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Scherer TP, Saba K, Wettstein MS, Lucca I, Mortezavi A, Waisbrod S, Aujesky D, Capaul R, Strebel RT. Do Swiss urologists and Swiss internists screen themselves and their relatives for prostate cancer? A questionnaire study. Swiss Med Wkly 2023; 153:40115. [PMID: 37774392 DOI: 10.57187/smw.2023.40115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
PURPOSE Prostate-specific antigen (PSA) screening for men at risk of prostate cancer is controversial. The current recommendation is to raise awareness of prostate cancer and offer PSA screening in accordance with shared decision- making. Whether the possibility of a PSA screen is discussed with the patient depends on the treating physician, but data on physicians' attitudes towards PSA screening are scarce. This study aimed to examine internists' and urologists' personal PSA screening activity as an indicator of their attitude towards PSA screening. MATERIALS AND METHODS Members of the Swiss Society of Urology and the Swiss Society of General Internal Medicine were asked in 08/2020 to anonymously complete an online survey about personal PSA screening behaviour for themselves, their fathers, brothers and partners. Categorical and continuous variables were compared by chi-squared tests and t-tests, respectively. RESULTS In total, 190/295 (response rate: 64%) urologists and 893/7400 (response rate: 12%) internists participated in the survey. Of the participants, 297/1083 (27.4%) were female. Male urologists >50 years of age screened themselves more often than male internists >50 years of age (89% vs 70%, p <0.05). Furthermore, urologists reported recommending screening statistically significantly more often than internists to their brother, father or partner regardless of their sex (men: 38.1% vs 18.5%; p <0.05; women: 81.8% vs 32.2%; p <0.05). CONCLUSIONS: Most participating male physicians >50 years of age have screened themselves for prostate cancer. Furthermore, PSA screening of relatives was significantly associated with the urology specialty. The reasons physicians screen themselves substantially more often than the public and why male and female urologists as well as male internists perform PSA screening more frequently in their private environment than female internists should be further examined.
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Affiliation(s)
- Thomas P Scherer
- Department of Urology, Cantonal Hospital Grisons, Chur, Switzerland
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Karim Saba
- Department of Urology, Cantonal Hospital Grisons, Chur, Switzerland
- Urology Centre, Hirslanden Klinik Aarau, Aarau, Switzerland
| | - Marian S Wettstein
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Ilaria Lucca
- Department of Urology, University Hospital Lausanne, Lausanne, Switzerland
| | - Ashkan Mortezavi
- University of Zurich, Zurich, Switzerland
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | | | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss Society of General Internal Medicine, SGAIM, Berne, Switzerland
| | - Regula Capaul
- Swiss Society of General Internal Medicine, SGAIM, Berne, Switzerland
| | - Raeto T Strebel
- Department of Urology, Cantonal Hospital Grisons, Chur, Switzerland
- University of Zurich, Zurich, Switzerland
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2
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Bryant AK, Lee KM, Alba PR, Murphy JD, Martinez ME, Natarajan L, Green MD, Dess RT, Anglin-Foote TR, Robison B, DuVall SL, Lynch JA, Rose BS. Association of Prostate-Specific Antigen Screening Rates With Subsequent Metastatic Prostate Cancer Incidence at US Veterans Health Administration Facilities. JAMA Oncol 2022; 8:1747-1755. [PMID: 36279204 PMCID: PMC9593319 DOI: 10.1001/jamaoncol.2022.4319] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023]
Abstract
Importance There is controversy about the benefit of prostate-specific antigen (PSA) screening. Prostate-specific antigen screening rates have decreased since 2008 in the US, and the incidence of metastatic prostate cancer has increased. However, there is no direct epidemiologic evidence of a correlation between population PSA screening rates and subsequent metastatic prostate cancer rates. Objective To assess whether facility-level variation in PSA screening rates is associated with subsequent facility-level metastatic prostate cancer incidence. Design, Setting, and Participants This retrospective cohort used data for all men aged 40 years or older with an encounter at 128 facilities in the US Veterans Health Administration (VHA) from January 1, 2005, to December 31, 2019. Exposures Yearly facility-level PSA screening rates, defined as the proportion of men aged 40 years or older with a PSA test in each year, and long-term nonscreening rates, defined as the proportion of men aged 40 years or older without a PSA test in the prior 3 years, from January 1, 2005, to December 31, 2014. Main Outcomes and Measures The main outcomes were facility-level yearly counts of incident metastatic prostate cancer diagnoses and age-adjusted yearly metastatic prostate cancer incidence rates (per 100 000 men) 5 years after each PSA screening exposure year. Results The cohort included 4 678 412 men in 2005 and 5 371 701 men in 2019. Prostate-specific antigen screening rates decreased from 47.2% in 2005 to 37.0% in 2019, and metastatic prostate cancer incidence increased from 5.2 per 100 000 men in 2005 to 7.9 per 100 000 men in 2019. Higher facility-level PSA screening rates were associated with lower metastatic prostate cancer incidence 5 years later (incidence rate ratio [IRR], 0.91 per 10% increase in PSA screening rate; 95% CI, 0.87-0.96; P < .001). Higher long-term nonscreening rates were associated with higher metastatic prostate cancer incidence 5 years later (IRR, 1.11 per 10% increase in long-term nonscreening rate; 95% CI, 1.03-1.19; P = .01). Conclusions and Relevance From 2005 to 2019, PSA screening rates decreased in the national VHA system. Facilities with higher PSA screening rates had lower subsequent rates of metastatic prostate cancer. These data may be used to inform shared decision-making about the potential benefits of PSA screening among men who wish to reduce their risk of metastatic prostate cancer.
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Affiliation(s)
- Alex K. Bryant
- Department of Radiation Oncology, University of Michigan, Ann Arbor
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Health System, Ann Arbor, Michigan
| | - Kyung Min Lee
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Patrick R. Alba
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - James D. Murphy
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
| | - Maria Elena Martinez
- Moores Cancer Center, University of California, San Diego, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Loki Natarajan
- Moores Cancer Center, University of California, San Diego, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Michael D. Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Health System, Ann Arbor, Michigan
| | - Robert T. Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Tori R. Anglin-Foote
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Brian Robison
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Scott L. DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Julie A. Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Brent S. Rose
- Veterans Affairs San Diego Healthcare System, San Diego, California
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Department of Urology, University of California, San Diego, La Jolla
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3
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PSA Testing in Men Receiving Testosterone Therapy with History of Prostate Cancer: A Matched Analysis of a Large Multi-Institutional Research Network. Urology 2022; 165:237-241. [DOI: 10.1016/j.urology.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/11/2022] [Indexed: 12/12/2022]
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4
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Clinical utility of a serum biomarker panel in distinguishing prostate cancer from benign prostate hyperplasia. Sci Rep 2021; 11:15052. [PMID: 34302010 PMCID: PMC8302659 DOI: 10.1038/s41598-021-94438-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/06/2021] [Indexed: 12/17/2022] Open
Abstract
Prostate-specific antigen (PSA) screening for prostate cancer (PCa) is limited by the lack of specificity but is further complicated in the benign prostatic hyperplasia (BPH) population which also exhibit elevated PSA, representing a clear unmet need to distinguish BPH from PCa. Herein, we evaluated the utility of FLNA IP-MRM, age, and prostate volume to stratify men with BPH from those with PCa. Diagnostic performance of the biomarker panel was better than PSA alone in discriminating patients with negative biopsy from those with PCa, as well as those who have had multiple prior biopsies (AUC 0.75 and 0.87 compared to AUC of PSA alone 0.55 and 0.57 for patients who have had single compared to multiple negative biopsies, respectively). Of interest, in patients with PCa, the panel demonstrated improved performance than PSA alone in those with Gleason scores of 5–7 (AUC 0.76 vs. 0.56) and Gleason scores of 8–10 (AUC 0.74 vs. 0.47). With Gleason scores (8–10), the negative predictive value of the panel is 0.97, indicating potential to limit false negatives in aggressive cancers. Together, these data demonstrate the ability of the biomarker panel to perform better than PSA alone in men with BPH, thus preventing unnecessary biopsies.
