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Parker LA, Caballero-Romeu JP, Chilet-Rosell E, Hernandez-Aguado I, Gómez-Pérez L, Alonso-Coello P, Cebrián A, López-Garrigós M, Moral-Pélaez I, Ronda E, Gilabert M, Canelo-Aybar C, Párraga-Martínez I, del Campo-Giménez M, Lumbreras B. Knowledge and practices regarding prostate cancer screening in Spanish men: The importance of personal and clinical characteristics (PROSHADE study). PLoS One 2024; 19:e0303203. [PMID: 38814917 PMCID: PMC11139292 DOI: 10.1371/journal.pone.0303203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Patients' decisions on prostate cancer (PCa) opportunistic screening may vary. This study aimed to assess how demographic and health-related characteristics may influence knowledge and decisions regarding PCa screening. METHODS A cross-sectional survey was conducted among men aged over 40, randomly sampled from the Spanish population, 2022. The survey underwent development and content validation using a modified Delphi method and was administered via telephone. Binomial logistic regression was used to explore the relationship between respondents' characteristics and participants' knowledge and practices concerning PCa and the PSA test. RESULTS Out of 1,334 men, 1,067 (80%) respondents were interviewed with a mean age of 58.6 years (sd 11.9). Most had secondary or university studies (787, 73.8%) and 61 (5.7%) self-reported their health status as bad or very bad. Most of the respondents (1,018, 95.4%) had knowledge regarding PCa with nearly 70% expressed significant concern about its potential development (720, 70.8%), particularly among those under 64 years (p = 0.001). Out of 847 respondents, 573 (67.7%) reported that they have knowledge regarding the PSA test: 374 (65.4%) reported receiving information from a clinicians, 324 (86.6%) information about the benefits of the test and 189 (49,5%) about its risks, with differences based on educational background. In a multivariable analysis (adjusted for age, educational level and previous prostate problems), respondents with higher levels of education were more likely to have higher knowledge regarding the PSA test (OR 1.75, 95%CI 1.24-2.50, p<0.001). CONCLUSIONS Although most of the patients reported to have knowledge regarding PCa, half of the interviewed men reported knowledge about PSA test. Differences in knowledge prostate cancer screening and undesirable consequences highlight the need to develop and provide tailored information for patients.
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Affiliation(s)
- Lucy A. Parker
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Juan-Pablo Caballero-Romeu
- Department of Urology, Dr. Balmis General University Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Elisa Chilet-Rosell
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Ildefonso Hernandez-Aguado
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Luis Gómez-Pérez
- Department of Urology, University General Hospital of Elche, Elche, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Re-search Institute Sant Pau, Barcelona, Spain
| | - Ana Cebrián
- Cartagena Casco Healthcare Centre, Cartagena, Spain
| | - Maite López-Garrigós
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Spain
| | | | - Elena Ronda
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Public Health Research group, Alicante University, San Vicente del Raspeig, Spain
| | - Mercedes Gilabert
- Department of Health Psychology, Miguel Hernandez University, Elche, Spain
| | - Carlos Canelo-Aybar
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Re-search Institute Sant Pau, Barcelona, Spain
| | | | - Mª del Campo-Giménez
- Integrated Care Management of Albacete. Health Service of Castilla-La Mancha, Spain
| | - Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, San Juan de Alicante, Spain
- CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
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Yu XQ, Weber M, Smith D, Velentzis L, Kliewer EV, David M, Feletto E. Incidence profile of four major cancers among migrants in Australia, 2005-2014. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04764-5. [PMID: 37072554 PMCID: PMC10374701 DOI: 10.1007/s00432-023-04764-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To compare the incidence profile of four major cancers in Australia by place of birth. METHODS In this retrospective population-based cohort study, the analysis included 548,851 residents diagnosed with primary colorectum, lung, female breast, or prostate cancer during 2005-2014. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were calculated for migrant groups relative to Australian-born. RESULTS Compared with Australian-born residents, most migrant groups had significantly lower incidence rates for cancers of the colorectum, breast and prostate. The lowest rates of colorectal cancer were among males born in Central America (IRR = 0.46, 95% CI 0.29-0.74) and females born in Central Asia (IRR = 0.38, 95% CI 0.23-0.64). Males born in North-East Asia had the lowest rates of prostate cancer (IRR = 0.40, 95% CI 0.38-0.43) and females born in Central Asia had the lowest rates of breast cancer (IRR = 0.55, 95% CI 0.43-0.70). For lung cancer, several migrant groups had higher rates than Australian-born residents, with the highest rates among those from Melanesia (males IRR = 1.39, 95% CI 1.10-1.76; females IRR = 1.40, 95% CI 1.10-1.78). CONCLUSIONS This study describes cancer patterns among Australian migrants, which are potentially helpful in understanding the etiology of these cancers and guiding the implementation of culturally sensitive and safe prevention measures. The lower incidence rates observed for most migrant groups may be maintained with continued emphasis on supporting communities to minimize modifiable risk factors such as smoking and alcohol consumption and participation in organized cancer screening programmes. Additionally, culturally sensitive tobacco control measures should be targeted to migrant communities with high lung cancer incidence rates.
