The number of tPSA tests continues to rise and variation in testing practices persists: a survey of laboratory services in Ireland 2008-2010

Raising awareness of prostate cancer amongst black communities in the south of England

Background: Black men are more likely to be diagnosed with prostate cancer than white men and may present with prostate cancer at a much later stage during the cancer journey. This could be due to a lower awareness of the signs and symptoms of prostate cancer, an unwillingness to report symptoms or a lack of trust in the healthcare system or a combination of these.Aim: The aims of this study were to raise awareness of prostate cancer in black communities in South of England and to evaluate the engagement and raising awareness campaigns.Method: This project involved two phases. The first phase focused on raising awareness of prostate cancer in black men and their families. The awareness was delivered using public facing activities such as stands and talks with participants. Additionally, online awareness activities were undertaken with either black men alone or black men and their families. The second phase of the project involved an evaluation of the raising awareness campaigns through interviews. A total of 320 black men and their families were involved in the awareness sessions and of these, 12 black men were interviewed. The interview transcripts were analysed using thematic analysis.Results: Analysis of the data generated three main themes including: increased knowledge and mindset change regarding prostate cancer, empowered to take community and personal action, as well as strategies and tools to raise awareness of prostate cancer among black communities.Conclusion: The raising awareness campaigns had a positive effect in terms of increasing black men's awareness of the risk factors associated with prostate cancer. Moreover, the campaigns enabled them to make lifestyle adjustments that could help them to reduce their likelihood of developing prostate cancer. Additionally, the participant's knowledge had improved, and they were empowered and motivated to make a difference to their lives and that of their communities.

Men's information-seeking behavior regarding cancer risk and screening: A meta-narrative systematic review

OBJECTIVE

Preventive strategies are known to reduce cancer risk and incidence and improve prognosis. Men seldom seek medical information about cancer prevention and risk reduction. The aim of this meta-narrative systematic review was to critically appraise evidence from qualitative, quantitative, and mixed-methods studies that explored men's information-seeking behaviors in relation to cancer prevention and risk reduction.

METHODS

MEDLINE, CINAHL Plus with Full Text, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, Education Full Text, and ERIC were systematically searched for studies published in English between January 1, 2006 and May 30, 2016. A total of 4117 titles were identified; of which, 31 studies were included (21 qualitative studies, 9 quantitative studies, and 1 mixed-methods study). The methodological quality of the studies was appraised by using different tools.

RESULTS

Most studies focused on screening for prostate (n = 18) and colorectal cancer (n = 7). Most men were passive information-gatherers rather than active information-seekers. Key sources of information included the Internet for active information-seekers and health care professionals for passive information-gatherers. Barriers to information-seeking included information overload, embarrassment, and fear. Low literacy and health literacy levels were addressed in 3 studies and were identified as impediments to active information-seeking. Facilitators to information-seeking included family support, media, celebrity endorsements, and targeted information.

CONCLUSIONS

Men's information-seeking behavior regarding cancer risk reduction, prevention, and screening is influenced by several factors. This necessitates targeted interventions aimed at raising awareness of cancer prevention and screening, while accounting for men's informational needs, preferred learning strategies, and literacy levels.

Increasing detection of significant prostate cancer in younger men - ten year trends in prostate cancer risk profile in the Mid-West of Ireland

INTRODUCTION

Although PSA (prostate specific antigen) based screening for prostate cancer (PCa) is controversial, an increasing number of men are undergoing Transrectal Ultrasound Guided prostate biopsy (TRUSPB) through primary care-based PSA testing and referral to hospitals. The aim of our study was to investigate presenting risk profiles of PCa over the last decade in a cohort of men in Ireland and to examine any change in the same over this time period.

MATERIAL AND METHODS

The hospital patient administration system was analysed for patients who underwent TRUSPB from January 2005 to December 2015. Clinically significant PCa was defined as Gleason score of 7 or above.