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5
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Becker DJ, Rude T, Walter D, Wang C, Loeb S, Li H, Ciprut S, Kelly M, Zeliadt SB, Fagerlin A, Lepor H, Sherman S, Ravenell JE, Makarov DV. The Association of Veterans' PSA Screening Rates With Changes in USPSTF Recommendations. J Natl Cancer Inst 2021; 113:626-631. [PMID: 32797212 DOI: 10.1093/jnci/djaa120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2012, the United States Preventative Services Task Force (USPSTF) formally recommended against all prostate-specific antigen (PSA) screening for prostate cancer. Our goal was to characterize PSA screening trends in the Veterans Health Administration (VA) before and after the USPSTF recommendation and to determine if PSA screening was more likely to be ordered based on a veteran's race or age. METHODS Using the VA Corporate Data Warehouse, we created 10 annual groups of PSA-eligible men covering 2009-2018. We identified all PSA tests performed in the VA to determine yearly rates of PSA screening. All statistical tests were 2-sided. RESULTS The overall rate of PSA testing in the VA decreased from 63.3% in 2009 to 51.2% in 2018 (P < .001). PSA screening rates varied markedly by age group during our study period, with men aged 70-80 years having the highest initial rate and greatest decline (70.6% in 2009 to 48.4% in 2018, P < .001). Men aged 55-69 years had a smaller decline (65.2% in 2009 to 58.9% in 2018, P < .001) whereas the youngest men, aged 40-54 years, had an increase in PSA screening (26.2% in 2009 to 37.8% in 2018, P < .001). CONCLUSIONS In this analysis of PSA screening rates among veterans before and after the 2012 USPSTF recommendation against screening, we found that overall PSA screening decreased only modestly, continuing for more than one-half of the men in our study. Veterans of different races had similar screening rates, suggesting that VA care may minimize racial disparities. Veterans of varying ages experienced statistically significantly differences in PSA screening trends.
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Affiliation(s)
- Daniel J Becker
- VA New York Harbor Healthcare System, New York University, New York, NY, USA.,Perlmutter Cancer Center, New York University, New York, NY, USA
| | - Temitope Rude
- VA New York Harbor Healthcare System, New York University, New York, NY, USA.,Department of Urology, New York University, New York, NY, USA
| | - Dawn Walter
- VA New York Harbor Healthcare System, New York University, New York, NY, USA.,Department of Population Health, New York University, New York, NY, USA
| | - Chan Wang
- Department of Population Health, New York University, New York, NY, USA
| | - Stacy Loeb
- VA New York Harbor Healthcare System, New York University, New York, NY, USA.,Department of Population Health, New York University, New York, NY, USA
| | - Huilin Li
- Department of Population Health, New York University, New York, NY, USA
| | - Shannon Ciprut
- VA New York Harbor Healthcare System, New York University, New York, NY, USA.,Department of Urology, New York University, New York, NY, USA.,Department of Population Health, New York University, New York, NY, USA
| | - Matthew Kelly
- VA New York Harbor Healthcare System, New York University, New York, NY, USA.,Department of Urology, New York University, New York, NY, USA.,Department of Population Health, New York University, New York, NY, USA
| | - Steven B Zeliadt
- VA Puget Sound Healthcare System and University of Washington, Seattle, WA, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.,Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, UT, USA
| | - Herbert Lepor
- Perlmutter Cancer Center, New York University, New York, NY, USA.,Department of Urology, New York University, New York, NY, USA
| | - Scott Sherman
- VA New York Harbor Healthcare System, New York University, New York, NY, USA.,Perlmutter Cancer Center, New York University, New York, NY, USA.,Department of Population Health, New York University, New York, NY, USA
| | - Joseph E Ravenell
- Department of Population Health, New York University, New York, NY, USA
| | - Danil V Makarov
- VA New York Harbor Healthcare System, New York University, New York, NY, USA.,Department of Population Health, New York University, New York, NY, USA.,Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA
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6
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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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7
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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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8
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Ajami T, Durruty J, Mercader C, Rodriguez L, Ribal MJ, Alcaraz A, Vilaseca A. Impact on prostate cancer clinical presentation after non-screening policies at a tertiary-care medical center- a retrospective study. BMC Urol 2021; 21:20. [PMID: 33557801 PMCID: PMC7871577 DOI: 10.1186/s12894-021-00784-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/22/2021] [Indexed: 12/30/2022] Open
Abstract
Background In May 2012 the US Preventive Task Force issued a ‘D’ recommendation against routine PSA-based early detection of prostate cancer. This recommendation was implemented progressively in our health system. The aim of this study is to define its impact on prostate cancer staging at a tertiary care institution. Methods A retrospective analysis was performed from 2012 until 2015 at a single center. We analyzed the total number of biopsies performed per year and the positive biopsy rate. For those patients with positive biopsies we recorded diagnostic PSA, clinical stage, ISUP grade group, nodal involvement and metastatic status at diagnosis. Results A total of 1686 biopsies were analyzed. The positive biopsy rate increased from 25% in 2012 to 40% in 2015 (p < 0.05). No change in median PSA was noticed (p = 0.627). The biopsies detected higher ISUP grades (p = 0.000). In addition, newly diagnosed prostate cancer presented a higher clinical stage (p = 0.005), higher metastatic rates (p = 0.03) and a tendency to higher lymph node involvement although not statistically significant (p = 0.09). Conclusion After the 2012 recommendation, patients presented a higher probability of a prostate cancer diagnosis, with a more adverse ISUP group, clinical stage and metastatic disease. These results should be taken into consideration to implement a risk adapted strategy for prostate cancer screening.
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Affiliation(s)
- Tarek Ajami
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - Jaime Durruty
- Urology Department, Hospital Fuerza Aérea de Chile, Santiago, Chile
| | - Claudia Mercader
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | | | - Maria J Ribal
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - Antonio Alcaraz
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain
| | - Antoni Vilaseca
- Urology Department, Hospital Clínic de Barcelona, C/ Villarroel, 170, 08036, Barcelona, Spain.
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Associations of Prostate-Specific Antigen (PSA) Testing in the US Population: Results from a National Cross-Sectional Survey. J Community Health 2020; 46:389-398. [PMID: 33064229 DOI: 10.1007/s10900-020-00923-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 01/12/2023]
Abstract
Prostate-specific antigen (PSA) testing is one of the standard screening methods for prostate cancer (PC); however, a high proportion of men with abnormal PSA findings lack evidence for PC and may undergo unnecessary treatment. Furthermore, little is known about the prevalence of PSA testing for US men, after the US Preventive Services Task Force (USPSTF) recommended against routine PSA screening in 2012. Our objectives were to: (1) examine the self-reported patterns of PSA testing following a change in the USPSTF prostate cancer screening recommendations and (2) to determine the associated socio-demographic factors. Data were from the 2010 and 2015 National Health Interview Surveys. Men were ages ≥ 40 years and responded to the question "Ever had a PSA test?". Multivariable logistic regression was used to examine PSA testing prevalence in 2010 and 2015, and their associated socio-demographic factors. The analytic sample contained 15,372 men. A majority (75.2%) identified as non-Hispanic (NHW) and 14.2% were foreign-born. Those surveyed in 2015 were less likely to report ever having had a PSA test when compared to those in 2010. Compared to US-born and older NHW men, PSA testing was statistically significantly lower among foreign-born men and men belonging to all other racial categories. Fewer men reported PSA testing following the USPSTF 2012 recommendations. Associated socio-demographic factors included nativity, age, race/ethnicity, educational attainment and type of health insurance. Further studies are required to elucidate our findings and their health implications for the US native and foreign-born population.