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Affiliation(s)
- Xue Qin Yu
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Kings Cross, PO Box 572, Sydney, NSW, 1340, Australia.
| | - Marianne Weber
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Kings Cross, PO Box 572, Sydney, NSW, 1340, Australia
| | - David Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Kings Cross, PO Box 572, Sydney, NSW, 1340, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Louiza Velentzis
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Kings Cross, PO Box 572, Sydney, NSW, 1340, Australia
| | | | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Kings Cross, PO Box 572, Sydney, NSW, 1340, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Eleonora Feletto
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Kings Cross, PO Box 572, Sydney, NSW, 1340, Australia
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Kohar A, Cramb SM, Pickles K, Smith DP, Baade PD. Changes in prostate specific antigen (PSA) "screening" patterns by geographic region and socio-economic status in Australia: Analysis of medicare data in 50-69 year old men. Cancer Epidemiol 2023; 83:102338. [PMID: 36841020 DOI: 10.1016/j.canep.2023.102338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND While it is known that national PSA testing rates have decreased in Australia since 2007, it is not known whether these trends are consistent by broad geographical areas, nor whether previously reported area-specific differences have remained in more recent time periods. METHODS Population-based cohort study of Australian men (n = 2793,882) aged 50-69 who received at least one PSA test (Medicare Benefit Schedule item number 66655) during 2002-2018. Outcome measures included age-standardised participation rate, annual percentage change using JoinPoint regression and indirectly standardised participation rate ratio using multivariable Poisson regression. RESULTS During 2005-09, two thirds (68%) of Australian men aged 50-69 had at least one PSA test, reducing to about half (48%) during 2014-18. In both periods, testing rates were highest among men living in major cities, men aged 50-59 years, and among men living in the most advantaged areas. Nationally, the Australian PSA testing rate increased by 9.2% per year between 2002 and 2007, but then decreased by 5.0% per year to 2018. This pattern was generally consistent across States and Territories, and socio-economic areas, however the magnitude of the trends was less pronounced in remote and very remote areas. CONCLUSIONS The decreasing trends are consistent with a greater awareness of the current guidelines for clinical practice in Australia, which recommend a PSA test be done only with the informed consent of individual men who understand the potential benefits and risks. However, given there remain substantial geographical disparities in prostate cancer incidence and survival in Australia, along with the equivocal evidence for any benefit from PSA screening, there remains a need for more effective diagnostic strategies for prostate cancer to be implemented consistently regardless of where men live.
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Affiliation(s)
- Ankur Kohar
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; Sydney School of Public Health, The University of Sydney, Australia
| | - Susanna M Cramb
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, Australia
| | - Kristen Pickles
- Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Sydney, Australia
| | - David P Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Australia; Centre for Data Science, Queensland University of Technology, Brisbane, Australia; Menzies Health Institute, Griffith University, Gold Coast, Australia.