RESULTS

Complete data was available on 2391 TRUSPB patients: number of biopsies increased by 53%, median age decreased by 0.9%, median PSA decreased by 6% (p = 0.001, ANOVA) and abnormal DRE increased by 9% (p = 0.001, chi square). Overall positive biopsy was 44% and significant cancer rate was 21%. There was a significant change in trend of detection (p = 0.02) with average annual increase in significant cancer of 3%. The median age of the significant cancer cohort reduced by 1% and the PSA at diagnosis reduced by 9%. In younger men (<50 years), the rate of significant cancer detection increased by 18%.

CONCLUSIONS

Significant PCa detection increased across all age groups but recently, a younger patient profile was diagnosed with high-grade disease. This paves the way for future research on early-onset PCa. Younger patients with significant disease would result in increasing number of patients being eligible for radical treatment with implications on health resource planning and provision.

Do men regret prostate biopsy: Results from the PiCTure study

Background

Understanding men’s experience of prostate biopsy is important as the procedure is common, invasive and carries potential risks. The psychological aspects of prostate biopsy have been somewhat neglected. The aim of this study was to explore the level of regret experienced by men after prostate biopsy and identify any associated factors.

Methods

Men attending four clinics in Republic of Ireland and two in Northern Ireland were given a questionnaire to explore their experience of prostate biopsy. Regret was measured on a Likert scale asking men how much they agreed with the statement “It [the biopsy] is something I regret.”

Results

Three hundred thirty-five men responded to the survey. The mean age was 63 years (SD ±7 years). Three quarters of respondents (76%) were married or co-habiting, and (75%) finished education at primary or secondary school level. For just over two thirds of men (70%) their recent biopsy represented their first ever prostate biopsy. Approximately one third of men reported a diagnosis of cancer, one third a negative biopsy result, and the remaining third did not know their result. Two thirds of men reported intermediate or high health anxiety. 5.1% of men agreed or strongly agreed that they regretted the biopsy.

Conclusions

Level of regret was low overall. Health anxiety was the only significant predictor of regret, with men with higher anxiety reporting higher levels of regret than men with low anxiety (OR = 3.04, 95% CI 1.58, 5.84).

Men with high health anxiety may especially benefit from careful counselling before and after prostate biopsy.

Electronic supplementary material

The online version of this article (doi:10.1186/s12894-016-0194-y) contains supplementary material, which is available to authorized users.

Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study

AIM

To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations.

PARTICIPANTS

PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI).

METHOD

A cross-sectional postal questionnaire was sent to PCa survivors 2-18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into 'late disease' (stage III/IV and any Gleason grade (GG) at diagnosis) and 'early disease' (stage I/II and GG 2-7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression.

RESULTS

3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score.

CONCLUSIONS

Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.

Comparing the costs of three prostate cancer follow-up strategies: a cost minimisation analysis

PURPOSE

Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. Growing numbers of prostate cancer survivors mean that this model of care may not be economically sustainable, and a number of alternative approaches have been suggested. The aim of this study was to develop an economic model to compare the costs of three alternative strategies for prostate cancer follow-up in Ireland-the European Association of Urology (EAU) guidelines, the National Institute of Health Care Excellence (NICE) guidelines and current practice.

METHODS

A cost minimisation analysis was performed using a Markov model with three arms (EAU guidelines, NICE guidelines and current practice) comparing follow-up for men with prostate cancer treated with curative intent. The model took a health care payer's perspective over a 10-year time horizon.

RESULTS

Current practice was the least cost efficient arm of the model, the NICE guidelines were most cost efficient (74 % of current practice costs) and the EAU guidelines intermediate (92 % of current practice costs). For the 2562 new cases of prostate cancer diagnosed in 2009, the Irish health care system could have saved €760,000 over a 10-year period if the NICE guidelines were adopted.