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10
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Filella X, Albaladejo MD, Allué JA, Castaño MA, Morell-Garcia D, Ruiz MÀ, Santamaría M, Torrejón MJ, Giménez N. Prostate cancer screening: guidelines review and laboratory issues. Clin Chem Lab Med 2020; 57:1474-1487. [PMID: 31120856 DOI: 10.1515/cclm-2018-1252] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/21/2019] [Indexed: 12/19/2022]
Abstract
Background Prostate-specific antigen (PSA) remains as the most used biomarker in the detection of early prostate cancer (PCa). Clinical practice guidelines (CPGs) are produced to facilitate incorporation of evidence into clinical practice. This is particularly useful when PCa screening remains controversial and guidelines diverge among different medical institutions, although opportunistic screening is not recommended. Methods We performed a systematic review of guidelines about PCa screening using PSA. Guidelines published since 2008 were included in this study. The most updated version of these CPGs was used for the evaluation. Results Twenty-two guidelines were selected for review. In 59% of these guidelines, recommendations were graded according to level of evidence (n = 13), but only 18% of the guidelines provided clear algorithms (n = 4). Each CPG was assessed using a checklist of laboratory issues, including pre-analytical, analytical, and post-analytical factors. We found that laboratory medicine specialists participate in 9% of the guidelines reviewed (n = 2) and laboratory issues were frequently omitted. We remarked that information concerning the consequences of World Health Organization (WHO) standard in PSA testing was considered by only two of 22 CPGs evaluated in this study. Conclusions We concluded that the quality of PCa early detection guidelines could be improved properly considering the laboratory issues in their development.
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Affiliation(s)
- Xavier Filella
- Evidence Based Laboratory Medicine Commission and Biological Markers of Cancer Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Biochemistry and Molecular Genetics (CDB), Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - María Dolores Albaladejo
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Clinical Analysis and Biochemistry, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Juan Antonio Allué
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Synlab Diagnosticos Globales, Sevilla, Spain
| | - Miguel Angel Castaño
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Biochemistry, Hospital Clínico Universitario Juan Ramón Jiménez, Huelva, Spain
| | - Daniel Morell-Garcia
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Maria Àngels Ruiz
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Laboratory Medicine, Fundació Hospital de l'Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
| | - María Santamaría
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Department of Biochemistry, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - María José Torrejón
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,UGC of Clinical Analysis, Hospital Clínico San Carlos, Madrid, Spain
| | - Nuria Giménez
- Evidence Based Laboratory Medicine Commission, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain.,Committee of Evidence-Based Laboratory Medicine (C-EBLM), International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), Milano, Italy.,Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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11
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Teoh JYC, Hirai HW, Ho JMW, Chan FCH, Tsoi KKF, Ng CF. Global incidence of prostate cancer in developing and developed countries with changing age structures. PLoS One 2019; 14:e0221775. [PMID: 31647819 PMCID: PMC6812812 DOI: 10.1371/journal.pone.0221775] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/14/2019] [Indexed: 11/18/2022] Open
Abstract
To investigate the global incidence of prostate cancer with special attention to the changing age structures. Data regarding the cancer incidence and population statistics were retrieved from the International Agency for Research on Cancer in World Health Organization. Eight developing and developed jurisdictions in Asia and the Western countries were selected for global comparison. Time series were constructed based on the cancer incidence rates from 1988 to 2007. The incidence rate of the population aged ≥ 65 was adjusted by the increasing proportion of elderly population, and was defined as the “aging-adjusted incidence rate”. Cancer incidence and population were then projected to 2030. The aging-adjusted incidence rates of prostate cancer in Asia (Hong Kong, Japan and China) and the developing Western countries (Costa Rica and Croatia) had increased progressively with time. In the developed Western countries (the United States, the United Kingdom and Sweden), we observed initial increases in the aging-adjusted incidence rates of prostate cancer, which then gradually plateaued and even decreased with time. Projections showed that the aging-adjusted incidence rates of prostate cancer in Asia and the developing Western countries were expected to increase in much larger extents than the developed Western countries.
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Affiliation(s)
- Jeremy Y. C. Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hoyee W. Hirai
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jason M. W. Ho
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Felix C. H. Chan
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kelvin K. F. Tsoi
- Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- * E-mail: (CFN); (KKFT)
| | - Chi Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- * E-mail: (CFN); (KKFT)
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12
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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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13
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Araújo FAGDR, Sumita NM, Barroso UDO. A continuous fall of PSA use for prostate cancer screening among Brazilian doctors since 2001. Good or bad notice? Int Braz J Urol 2019; 45:478-485. [PMID: 31038862 PMCID: PMC6786128 DOI: 10.1590/s1677-5538.ibju.2018.0179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 01/08/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the trend of use of Prostate Specifi c Antigen (PSA) for screening of prostate cancer (PC) among Brazilian doctors, from the beginning of its regular availability in clinical laboratories. MATERIAL AND METHODS A serial cross-sectional study was performed using data obtained from a large database between 1997 and 2016. The general PSA screening trend during this period, adjusted for the total number of exams performed in men, was analyzed. Time-series analysis was performed through observation of the general regression curve using the generalized least squares method, and the impact of the recommendations was assessed with autoregressive integrated moving average (ARIMA) models. RESULTS During the period studied 2,521,383 PSA determinations were done. The age of the participants ranged from 21 to 111 years, with an average of 56.7 ± 22.7 years. The relative number of PSA tests/100.000 exams in males showed a constant reduction since 2001, and this trend was more evident in the group aged 55-69 years. Although statistically signifi cant, the impact of reduced PSA screening after the 2012 USPSTF publication was clinically irrelevant. CONCLUSIONS Our results indicated a continuous reduction in the use of PSA screening over time, regardless of the publication of recommendations or clinical guidelines. The fact that this trend was more pronounced among those with a greater benefi t potential (55-69 years), relative to groups with a greater damage potential due to overdiagnosis and overtreatment (aged >74 years and < 40 years), is a matter of concern. Follow-up studies of these trends are advisable.
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Affiliation(s)
| | | | - Ubirajara de Oliveira Barroso
- Departamento de Cirurgia Especial, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brasil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil
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14
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Impact of United States Preventive Services Task Force Recommendations on Utilization of Prostate-specific Antigen Screening in Medicare Beneficiaries. Am J Clin Oncol 2018; 41:1069-1075. [PMID: 29462124 DOI: 10.1097/coc.0000000000000431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous studies assessing the impact of United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of 2008 recommendations nor have they investigated the impact of 2012 recommendations in the Medicare population. This study aimed to evaluate change in utilization of PSA screening, post-2008 and 2012 USPSTF recommendations, and assessed trends and determinants of receipt of PSA screening in the Medicare population. METHODS This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey data and linked administrative claims from 2006 to 2013. Beneficiaries aged ≥65 years, with continuous enrollment in parts A and B for each year they were surveyed were included in the study. Beneficiaries with self-reported/claims-based diagnosis of prostate cancer were excluded. The primary outcome was receipt of PSA screening. Other measures included age groups (65 to 74 and ≥75), time periods (pre-2008/post-2008 and 2012 recommendations), and sociodemographic variables. RESULTS The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% in men aged ≥75 after 2008 recommendations and by 29% in men aged ≥65 after 2012 recommendations. CONCLUSIONS The 2008 and 2012 USPSTF recommendations against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services.