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Razavi M, Bergerot CD, Philip EJ, Dale W. Association of time intervals in cancer screenings and older participants' characteristics, in a nationally representative sample. J Geriatr Oncol 2023; 14:101392. [PMID: 36344421 DOI: 10.1016/j.jgo.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/16/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Health agencies and guidelines have proposed various recommendations regarding breast and prostate cancer screening intervals for older adults. However, there is limited data about factors that could impact older individuals' adherence to these guideline-based intervals. This study emphasized the differences in screening rates between men and women undergoing screening for breast (mammogram) and prostate (prostate-specific antigen [PSA] test) cancer. It also investigated the socio-demographic and emotional factors associated with screening time intervals. MATERIALS AND METHODS This cross-sectional design study used data from the National Social Life Health and Aging Project Wave 3 (NSHAP-W3, 2015). The outcome measures were screening time intervals (PSA test or mammogram). Individuals were asked, "About how long has it been since you last had a screening?" Response categories ranged from 1 = within the past year to 5 = never. Differences in screening time intervals were evaluated and displayed by age group (PSA vs. mammogram). The association between the outcome measures and participants' characteristics was evaluated via ordinal logistic regression. RESULTS There were 2320 participants included: 52% women and 48% men. They had a mean age of 66.9 years old, were mostly White (74%) and college graduates (68%). The average time interval between screenings was greater for PSA testing than mammography (mean [M] = 2.28 vs. M = 1.89, p < 0.001). The middle age groups (PSA: 60-79 and mammogram: 65-74), had significantly more frequent screenings compared to the youngest group (50-54). In contrast, older (80+) individuals did not display shorter screening time intervals compared to the youngest group. Furthermore, shorter time intervals between screenings were associated with higher household income (mammogram: odds ratio [OR] = 0.804; PSA: OR = 0.785, p < 0.05), African American descent (mammogram: OR = 0.458, p < 0.001), and higher frequency of physical activity (PSA: OR = 0.921, p = 0.030). Lastly, women who responded "yes" to skipping care due to lack of insurance reported longer periods between mammograms (OR = 1.784, p = 0.002). DISCUSSION Findings from this real-world US population representative database highlight the role of age, income, and insurance in the timing between screenings; participants aged between 60 and 79 years old, African American women, and physically active men are more likely to pursue earlier screening. These results emphasize the importance of socioeconomic and lifestyle factors when seeking to impact screening timing.
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Affiliation(s)
- Marianne Razavi
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Errol J Philip
- University of California San Francisco, San Francisco, CA, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
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Family history, obesity, urological factors and diabetic medications and their associations with risk of prostate cancer diagnosis in a large prospective study. Br J Cancer 2022; 127:735-746. [PMID: 35610365 PMCID: PMC9381576 DOI: 10.1038/s41416-022-01827-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Prostate cancer (PC) aetiology is unclear. PC risk was examined in relation to several factors in a large population-based prospective study. Methods Male participants were from Sax Institute’s 45 and Up Study (Australia) recruited between 2006 and 2009. Questionnaire and linked administrative health data from the Centre for Health Record Linkage and Services Australia were used to identify incident PC, healthcare utilisations, Prostate Specific Antigen (PSA) testing reimbursements and dispensing of metformin and benign prostatic hyperplasia (BPH) prescriptions. Multivariable Cox and Joint Cox regression analyses were used to examine associations by cancer spread, adjusting for various confounders. Results Of 107,706 eligible men, 4257 developed incident PC up to end 2013. Risk of PC diagnosis increased with: PC family history (versus no family history of cancer; HRadjusted = 1.36; 95% CI:1.21–1.52); father and brother(s) diagnosed with PC (versus cancer-free family history; HRadjusted = 2.20; 95% CI:1.61–2.99); severe lower-urinary-tract symptoms (versus mild; HRadjusted = 1.77; 95% CI:1.53–2.04) and vasectomy (versus none; HRadjusted = 1.08; 95% CI:1.00–1.16). PC risk decreased with dispensed prescriptions (versus none) for BPH (HRadjusted = 0.76; 95% CI:0.69–0.85) and metformin (HRadjusted = 0.57; 95% CI:0.48–0.68). Advanced PC risk increased with vasectomy (HRadjusted = 1.28; 95% CI:1.06–1.55) and being obese (versus normal weight; HRadjusted = 1.31; 95% CI:1.01–1.69). Conclusion Vasectomy and obesity are associated with an increased risk of advanced PC. The reduced risk of localised and advanced PC associated with BPH, and diabetes prescriptions warrants investigation.