CONCLUSIONS

This is the first study investigating costs of prostate cancer follow-up in the Irish setting. While economic models are designed as a simplification of complex real-world situations, these results suggest potential for significant savings within the Irish health care system associated with implementation of alternative models of prostate cancer follow-up care.

Stability and accuracy of total and free PSA values in samples stored at room temperature

INTRODUCTION

In 2010, an estimated 476,076 total PSA tests were performed in Ireland, at a cost of €3.6 million with the majority ordered by general practitioners. We aimed to replicate storage conditions at room temperature and see if prolonged storage affected total and free PSA values.

METHODS

Blood samples were taken from 20 male patients in four VACUETTE^® Serum Separator tubes (Greiner-Bio-One, Austria) and stored at room temperature (22 °C) for different time intervals (4, 8, 24, 48 h) before being centrifuged and analyzed. Total PSA (tPSA) and free PSA (fPSA) values were determined using the Tosoh AIA 1800 assay (Tokyo, Japan).

RESULTS

Mean tPSA values were measured at 4, 8, 24 and 48 h with values of 7.9, 8.1, 7.8 and 8.0 μg/L, respectively. Values ranged from -1.26 to +2.53 % compared to the initial 4 h interval reading, indicating tPSA remained consistent at room temperature. The tPSA showed no significance between groups (ANOVA, p = 0.283). Mean fPSA values at 4, 8, 24 and 48 h were 2.05, 2.04, 1.83, 1.82 μg/L, respectively. At 24 and 48 h there was 10.73 and 11.22 % reduction, respectively, in fPSA compared to the 4-h time interval, indicating prolonged storage resulted in reduced fPSA values. After 24 h, there was an 8.8 % reduction in the free/total PSA %. The fPSA showed significant differences between groups (ANOVA, p = 0.024).

CONCLUSIONS

Our recommendation is that samples that have been stored for prolonged amounts of time (greater than 24 h) should not be used for free PSA testing.

Prostate specific antigen testing is associated with men's psychological and physical health and their healthcare utilisation in a nationally representative sample: a cross-sectional study

BACKGROUND

Prostate cancer incidence has risen considerably in recent years, primarily due to Prostate Specific Antigen (PSA) testing in primary care. The objective of this study was to investigate associations between PSA testing and the psychological and physical health, and healthcare utilisation of men in a population where PSA testing is widespread.

METHODS

A cross-sectional study was carried out in a population-representative sample of men ≥ 50 years enrolled in The Irish Longitudinal Study on Ageing (TILDA). TILDA participants underwent structured interviews, health assessments and completed standardised questionnaires. Men were classified as ever/never having received a PSA test. Multivariate logistic regression (Odds Ratios (OR) and 95% Confidence Intervals (CI) was used to determine associations between PSA testing, and men's psychological and physical health and healthcare utilisation.

RESULTS

This analysis included 3,628 men, 68.2% of whom ever had a PSA test. In adjusted analysis, men with sub-threshold depression were significantly less likely to have had a PSA test, (OR=0.79, 95% CI 0.64-0.97). Likelihood of having a PSA test was inversely associated with anxiety, but this was not significant (OR=0.79, 95% CI 0.57-1.09). Frailty (OR=0.61, 95% CI 0.31-1.05) and eligibility for free primary care (OR=0.63, 95% CI 0.52-0.77) were also inversely associated with PSA testing. Positive associations were observed between PSA testing and more chronic illnesses (OR=1.11, 95% CI 1.05-1.19), more primary care visits (OR=1.03, 95% CI 1.01-1.05) and preventative health practices, including cholesterol testing and influenza vaccination (OR=1.35, 95% CI 1.13-1.60).

CONCLUSIONS

Men's psychological and physical health and their healthcare utilisation are associated with PSA testing in primary care. The association between poorer psychological health, in particular sub-threshold depression, and reduced likelihood of PSA testing in primary care requires further investigation. These findings may have wider implications for other cancer screening.