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15
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Bynum J, Passow H, Carmichael D, Skinner J. Exnovation of Low Value Care: A Decade of Prostate-Specific Antigen Screening Practices. J Am Geriatr Soc 2018; 67:29-36. [PMID: 30291742 DOI: 10.1111/jgs.15591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine prostate-specific antigen (PSA) screening practice change in subgroups of men defined in guidelines and in various regions and to identify factors associated with change in screening practices. DESIGN Observational study using serial cross-sections, 2003 to 2013. SETTING National fee-for-service Medicare. PARTICIPANTS Men aged 68 and older eligible for prostate cancer screening. MEASUREMENTS National PSA screening practices in men aged 68 and older from 2003 to 2013 and change in regional screening rates in men aged 75 and older. RESULTS The PSA screening rate in men aged 68 and older was 17.2% in 2003, 22.3% in 2008, and 18.6% in 2013 (p < .001 for all differences); rates ended slightly lower than rates in 2003 only in men 80 and older. Racial disparities in screening became less pronounced over this period. In men aged 75 and older, change in regional screening rates varied widely, with absolute rates growing by 15 per 100 enrollees in some areas and declining by the same amount in others. Areas with high social capital, a measure associated with diffusion of new ideas, were more likely to decline; malpractice intensity and managed care penetration had no effect. CONCLUSION Studying Medicare enrollees over time, we found little reduction in PSA screening and even increases according to race and in some regions. The heterogeneous changes across regions suggest that consistent reduction in the use of low-value care may require change strategies that go beyond evidence and guidelines to include monitoring and feedback on performance. J Am Geriatr Soc 67:29-36, 2019.
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Affiliation(s)
- Julie Bynum
- Department of Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan.,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Honor Passow
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Donald Carmichael
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Jonathan Skinner
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Economics, Dartmouth College, Hanover, New Hampshire.,National Bureau of Economic Research, Cambridge, Massachusetts
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16
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Filson CP. Moving toward a more rational, evidence-based approach to PSA screening, diagnosis, and treatment of prostate cancer. Cancer 2018; 124:2684-2686. [DOI: 10.1002/cncr.31332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/09/2018] [Indexed: 11/10/2022]
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17
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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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18
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Mahal BA, Chen YW, Muralidhar V, Mahal AR, Choueiri TK, Hoffman KE, Hu JC, Sweeney CJ, Yu JB, Feng FY, Kim SP, Beard CJ, Martin NE, Trinh QD, Nguyen PL. Racial disparities in prostate cancer outcome among prostate-specific antigen screening eligible populations in the United States. Ann Oncol 2018; 28:1098-1104. [PMID: 28453693 DOI: 10.1093/annonc/mdx041] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background In 2012, the United States Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA) screening, despite evidence that Black men are at a higher risk of prostate cancer-specific mortality (PCSM). We evaluated whether Black men of potentially screening-eligible age (55-69 years) are at a disproportionally high risk of poor outcomes. Patients and methods The SEER database was used to study 390 259 men diagnosed with prostate cancer in the United States between 2004 and 2011. Multivariable logistic regression modeled the association between Black race and stage of presentation, while Fine-Gray competing risks regression modeled the association between Black race and PCSM, both as a function of screening eligibility (age 55-69 years versus not). Results Black men were more likely to present with metastatic disease (adjusted odds ratio [AOR] 1.65; 1.58-1.72; P < 0.001) and were at a higher risk of PCSM (adjusted hazard ratio [AHR] 1.36; 1.27-1.46; P < 0.001) compared to non-Black men. There were significant interactions between race and PSA-screening eligibility such that Black patients experienced more disproportionate rates of metastatic disease (AOR 1.76; 1.65-1.87 versus 1.55; 1.47-1.65; Pinteraction < 0.001) and PCSM (AHR 1.53; 1.37-1.70 versus 1.25; 1.14-1.37; Pinteraction = 0.01) in the potentially PSA-screening eligible group than in the group not eligible for screening. Conclusions Racial disparities in prostate cancer outcome among Black men are significantly worse in PSA-screening eligible populations. These results raise the possibility that Black men could be disproportionately impacted by recommendations to end PSA screening in the United States and suggest that Black race should be included in the updated USPSTF PSA screening guidelines.
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Affiliation(s)
- B A Mahal
- Harvard Radiation Oncology Program, Boston, USA.,Harvard Medical School, Boston, USA
| | - Y-W Chen
- Harvard Medical School, Boston, USA.,Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA
| | - V Muralidhar
- Harvard Medical School, Boston, USA.,Deparment of Internal Medicine, Brigham and Women's Hospital, Boston, USA
| | - A R Mahal
- Department of Therapeutic Radiology/Radiation Oncology, Yale, New Haven, USA
| | - T K Choueiri
- Harvard Medical School, Boston, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA
| | - K E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J C Hu
- Department of Urology, Cornell (New York-Presbyterian Hospital), New York, USA
| | - C J Sweeney
- Harvard Medical School, Boston, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA
| | - J B Yu
- Department of Therapeutic Radiology/Radiation Oncology, Yale, New Haven, USA
| | - F Y Feng
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI, USA
| | - S P Kim
- Department of Urology, Case Western Reserve University School of Medicine (University Hospitals), Cleveland, USA
| | - C J Beard
- Harvard Medical School, Boston, USA.,Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA
| | - N E Martin
- Harvard Medical School, Boston, USA.,Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA
| | - Q-D Trinh
- Harvard Medical School, Boston, USA.,Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - P L Nguyen
- Harvard Medical School, Boston, USA.,Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, USA
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Abstract
During the prostate-specific antigen-based prostate cancer (PCa) screening era there has been a 53% decrease in the US PCa mortality rate. Concerns about overdiagnosis and overtreatment combined with misinterpretation of clinical trial data led to a recommendation against PCa screening, resulting in a subsequent reversion to more high-risk disease at diagnosis. Re-evaluation of trial data and increasing acceptance of active surveillance led to a new draft recommendation for shared decision making for men aged 55 to 69 years old. Further consideration is needed for more intensive screening in men with high-risk factors. PCa screening significantly reduces PCa morbidity and mortality.
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Affiliation(s)
- William J Catalona
- Department of Urology, Northwestern University Feinberg School of Medicine, 675 North Saint Clair Street, Suite 20-150, Chicago, IL 63110, USA.