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Trends in Prostate Specific Antigen (PSA) testing and prostate cancer incidence and mortality in Australia: A critical analysis. Cancer Epidemiol 2022; 77:102093. [PMID: 35026706 DOI: 10.1016/j.canep.2021.102093] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Population trends in PSA testing and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA testing, prostate cancer incidence and mortality in Australia and factors that influence them. METHODS We calculated and described standardised time trends in PSA tests, prostate biopsies, treatment of benign prostatic hypertrophy (BPH) and prostate cancer incidence and mortality in Australia in men aged 45-74, 75-84, and 85 + years. RESULTS PSA testing increased from its introduction in 1989 to a peak in 2008 before declining in men aged 45-84 years. Prostate biopsies and cancer incidence fell from 1995 to 2000 in parallel with decrease in trans-urethral resections of the prostate (TURP) and, latterly, changes in pharmaceutical management of BPH. After 2000, changes in biopsies and incidence paralleled changes in PSA screening in men 45-84 years, while in men ≥85 years biopsy rates stabilised, and incidence fell. Prostate cancer mortality in men aged 45-74 years remained low throughout. Mortality in men 75-84 years gradually increased until mid 1990s, then gradually decreased. Mortality in men ≥ 85 years increased until mid 1990s, then stabilised. CONCLUSION Age specific prostate cancer incidence largely mirrors PSA testing rates. Most deviation from this pattern may be explained by less use of TURP in management of BPH and consequent less incidental cancer detection in TURP tissue specimens. Mortality from prostate cancer initially rose and then fell below what it was when PSA testing began. Its initial rise and fall may be explained by a possible initial tendency to over-attribute deaths of uncertain cause in older men with a diagnosis of prostate cancer to prostate cancer. Decreases in mortality rates were many fold smaller than the increases in incidence, suggesting substantial overdiagnosis of prostate cancer after introduction of PSA testing.
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Pickles K, Scherer LD, Cvejic E, Hersch J, Barratt A, McCaffery KJ. Preferences for More or Less Health Care and Association With Health Literacy of Men Eligible for Prostate-Specific Antigen Screening in Australia. JAMA Netw Open 2021; 4:e2128380. [PMID: 34636915 PMCID: PMC8511975 DOI: 10.1001/jamanetworkopen.2021.28380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Understanding personal factors that influence diverse responses to health care information, such as preferences for more or less health care, might be beneficial to more effective communication and better involvement in health care choices. OBJECTIVE To determine whether individuals' preferences for more or less health care are associated with informed choice and understanding of overdiagnosis in routine prostate cancer screening and to examine associations among preferences, educational status, and health literacy. DESIGN, SETTING, AND PARTICIPANTS This survey study included a community-based sample of men in Australia aged 45 to 60 years eligible for prostate-specific antigen (PSA) screening, recruited via an international social research company. Survey data were collected online from June 27 to July 26, 2018. Data were analyzed in April 2020. EXPOSURES Participants were randomized to 1 of 2 versions of an online decision aid (full-length or abbreviated) about PSA screening and completed an online survey that included a measure of preference for more or less health care, the Medical Maximizer-Minimizer Scale (MMS), in which higher score indicates preference for more health care. MAIN OUTCOMES AND MEASURES The primary outcome was informed choice; knowledge, attitudes, and intentions about screening for prostate cancer were also measured. RESULTS Of 3722 participants who began the survey, 2993 (80.4%) completed it (mean [SD] age, 52.15 [6.65] years). Stronger preferences for more heath care were observed in those without tertiary education (mean difference, 0.15; 95% CI, 0.09-0.22; P < .001) and with inadequate health literacy (mean difference, 0.16; 95% CI, 0.09-0.22; P < .001). After controlling for health and demographic variables, a 1-unit increase in MMS score was associated with reduced relative risk (RR) of making an informed choice (RR, 0.78; 95% CI, 0.74-0.82; P < .001) and of having adequate conceptual knowledge (RR, 0.87; 95% CI, 0.84-0.90; P < .001), correct numerical knowledge (RR, 0.93; 95% CI, 0.89-0.97; P = .001), and correct understanding of overdiagnosis (RR, 0.84; 95% CI, 0.79-0.90; P < .001). A 1-unit increase in MMS score was associated with a more positive attitude toward screening (RR, 1.18; 95% CI, 1.15-1.21; P < .001) and more positive intention to screen (RR, 1.20; 95% CI, 1.16-1.25; P < .001) after adjusting for control variables. CONCLUSIONS AND RELEVANCE This survey study examined associations between preferences for more or less health care and knowledge about overdiagnosis and informed choice among men in Australia. These results may motivate clinicians to elicit individual patient preferences to facilitate tailored discussions with patients about low-value care, such as prostate cancer screening, for which benefit is uncertain.
