, Partin AW, Carducci MA, Kanarek NF. Risk factors for metastatic prostate cancer: A sentinel event case series. Prostate 2017; 77:1366-1372. [PMID: 28786124 PMCID: PMC5621513 DOI: 10.1002/pros.23396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/17/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Root cause analysis is a technique used to assess systems factors related to "sentinel events"-serious adverse events within healthcare systems. This technique is commonly used to identify factors, which allowed these adverse events to occur, to target areas for improvement and to improve health care delivery systems. We sought to apply this technique to men presenting with metastatic prostate cancer (PCa). METHODS We performed an in-depth case series analysis of 15 patients, who presented with metastatic disease at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center using root cause analysis to refine a list of health system factors that lead to late stage presentation in the current era. RESULTS Key factors in late diagnosis of PCa included lack of insurance, lack of routine PSA testing, comorbidities, reticence of patients to follow up actionable PSA, and aggressive disease. Three patients had aggressive disease that would not have been discovered at an early stage in the disease process, despite routine screening. However, analysis of the remaining 12 patients illuminated health system factors led to missing important diagnostic information, which might have led to diagnosis of PCa at a curable stage. CONCLUSIONS The cases help highlight the need for systems based approaches to early diagnosis of PCa. A heterogeneous group of barriers to early diagnosis were identified in our series of patients including economic, health systems, and cultural factors. These findings underscore the need for individualized approaches to preventing delayed diagnosis of PCa. While limited by our single-institution scope, this approach provides a model for research and quality improvement initiatives to identify modifiable systems factors impeding appropriate diagnoses of PCa.
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Affiliation(s)
- Channing J. Paller
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Alexander P. Cole
- Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA
| | - Alan W. Partin
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Michael A. Carducci
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Norma F. Kanarek
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Wallner LP, Jacobsen SJ. Prostate cancer in black men: Is it time for personalized screening approaches? Cancer 2017; 123:2203-2205. [PMID: 28436012 DOI: 10.1002/cncr.30685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/18/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Lauren P Wallner
- Department of Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.,Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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19
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Misra-Hebert AD, Hu B, Klein EA, Stephenson A, Taksler GB, Kattan MW, Rothberg MB. Prostate cancer screening practices in a large, integrated health system: 2007-2014. BJU Int 2017; 120:257-264. [PMID: 28139034 DOI: 10.1111/bju.13793] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess prostate cancer screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA) testing for older men, and to assess primary provider variation associated with prostate cancer screening. PATIENTS AND METHODS Our study population included 160 211 men aged ≥40 years with at least one visit to a primary care clinic in any of the study years in a large, integrated health system. We conducted a retrospective cohort study using electronic medical record data from January 2007 to December 2014. Yearly rates of screening PSA testing by primary care providers (PCPs), rates of re-screening, and rates of prostate biopsies were assessed. RESULTS Annual PSA-screening testing declined from 2007 to 2014 in all age groups, as did biennial and quadrennial screening. Yearly rates declined for men aged ≥70 years, from 22.8% to 8.9%; ages 50-69 years, from 39.2% to 20%; and ages 40-49 years, from 11% to 4.6%. Overall rates were lower for African-American (A-A) men vs non-A-A men; for men with a family history of prostate cancer, rates were similar or slightly higher than for those without a family history. PCP variation associated with ordering of PSA testing did not substantially change after the USPSTF recommendations. While the number of men screened and rates of follow-up prostate cancer screening declined in 2011-2014 compared to 2007-2010, similar re-screening rates were noted for men aged 45-75 years with initial PSA levels of <1 ng/mL or 1-3 ng/mL in both the earlier and later cohorts. For men aged >75 years with initial PSA levels of <3 ng/mL screened in both cohorts, follow-up screening rates were similar. Rates of prostate biopsy declined for men aged ≥70 years in 2014 compared to 2007. For men who had PSA screening, rates of first prostate biopsy increased in later years for A-A men and men with a family history of prostate cancer. CONCLUSIONS Prostate cancer screening declined from 2007 to 2014 even in higher-risk groups and follow-up screening rates were not related to previous PSA level. However, rates of first prostate biopsy in men who were screened with a PSA test were higher for men with an increased risk of prostate cancer in later years. Variation in PSA testing was noted among PCPs. Future work should further explore sources of variation in screening practices and implementation of risk-based strategies for prostate cancer screening in primary care.
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Affiliation(s)
- Anita D Misra-Hebert
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.,Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Hu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric A Klein
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Stephenson
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Glen B Taksler
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.,Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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20
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Fleshner K, Carlsson SV, Roobol MJ. The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nat Rev Urol 2017; 14:26-37. [PMID: 27995937 PMCID: PMC5341610 DOI: 10.1038/nrurol.2016.251] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Guidelines regarding recommendations for PSA screening for early detection of prostate cancer are conflicting. In 2012, the United States Preventive Services Task Force (USPSTF) assigned a grade of D (recommending against screening) for men aged ≥75 years in 2008 and for men of all ages in 2012. Understanding temporal trends in rates of screening before and after the 2012 recommendation in terms of usage patterns in PSA screening, changes in prostate cancer incidence and biopsy patterns, and how the recommendation has influenced physician's and men's attitudes about PSA screening and subsequent ordering of other screening tests is essential within the scope of prostate cancer screening policy. Since the 2012 recommendation, rates of PSA screening decreased by 3-10% in all age groups and across most geographical regions of the USA. Rates of prostate biopsy and prostate cancer incidence have declined in unison, with a shift towards tumours being of higher grade and stage upon detection. Despite the recommendation, some physicians report ongoing willingness to screen appropriately selected men, and many men report intending to continue to ask for the PSA test from their physician. In the coming years, we expect to have an improved understanding of whether these decreased rates of screening will affect prostate cancer metastasis and mortality.
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Affiliation(s)
- Katherine Fleshner
- Schulich School of Medicine and Dentistry, University of
Western Ontario, Canada
| | - Sigrid V. Carlsson
- Department of Surgery; and Department of Epidemiology and
Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
- Institute of Clinical Sciences, Department of Urology,
Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Monique J. Roobol
- Department of Urology, Erasmus Medical Center, Rotterdam,
The Netherlands
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21
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Moul JW. Comparison of DRE and PSA in the Detection of Prostate Cancer. J Urol 2016; 197:S208-S209. [PMID: 28010975 DOI: 10.1016/j.juro.2016.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Judd W Moul
- Division of Urology, Department of Surgery, Duke Cancer Institute, Duke University, Durham, North Carolina
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22
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Kearns JT, Gore JL. Prostate cancer screening: Do guidelines matter? Cancer 2016; 122:3760-3761. [DOI: 10.1002/cncr.30331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 11/08/2022]
Affiliation(s)
- James T. Kearns
- Department of Urology; University of Washington; Seattle Washington
| | - John L. Gore
- Department of Urology; University of Washington; Seattle Washington
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