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20
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Evaluation and Treatment for Older Men with Elevated PSA. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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21
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Secular Trends in Prostate Biopsy Criteria and Outcomes: The Dartmouth Experience. Urology 2017; 107:178-183. [PMID: 28595934 DOI: 10.1016/j.urology.2017.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/12/2017] [Accepted: 04/17/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate trends in prostate biopsy and cancer diagnosis at a center with conservative screening practices in the pre- and post-2012 era. More restrictive prostate-specific antigen (PSA) screening guidelines have led to lower rates of screening, biopsy, and diagnosis of prostate cancer. It is not clear, however, how regions with low baseline screening rates (the Lebanon, New Hampshire hospital referral region centered on Dartmouth-Hitchcock Medical Center had the lowest rate of screening among Medicare patients in 2012) have responded to these guidelines. METHODS We retrospectively analyzed patients who underwent prostate biopsy from January 2011 to March 2016. Demographic and clinical characteristics were analyzed by time. Multivariable analysis assessed for factors associated with higher grade cancer. RESULTS There were 614 prostate biopsies were performed. PSA at biopsy increased with time (7.2 in 2011 vs 10.1 in 2015, P = .0085); age did not. There was a stable proportion of benign findings; proportions of low-grade disease decreased, whereas intermediate- and high-grade disease increased (2011 vs 2015: 21.1% vs 10.8% Gleason 3 + 3, 32.9% vs 43.3% ≥ Gleason 3 + 4, P = .0454). Factors predictive of higher grade disease included abnormal digital examination (odds ratio [OR] 2.19, P = .0076), higher PSA (OR 1.09, P = .0040), and later biopsy date (OR 1.01, P = .0469). CONCLUSION In an environment of conservative baseline screening practices, there has been a shift in prostate biopsy criteria and outcomes, namely a rising PSA threshold for biopsy and a 50% decrease in the diagnosis of low-grade disease. Additional study is needed to ensure these trends are favorably impacting the quality of care.
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22
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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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23
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Zhang K, Bangma CH, Roobol MJ. Prostate cancer screening in Europe and Asia. Asian J Urol 2017; 4:86-95. [PMID: 29264211 PMCID: PMC5717985 DOI: 10.1016/j.ajur.2016.08.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the second most common cancer among men worldwide and even ranks first in Europe. Although Asia is known as the region with the lowest PCa incidence, it has been rising rapidly over the last 20 years mostly due to the introduction of prostate-specific antigen (PSA) testing. Randomized PCa screening studies in Europe show a mortality reduction in favor of PSA-based screening but coincide with high proportions of unnecessary biopsies, overdiagnosis and subsequent overtreatment. Conclusive data on the value of PSA-based screening and hence the balance between harms and benefits in Asia is still lacking. Because of known racial variations, Asian countries should not directly apply the European screening models. Like in the western world also in Asia, new predictive markers, tools and risk stratification strategies hold great potential to improve the early detection of PCa and to reduce the worldwide existing negative aspects of PSA-based PCa screening.
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Affiliation(s)
| | | | - Monique J. Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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24
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Jackson-Spence F, Gillott H, Tahir S, Nath J, Mytton J, Evison F, Sharif A. Cancer-related outcomes in kidney allograft recipients in England versus New York State: a comparative population-cohort analysis between 2003 and 2013. Cancer Med 2017; 6:563-571. [PMID: 28135042 PMCID: PMC5345656 DOI: 10.1002/cam4.1015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/08/2016] [Accepted: 12/13/2016] [Indexed: 11/15/2022] Open
Abstract
It is unclear whether cancer‐related epidemiology after kidney transplantation is translatable between countries. In this population‐cohort study, we compared cancer incidence and all‐cause mortality after extracting data for every kidney‐alone transplant procedure performed in England and New York State (NYS) between 2003 and 2013. Data were analyzed for 18,493 and 11,602 adult recipients from England and NYS respectively, with median follow up 6.3 years and 5.5 years respectively (up to December 2014). English patients were more likely to have previous cancer at time of transplantation compared to NYS patients (5.6% vs. 3.5%, P < 0.001). Kidney allograft recipients in England versus NYS had increased cancer incidence (12.3% vs. 5.9%, P < 0.001) but lower all‐cause mortality during the immediate postoperative stay (0.7% vs. 1.0%, P = 0.011), after 30‐days (0.9% vs. 1.8%, P < 0.001) and after 1‐year post‐transplantation (3.0% vs. 5.1%, P < 0.001). However, mortality rates among patients developing post‐transplant cancer were equivalent between the two countries. During the first year of follow up, if patients had an admission with a cancer diagnosis, they were more likely to die in both England (Odds Ratio 4.28 [95% CI: 3.09–5.93], P < 0.001) and NYS (Odds Ratio 2.88 [95% CI: 1.70–4.89], P < 0.001). Kidney allograft recipients in NYS demonstrated higher hazard ratios for developing kidney transplant rejection/failure compared to England on Cox regression analysis. Our analysis demonstrates significant differences in cancer‐related epidemiology between kidney allograft recipients in England versus NYS, suggesting caution in translating post‐transplant cancer epidemiology between countries.
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Affiliation(s)
| | - Holly Gillott
- University of Birmingham, Birmingham, United Kingdom
| | - Sanna Tahir
- University of Birmingham, Birmingham, United Kingdom
| | - Jay Nath
- University of Birmingham, Birmingham, United Kingdom.,Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Jemma Mytton
- Department of Health Informatics, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Adnan Sharif
- University of Birmingham, Birmingham, United Kingdom.,Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
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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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26
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Abascal Junquera JM, Fumadó Ciutat L, Francés Comalat A, Cecchini Rosell L. Análisis de las recomendaciones en contra del cribado con antígeno prostático específico en cáncer de próstata. Med Clin (Barc) 2016; 147:361-365. [DOI: 10.1016/j.medcli.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 11/16/2022]
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27
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Crawford ED, Rosenberg MT, Partin AW, Cooperberg MR, Maccini M, Loeb S, Pettaway CA, Shore ND, Arangua P, Hoenemeyer J, Leveridge M, Leapman M, Pinto P, Thompson IM, Carroll P, Eastham J, Gomella L, Klein EA. An Approach Using PSA Levels of 1.5 ng/mL as the Cutoff for Prostate Cancer Screening in Primary Care. Urology 2016; 96:116-120. [PMID: 27450937 DOI: 10.1016/j.urology.2016.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Alan W Partin
- Department of Pathology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | | | - Stacy Loeb
- Department of Urology and Population Health, New York University, New York, NY
| | - Curtis A Pettaway
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Neal D Shore
- Atlantic Urology Clinics, Carolina Urologic Research Center, Myrtle Beach, SC
| | - Paul Arangua
- University of Colorado Health Science Center, Aurora, CO
| | | | - Mike Leveridge
- Department of Urology, Department of Oncology, Kingston General Hospital, Queen's University, Kingston, ON
| | - Michael Leapman
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Peter Pinto
- National Cancer Institute, Center for Cancer Research, Bethesda, MD
| | - Ian M Thompson
- Department of Urology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Peter Carroll
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - James Eastham
- Department of Urology, Memorial Sloan Kettering Cancer Institute, New York, NY
| | - Leonard Gomella
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Eric A Klein
- Cleveland Clinic, Glickman Urological & Kidney Institute, Cleveland, OH
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28
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Gershman B, Van Houten HK, Herrin J, Moreira DM, Kim SP, Shah ND, Karnes RJ. Impact of Prostate-specific Antigen (PSA) Screening Trials and Revised PSA Screening Guidelines on Rates of Prostate Biopsy and Postbiopsy Complications. Eur Urol 2016; 71:55-65. [PMID: 26995328 DOI: 10.1016/j.eururo.2016.03.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prostate biopsy and postbiopsy complications represent important risks of prostate-specific antigen (PSA) screening. Although landmark randomized trials and updated guidelines have challenged routine PSA screening, it is unclear whether these publications have affected rates of biopsy or postbiopsy complications. OBJECTIVE To evaluate whether publication of the 2008 and 2012 US Preventive Services Task Force (USPSTF) recommendations, the 2009 European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or the 2013 American Urological Association (AUA) guidelines was associated with changes in rates of biopsy or postbiopsy complications, and to identify predictors of postbiopsy complications. DESIGN, SETTING, AND PARTICIPANTS This quasiexperimental study used administrative claims of 5279315 commercially insured US men aged ≥40 yr from 2005 to 2014, of whom 104584 underwent biopsy. INTERVENTIONS Publications on PSA screening. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Interrupted time-series analysis was used to evaluate the association of publications with rates of biopsy and 30-d complications. Logistic regression was performed to identify predictors of complications. RESULTS AND LIMITATIONS From 2005 to 2014, biopsy rates fell 33% from 64.1 to 42.8 per 100000 person-months, with immediate reductions following the 2008 USPSTF recommendations (-10.1; 95% confidence interval [CI], -17.1 to -3.0; p<0.001), 2012 USPSTF recommendations (-13.8; 95% CI, -21.0 to -6.7; p<0 .001), and 2013 AUA guidelines (-8.8; 95% CI, -16.7 to -0.92; p=0.03). Concurrently, complication rates decreased 10% from 8.7 to 7.8 per 100000 person-months, with a reduction following the 2012 USPSTF recommendations (-2.5; 95% CI, -4.5 to -0.45; p=0.02). However, the proportion of men undergoing biopsy who experienced complications increased from 14% to 18%, driven by nonsepsis infectious complications (p<0.001). Predictors of complications included prior fluoroquinolone use (odds ratio [OR]: 1.27; 95% CI, 1.22-1.32; p<0.001), anticoagulant use (OR: 1.14; 95% CI, 1.04-1.25; p=0.004), and age ≥70 yr (OR: 1.25; 95% CI, 1.15-1.36; p<0.001). Limitations included the retrospective design. CONCLUSIONS Although there has been an absolute reduction in rates of biopsy and 30-d complications, the relative morbidity of biopsy continues to increase. These observations suggest a need to reduce the morbidity of biopsy. PATIENT SUMMARY Absolute rates of biopsy and postbiopsy complications have decreased following landmark publications about prostate-specific antigen screening; however, the relative morbidity of biopsy continues to increase.