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Affiliation(s)
- Kristen Pickles
- University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, Sydney, Australia
| | - Laura D. Scherer
- Division of Cardiology, University of Colorado School of Medicine, Aurora
- VA Denver Center for Innovation, Denver, Colorado
| | - Erin Cvejic
- University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, Sydney, Australia
| | - Jolyn Hersch
- University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, Sydney, Australia
| | - Alexandra Barratt
- University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, Sydney, Australia
| | - Kirsten J. McCaffery
- University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, Sydney, Australia
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Chiam K, Bang A, Patel MI, Nair-Shalliker V, O'Connell DL, Smith DP. Characteristics Associated with the Use of Diagnostic Prostate Biopsy and Biopsy Outcomes in Australian Men. Cancer Epidemiol Biomarkers Prev 2021; 30:1735-1743. [PMID: 34155065 DOI: 10.1158/1055-9965.epi-20-1571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/28/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Population characteristics associated with the use of prostate biopsy are poorly understood. We described the use of diagnostic prostate biopsy and subsequent biopsy outcomes in a population-based Australian cohort. METHODS A total of 91,764 men from the Sax Institute's 45 and Up Study (New South Wales, Australia) recruited during 2006 to 2009 were included. Self-completed baseline questionnaires and linked administrative health data were used. Study period was from the date of recruitment to December 2013. Cox regression and logistic regression identified factors associated with receipt of biopsy and subsequent prostate cancer diagnosis. RESULTS During the study period, 5,089 participants had a diagnostic prostate biopsy, and 2,805 men (55.1% of those biopsied) received a cancer diagnosis. Men with a family history of prostate cancer (HR 1.55; 95% confidence interval (CI), 1.43-1.68), severe lower urinary tract symptoms (HR 1.62; 95% CI, 1.41-1.86), or a record of medication for benign prostatic hyperplasia (HR 1.34; 95% CI, 1.23-1.47) had increased risks of receiving a biopsy. Men with a family history of prostate cancer had increased odds of a positive biopsy (OR 1.21; 95% CI, 1.01-1.43). High alcohol consumption (≥21 drinks per week compared with 1-6 drinks per week) was associated with decreased risk of biopsy (HR 0.88; 95% CI, 0.80-0.96) but increased odds of a positive biopsy (OR 1.63; 95% CI, 1.32-2.02). CONCLUSIONS Certain characteristics are associated with both undertaking diagnostic prostate biopsy and positive biopsy outcomes. IMPACT This highlights the need to improve management of specific groups of men, especially those with clinical symptoms that overlap with prostate cancer, in their investigation for prostate cancer.
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Affiliation(s)
- Karen Chiam
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, New South Wales, Australia.
| | - Albert Bang
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, New South Wales, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, New South Wales, Australia
- Discipline of Surgery, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Visalini Nair-Shalliker
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, New South Wales, Australia
- Department of Clinical Medicine, Macquarie University, New South Wales, Australia
| | - Dianne L O'Connell
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - David P Smith
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, New South Wales, Australia
- Menzies Health Institute, Griffith University, Queensland, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Tchir D, Farag M, Szafron M. Prostate-specific antigen (PSA) screening rates and factors associated with screening in Eastern Canadian men: Findings from cross-sectional survey data. Can Urol Assoc J 2020; 14:E319-E327. [PMID: 32017690 DOI: 10.5489/cuaj.6072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The prostate-specific antigen (PSA) test is used in Canada to detect prostate cancer (PCa) despite mixed recommendations. Complications arising from false-positives are common, posing as a cancer-screening concern. This work estimates some Canadian rates of PSA screening and identifies men at increased odds for PSA screening. METHODS The Canadian Community Health Survey (CCHS) from 2009/10 (Atlantic Canada; ATL), 2011/2012 (Ontario; ON), and 2013/2014 (Quebec; QC) were used. Lifetime and recent PSA screening with confidence intervals were constructed to estimate PSA screening in ATL, ON, and QC. Two logistic regression models (for men <50 and ≥50 years of age) were used to determine associations between factors and lifetime PSA screening. RESULTS PSA screening rates have increased in most age groups for ATL, ON, and QC since 2000/2001. Factors positively associated with lifetime PSA screening in men of all ages were: having a digital rectal exam, having a regular doctor, and having a colorectal exam. Fruit and vegetables consumption and non-smoking status were positively associated with lifetime PSA screening in men <50 years of age. High income and the presence of chronic health conditions were positively associated with lifetime PSA screening in men ≥50 years of age. CONCLUSIONS PSA screening rates have generally increased since 2000/2001 in Canada. Physician-related factors play a role in men at all ages, while different factors are associated in men <50 years of age and men ≥50 years of age. Limitations include the generalizability to all of Canada and the potential for recall bias.