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Affiliation(s)
| | - Holly K Van Houten
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Jeph Herrin
- Division of Cardiology, Yale University School of Medicine, New Haven, CT, USA; Health Research and Educational Trust, Chicago, IL, USA
| | | | - Simon P Kim
- Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH, USA
| | - Nilay D Shah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; OptumLabs, Cambridge, MA, USA
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Hoffman RM, Meisner ALW, Arap W, Barry M, Shah SK, Zeliadt SB, Wiggins CL. Trends in United States Prostate Cancer Incidence Rates by Age and Stage, 1995-2012. Cancer Epidemiol Biomarkers Prev 2015; 25:259-63. [PMID: 26646364 DOI: 10.1158/1055-9965.epi-15-0723] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 12/02/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The advent of PSA testing in the late 1980s substantially increased prostate cancer incidence rates. Concerns about overscreening and overdiagnosis subsequently led professional guidelines (circa 2000 and later) to recommend against routine PSA testing. We evaluated trends in prostate cancer incidence, including late-stage diagnoses, from 1995 through 2012. METHODS We used joinpoint regression analyses to evaluate all-, localized/regional-, and distant-stage prostate cancer incidence trends based on Surveillance, Epidemiology, and End Results (SEER) data. We stratified analyses by age (50-69, 70+). We reported incidence trends as annual percent change (APC). RESULTS Overall age-adjusted incidence rates for localized/regional stage prostate cancer have been declining since 2001, sharply from 2010 to 2012 [APC, -13.1; 95% confidence intervals (CI), -23.5 to -1.3]. Distant-stage incidence rates have declined since 1995, with greater declines from 1995 to 1997 (APC, -8.4; 95% CI, -2.3 to -14.1) than from 2003 to 2012 (APC, -1.0; 95% CI, -1.7 to -0.4). Distant-stage incidence rates declined for men ages 70+ from 1995 to 2012, but increased in men ages 50 to 69 years from 2004 to 2012 (APC, 1.7; 95% CI, 0.2 to 3.2). CONCLUSIONS Guidelines discouraging routine prostate cancer screening were temporally associated with declining localized/regional prostate cancer incidence rates; however, incidence rates of distant-stage disease are now increasing in younger men. IMPACT This trend may adversely affect prostate cancer mortality rates.
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Affiliation(s)
- Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.
| | - Angela L W Meisner
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Wadih Arap
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Marc Barry
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Satyan K Shah
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | | | - Charles L Wiggins
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico. Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
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30
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Rosenberg MT, Spring AC, David Crawford E. Prostate cancer and the PCP: the screening dilemma. Int J Clin Pract 2015; 69:1438-47. [PMID: 26459772 DOI: 10.1111/ijcp.12745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - A C Spring
- Mid Michigan Health Centers, Jackson, MI, USA
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31
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Drazer MW, Huo D, Eggener SE. National Prostate Cancer Screening Rates After the 2012 US Preventive Services Task Force Recommendation Discouraging Prostate-Specific Antigen–Based Screening. J Clin Oncol 2015; 33:2416-23. [DOI: 10.1200/jco.2015.61.6532] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In 2012, the US Preventive Services Task Force (USPSTF) discouraged prostate-specific antigen (PSA) –based prostate cancer screening. Previous USPSTF recommendations did not appreciably alter prostate cancer screening. Therefore, we designed a trend analysis to determine the population-based impact of the 2012 recommendation. Methods The nationally representative National Health Interview Survey was used to estimate the proportion of men age 40 years and older who saw a physician and were screened for prostate cancer in 2013. An externally validated 9-year mortality index was used to analyze screening rates based on remaining life expectancy. Screening rates from 2005, 2010, and 2013 were compared using logistic regression. Results PSA-based screening did not significantly change from 2010 to 2013 among 40- to 49-year-old men (from 12.5% to 11.2%; P = .4). Screening rates significantly declined in men age 50 to 59 years (from 33.2% to 24.8%; P < .01), age 60 to 74 years (from 51.2% to 43.6%; P < .01), and age 75 years or older (from 43.9% to 37.1%; P = .03). A large percentage of men were screened for prostate cancer despite a high risk (> 52%) of 9-year mortality, including approximately one third of men older than age 75 years. Approximately 1.4 million men age 65 years or older with a high risk (> 52%) of 9-year mortality were screened in 2013. Conclusion Prostate cancer screening significantly declined among men older than age 50 years after the 2012 USPSTF guideline discouraging PSA-based screening. A significant proportion of men continue to be screened despite a high risk of 9-year mortality, including one third of men age 75 years and older.
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Affiliation(s)
| | - Dezheng Huo
- All authors: University of Chicago Medical Center, Chicago, IL
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32
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Barocas DA, Mallin K, Graves AJ, Penson DF, Palis B, Winchester DP, Chang SS. Effect of the USPSTF Grade D Recommendation against Screening for Prostate Cancer on Incident Prostate Cancer Diagnoses in the United States. J Urol 2015; 194:1587-93. [PMID: 26087383 DOI: 10.1016/j.juro.2015.06.075] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE In October 2011 the USPSTF (U.S. Preventive Services Task Force) issued a draft guideline discouraging prostate specific antigen based screening for prostate cancer (grade D recommendation). We evaluated the effect of the USPSTF guideline on the number and distribution of new prostate cancer diagnoses in the United States. MATERIALS AND METHODS We identified incident cancers diagnosed between January 2010 and December 2012 in NCDB (National Cancer Database). We performed an interrupted time series to evaluate the trend of new prostate cancers diagnosed each month before and after the draft guideline with colon cancer as a comparator. RESULTS Incident monthly prostate cancer diagnoses decreased by -1,363 cases (12.2%, p<0.01) in the month after the USPSTF draft guideline and continued to decrease by 164 cases per month relative to baseline (-1.8%, p<0.01). In contrast monthly colon cancer diagnoses remained stable. Diagnoses of low, intermediate and high risk prostate cancers decreased significantly but new diagnoses of nonlocalized disease did not change. Subgroups of age, comorbidity, race, income and insurance showed comparable decreases in incident prostate cancer following the draft guideline. CONCLUSIONS There was a 28% decrease in incident diagnoses of prostate cancer in the year after the USPSTF draft recommendation against prostate specific antigen screening. This study helps quantify the potential benefits (reduced harms of over diagnosis and overtreatment of low risk disease and disease found in elderly men) and potential harms (missed opportunities to diagnose important cancers in men who may benefit from treatment) of this guideline.
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Affiliation(s)
- Daniel A Barocas
- Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Katherine Mallin
- National Cancer Data Base, American College of Surgeons, Chicago, Illinois
| | - Amy J Graves
- Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan Palis
- National Cancer Data Base, American College of Surgeons, Chicago, Illinois
| | - David P Winchester
- National Cancer Data Base, American College of Surgeons, Chicago, Illinois
| | - Sam S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Bhindi B, Mamdani M, Kulkarni GS, Finelli A, Hamilton RJ, Trachtenberg J, Zlotta AR, Evans A, van der Kwast TH, Toi A, Fleshner NE. Impact of the U.S. Preventive Services Task Force Recommendations against Prostate Specific Antigen Screening on Prostate Biopsy and Cancer Detection Rates. J Urol 2015; 193:1519-24. [DOI: 10.1016/j.juro.2014.11.096] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Bimal Bhindi
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Applied Health Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Girish S. Kulkarni
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John Trachtenberg
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre R. Zlotta
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Evans
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Ants Toi
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Neil E. Fleshner
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Eisinger F, Morère JF, Touboul C, Pivot X, Coscas Y, Blay JY, Lhomel C, Viguier J. Prostate cancer screening: contrasting trends. Cancer Causes Control 2015; 26:949-52. [DOI: 10.1007/s10552-015-0573-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 03/24/2015] [Indexed: 04/11/2023]
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35
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Feletto E, Bang A, Cole-Clark D, Chalasani V, Rasiah K, Smith DP. An examination of prostate cancer trends in Australia, England, Canada and USA: Is the Australian death rate too high? World J Urol 2015; 33:1677-87. [PMID: 25698456 PMCID: PMC4617845 DOI: 10.1007/s00345-015-1514-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/23/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To compare prostate cancer incidence and mortality rates in Australia, USA, Canada and England and quantify the gap between observed prostate cancer deaths in Australia and expected deaths, using US mortality rates. METHODS Analysis of age-standardised prostate cancer incidence and mortality rates, using routinely available data, in four similarly developed countries and joinpoint regression to quantify the changing rates (annual percentage change: APC) and test statistical significance. Expected prostate cancer deaths, using US mortality rates, were calculated and compared with observed deaths in Australia (1994-2010). RESULTS In all four countries, incidence rates initially peaked between 1992 and 1994, but a second, higher peak occurred in Australia in 2009 (188.9/100,000), rising at a rate of 5.8 % (1998-2008). Mortality rates in the USA (APC: -2.9 %; 2004-2010), Canada (APC: -2.9 %; 2006-2011) and England (APC: -2.6 %; 2003-2008) decreased at a faster rate compared with Australia (APC: -1.7 %; 1997-2011). In 2010, mortality rates were highest in England and Australia (23.8/100,000 in both countries). The mortality gap between Australia and USA grew from 1994 to 2010, with a total of 10,895 excess prostate cancer deaths in Australia compared with US rates over 17 preceding years. CONCLUSIONS Prostate cancer incidence rates are likely heavily influenced by prostate-specific antigen testing, but the fall in mortality occurred too soon to be solely a result of testing. Greater emphasis should be placed on addressing system-wide differences in the management of prostate cancer to reduce the number of men dying from this disease.
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Affiliation(s)
- E Feletto
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
| | - A Bang
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.
| | - D Cole-Clark
- Department of Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - V Chalasani
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Discipline of Surgery, University of Sydney, Camperdown, NSW, Australia. .,Northern Sydney Local Health District, St Leonards, NSW, Australia.
| | - K Rasiah
- Northern Sydney Local Health District, St Leonards, NSW, Australia. .,Kinghorn Cancer Centre, Garvan Institute of Medical Research, St Leonards, NSW, Australia.
| | - D P Smith
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia. .,Griffith Health Institute, Griffith University, Nathan, QLD, Australia.
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Ranasinghe WKB, Kim SP, Papa NP, Sengupta S, Frydenberg M, Bolton D, Pond D, Ried K, Marshall MJ, Persad R, Lawrentschuk N. Prostate cancer screening in Primary Health Care: the current state of affairs. SPRINGERPLUS 2015; 4:78. [PMID: 25713765 PMCID: PMC4332913 DOI: 10.1186/s40064-015-0819-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022]
Abstract
This study aims to examine the current practice of General practitioners (GPs)/primary care physicians in opportunistic screening for prostate cancer (PC) by digital rectal examination(DRE) and Prostate Specific Antigen(PSA) testing and identify any difference in screening practice. Printed copies and/or electronic versions of a survey was distributed amongst 438 GPs throughout Australia in 2012. Statistical analyses (Wilcoxon rank-sum test, Fisher's exact test or Pearson chi-square test)were performed by outcomes and GP characteristics.There were a total of 149 responses received (34%), with similar gender distribution in rural and metropolitan settings. 74% GPs believed PSA testing was at least 'somewhat effective' in reducing PC mortality with annual PSA screening being conducted by more GPs in the metropolitan setting compared to the rural GPs (35% vs 18.4%), while 25% of rural GPs would not advocate routine PSA screening. When examining the concordance between DRE and PSA testing by gender of GP, the male GPs reported performing PSA testing more frequently than DRE in patients between ages 40 to 69 (p = 0.011). Urology Society guidelines (77.2%) and College of GPs (73.2%) recommendations for PC screening were thought to be at least 'somewhat useful'. Although reference ranges for PSA tests were felt to be useful, the majority (65.8%) found it easier to refer to an urologist due to the disagreements in guidelines. In conclusion, the current guidelines for PSA screening appear to cause more confusion due to their conflicting advice, leaving GPs to formulate their own practice methods, calling for an urgent need for uniform collaborative guidelines.