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Affiliation(s)
- Devan Tchir
- University of Saskatchewan, School of Public Health, Saskatoon, SK, Canada
| | - Marwa Farag
- University of Saskatchewan, School of Public Health, Saskatoon, SK, Canada.,SPADE, Doha Institute for Graduate Studies, Doha, Qatar
| | - Michael Szafron
- University of Saskatchewan, School of Public Health, Saskatoon, SK, Canada
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Afshar N, English DR, Blakely T, Thursfield V, Farrugia H, Giles GG, Milne RL. Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data. PLoS One 2020; 15:e0228551. [PMID: 31999795 PMCID: PMC6992207 DOI: 10.1371/journal.pone.0228551] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/19/2020] [Indexed: 11/23/2022] Open
Abstract
Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001–2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Dallas R. English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Helen Farrugia
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Graham G. Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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McCaffery K, Nickel B, Pickles K, Moynihan R, Kramer B, Barratt A, Hersch J. Resisting recommended treatment for prostate cancer: a qualitative analysis of the lived experience of possible overdiagnosis. BMJ Open 2019; 9:e026960. [PMID: 31122983 PMCID: PMC6537980 DOI: 10.1136/bmjopen-2018-026960] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To describe the lived experience of a possible prostate cancer overdiagnosis in men who resisted recommended treatment. DESIGN Qualitative interview study SETTING: Australia PARTICIPANTS: 11 men (aged 59-78 years) who resisted recommended prostate cancer treatment because of concerns about overdiagnosis and overtreatment. OUTCOMES Reported experience of screening, diagnosis and treatment decision making, and its impact on psychosocial well-being, life and personal circumstances. RESULTS Men's accounts revealed profound consequences of both prostate cancer diagnosis and resisting medical advice for treatment, with effects on their psychological well-being, family, employment circumstances, identity and life choices. Some of these men were tested for prostate-specific antigen without their knowledge or informed consent. The men felt uninformed about their management options and unsupported through treatment decision making. This often led them to develop a sense of disillusionment and distrust towards the medical profession and conventional medicine. The findings show how some men who were told they would soon die without treatment (a prognosis which ultimately did not eventuate) reconciled issues of overdiagnosis and potential overtreatment with their own diagnosis and situation over the ensuing 1 to 20+ years. CONCLUSIONS Men who choose not to have recommended treatment for prostate cancer may avoid treatment-associated harms like incontinence and impotence, however our findings showed that the impact of the diagnosis itself is immense and far-reaching. A high priority for improving clinical practice is to ensure men are adequately informed of these potential consequences before screening is considered.
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Affiliation(s)
- Kirsten McCaffery
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristen Pickles
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ray Moynihan
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Barnett Kramer
- National Cancer Institute Division of Cancer Prevention, Bethesda, Maryland, USA
| | - Alexandra Barratt
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jolyn Hersch
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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12
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Calopedos RJS, Bang A, Baade P, Yu XQ, Ruthven S, Patel MI, Smith DP. Patterns of prostate‐specific antigen testing by remoteness of residence and socio‐economic status: An Australian population‐based study. Aust J Rural Health 2019; 27:216-223. [DOI: 10.1111/ajr.12504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ross J. S. Calopedos
- Cancer Research DivisionCancer Council NSW Sydney New South Wales Australia
- Gosford Hospital Gosford New South Wales Australia
| | - Albert Bang
- Cancer Research DivisionCancer Council NSW Sydney New South Wales Australia
| | - Peter Baade
- Cancer Research CentreCancer Council Queensland Brisbane Queensland Australia
- School of Mathematical SciencesQueensland University of Technology Brisbane Queensland Australia
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
| | - Xue Q. Yu
- Cancer Research DivisionCancer Council NSW Sydney New South Wales Australia
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
| | | | - Manish I. Patel
- Discipline of SurgerySydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- Department of UrologyWestmead Hospital Westmead New South Wales Australia
| | - David P. Smith
- Cancer Research DivisionCancer Council NSW Sydney New South Wales Australia
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
- Sydney Medical SchoolThe University of Sydney Sydney New South Wales Australia
- School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
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