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Affiliation(s)
- Weranja KB Ranasinghe
- />Department of Urology, Monash Medical Centre, 823-865 Centre Road, Bentleigh, 3165 Victoria Australia
| | - Simon P Kim
- />Yale University; Department of Urology; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut USA
- />University Hospital Case Medical Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, Ohio USA
| | - Nathan P Papa
- />Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Shomik Sengupta
- />Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Mark Frydenberg
- />Department of Urology, Monash Medical Centre, 823-865 Centre Road, Bentleigh, 3165 Victoria Australia
- />Department of Surgery, Monash University, Melbourne, Australia
| | - Damien Bolton
- />Department of Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Dimity Pond
- />University of Newcastle, Newcastle, Australia
| | - Karin Ried
- />National Institute of Integrative Medicine, Melbourne, Australia
| | - Melanie J Marshall
- />University of New South Wales, NSW (on behalf of PHReNet-GP, a Practice Based Research Network, University of New South Wales), Paddington, Australia
| | - Raj Persad
- />University Hospitals Bristol NHS Trust, Bristol, UK
| | - Nathan Lawrentschuk
- />University of Melbourne, Dept of Surgery, Olivia Newton-John Cancer Research Institute, Austin Hospital and Peter MacCallum Cancer Centre, Dept of Surgical Oncology, Melbourne, Australia
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37
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Marcus JL, Chao CR, Leyden WA, Xu L, Klein DB, Horberg MA, Towner WJ, Quesenberry CP, Abrams DI, Van Den Eeden SK, Silverberg MJ. Prostate cancer incidence and prostate-specific antigen testing among HIV-positive and HIV-negative men. J Acquir Immune Defic Syndr 2014; 66:495-502. [PMID: 24820107 DOI: 10.1097/qai.0000000000000202] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We investigated whether the reported lower incidence of prostate cancer in HIV-positive men is a result of confounding factors or reduced screening. METHODS We conducted a cohort study of 17,424 HIV-positive and 182,799 HIV-negative men enrolled in Kaiser Permanente (KP). Subjects were followed from the first KP enrollment after January 01, 1996 for KP Northern California (KPNC) and January 01, 2000 for KP Southern California until the earliest of prostate cancer diagnosis, loss to follow-up, or December 31, 2007. Poisson regression was used to compare cancer rates by HIV status adjusting for age, race, smoking, alcohol/drug abuse, overweight/obesity, and diabetes. For the KPNC subset, we analyzed additional available data by HIV status on testosterone deficiency, and on prostate-specific antigen (PSA) tests as a proxy for cancer screening. RESULTS The prostate cancer incidence rate was 102/100,000 person-years in HIV-positive men (n = 74 cases) and 131/100,000 person-years in HIV-negative men (n = 1195 cases), with an adjusted rate ratio of 0.73 (95% confidence interval: 0.57 to 0.92; P = 0.008). The reduced risk among HIV-positive men was greater for higher-stage cancers, which are less likely to be biased by screening differences than lower-stage cancers. In the KPNC subset, more HIV-positive (90.8%) than HIV-negative men (86.2%) received a PSA test by age 55 (P < 0.001). Decreased risk for HIV-positive men remained when examined only among those with a previous PSA test, and with adjustment for testosterone deficiency (rate ratio = 0.55; 95% confidence interval: 0.39 to 0.80; P = 0.001). CONCLUSIONS Prostate cancer incidence rates are lower in HIV-positive compared with HIV-negative men, which is not explained by screening differences or the risk factors evaluated.
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Affiliation(s)
- Julia L Marcus
- *Division of Research, Kaiser Permanente Northern California, Oakland, CA; †Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA; ‡Department of Infectious Diseases, Kaiser Permanente, San Leandro Medical Center, San Leandro, CA; §Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD; ‖Department of Internal Medicine, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, CA; ¶Department of Hematology-Oncology, San Francisco General Hospital, University of California San Francisco, San Francisco, CA
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Gunawardena V, Aragon-Ching JB. Effects of USPSTF guidelines on patterns of screening and treatment outcomes for prostate cancer. World J Transl Med 2014; 3:112-118. [DOI: 10.5528/wjtm.v3.i2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/24/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
The updated United States Preventive Services Task Force (USPSTF) for prostate cancer in 2012 recommends against prostate-specific antigen (PSA) based screening for men of all ages. Prostate cancer is the second most common and second most deadly cancer in American men. PSA screening for prostate cancer has been present since 1994 leading to an over diagnosis and over treatment of low volume disease. There is an overall agreement of men towards the guidelines but even with the understanding of the USPSTF, these men tend to follow more personal beliefs that have been influenced by their knowledge of the disease process and physician influence. Physicians also followed the directions of the patients and opted not to change their current practice of PSA screening despite the new guidelines. Time, legal, and ethical issues were some of the barriers that physicians faced in tailoring their practice towards screening. The importance of informed consent is highlighted by both the patients and the physicians and clearly more effective when the patient was pre-informed of the disease process and prompted the physicians to initiate conversation of informed screening. Younger patients were inclined towards aggressive treatment and older patients opted towards watchful waiting both with emphasis on the importance of evidence-based information provided by the physician. Decision aids were useful in making informed decisions and could be used to educate patients on screening purposes and treatment options. However, even with well-created decision aids and physician influence, patients’ own belief system played a major part in healthcare decision making in either screening or treatment for prostate cancer.
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Auffenberg GB, Meeks JJ. Application of the 2013 American Urological Association early detection of prostate cancer guideline: who will we miss? World J Urol 2014; 32:959-64. [PMID: 24946729 DOI: 10.1007/s00345-014-1341-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/04/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The American Urological Association (AUA) published new prostate cancer (CaP) screening guidelines in 2013. We apply the guidelines to a retrospective cohort to compare tumor characteristics of those no longer recommended for screening with those who remain screening candidates. METHODS We identified cases of screening detected CaP (stage cT1c) in the Surveillance Epidemiology and End Results database from October 2005 to December 2010. The 2013 AUA Guidelines were retrospectively applied to the cohort. Men were categorized into three groups for comparison based on whether or not they would now be recommended for CaP screening (Unscreened, Young Unscreened, and Screened). We compared clinical and pathological characteristics of CaP across study groups. RESULTS A total of 142,382 men were identified. Screening would no longer be recommended for 40,160. Those no longer recommended for screening had higher median PSA (6.4 vs. 5.8 ng/mL, p < 0.01), more Gleason 7 and ≥8 CaP on prostate biopsy (36.4 vs. 34.8 %, p < 0.001; 12.4 vs. 9.2 %, p < 0.001, respectively) and slightly more Gleason ≥8 CaP (9.0 vs. 7.5 %, p = 0.03), and T3 tumors (17.3 vs. 16.5 %, p = 0.01) at prostatectomy. Nodal and distant metastasis rates were clinically equivalent among men screened and unscreened. Subgroup analysis of young patients (40-54 years old) no longer recommended for screening identified intermediate or high-risk Gleason scores at prostatectomy 57.6 % of the time. CONCLUSIONS Features of CaP in men no longer recommended for routine screening are largely equivalent to if not worse than those in screened men.
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Affiliation(s)
- Gregory B Auffenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave., Tarry 16-703, Chicago, IL, 60611, USA
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Maurice MJ, Abouassaly R. Patient opinions on prostate cancer screening are swayed by the United States Preventative Services Task Force recommendations. Urology 2014; 84:295-9. [PMID: 24929945 DOI: 10.1016/j.urology.2014.04.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/09/2014] [Accepted: 04/15/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To survey patient opinions on prostate cancer (PCa) screening in light of the United States Preventive Services Task Force recommendation against its use. METHODS We conducted a survey of all-comers to urology and primary care clinics. Participants provided demographic information and responded to a 5-item questionnaire regarding their opinions on screening before and after reading opposing position statements. RESULTS The overall response rate was 48%. After excluding incomplete questionnaires, 54 surveys were available for analysis. Patients were predominantly white, middle-aged and older, college-educated men with middle-to-upper-middle-class incomes who were seen at urology clinics. Patients rated their "pre" level of understanding of screening recommendations as good or very good (52%), okay (30%), and poor (19%). After reading the information sheets, good or very good understanding of screening recommendations improved (65%; P = .05), and agreement with the importance of screening remained high (80%). However, nearly 20% of patients expressed a more neutral or less favorable attitude toward the risk-benefit ratio of screening (P = .09). Agreement that men should undergo screening, that screening helps detect cancer, and that screening saves lives remained high, regardless of the exposure. CONCLUSION Overall, patients favor PCa screening, but heightened awareness of the current controversy raises concerns about its potential harms. PCa screening is a complex issue, and insight into changing public opinion will be crucial to our future discussions with patients who are wrestling with the decision whether to undergo screening.
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Affiliation(s)
- Matthew J Maurice
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Robert Abouassaly
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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