Practice of opportunistic PSA screening in the Florence District

Knowledge, attitudes, and practices towards prostate cancer screening amongst men living in the southern Italian peninsula: the Prevention and Research in Oncology (PRO) non-profit Foundation experience

PURPOSE

We aimed to explore the knowledge, attitudes, and practices towards prostate cancer (PCa) risk factors and prevention amongst men living in the southern Italian peninsula.

METHODS

We retrospectively reviewed data collected during free preventive visits carried out by the Prevention and Research in Oncology (PRO) non-profit Foundation between July 2013 and July 2016. The following data were collected: demographic and clinical features, knowledge about PCa prevention and sources of knowledge, knowledge about PCa risk factors, previous prostate-specific antigen (PSA) test, previous digital rectal examination (DRE), previous prostate ultrasound, and general attitudes towards DRE.

RESULTS

The study population consisted of 2144 Caucasian men living in four regions in the south of Italy (Campania, Calabria, Molise, Puglia). Median age was 59 years. One thousand six hundred and ninety-nine (79.2%) subjects reported knowing the existence of PCa prevention programs. Most of them received information from the media while only 17.1% declared that the information on PCa prevention that they received was from their family physicians. One thousand two hundred seventy-five (59.5%) subjects declared knowing of the existence of PCa risk factors and 41.3% was aware of the existence of both genetic and exogenous factors. The percentage of subjects who reported having had at least one PSA test in their life was 77.8 and 55.4% reported having had a DRE.

CONCLUSIONS

Knowledge about PCa screening amongst male subjects living in southern peninsular Italy is quite high. Knowledge of PCa risk factors is suboptimal and the practice of DRE is underutilized.

Changes in incidence, survival and mortality of prostate cancer in Europe and the United States in the PSA era: additional diagnoses and avoided deaths

BACKGROUND

We describe changes in prostate cancer incidence, survival and mortality and the resulting impact in additional diagnoses and avoided deaths in European areas and the United States.

METHODS

Using data from 12 European cancer registries and the Surveillance, Epidemiology and End Results program, we describe changes in prostate cancer epidemiology between the beginning of the PSA era (USA: 1985-1989, Europe: 1990-1994) and 2002-2006 among patients aged 40-64, 65-74, and 75+. Additionally, we examine changes in yearly numbers of diagnoses and deaths and variation in male life expectancy.

RESULTS

Incidence and survival, particularly among patients aged <75, increased dramatically, yet both remain (with few exceptions in incidence) lower in Europe than in the United States. Mortality reductions, ongoing since the mid/late 1990 s, were more consistent in the United States, had a distressingly small absolute impact among patients aged 40-64 and the largest absolute impact among those aged 75+. Overall ratios of additional diagnoses/avoided deaths varied between 3.6 and 27.6, suggesting large differences in the actual impact of prostate cancer incidence and mortality changes. Ten years of remaining life expectancy was reached between 68 and 76 years.

CONCLUSION

Policies reflecting variation in population life expectancy, testing preferences, decision aids and guidelines for surveillance-based management are urgently needed.

Prostate biopsy in Western Australia 1998-2004

We reviewed the status of prostate cancer diagnosis in Western Australia (WA) with the aim of improving decision-making about PSA testing and prostate biopsy. Our patient cohort was 5145 men undergoing an initial biopsy for prostate cancer diagnosis in WA between 1998 and 2004. Transrectal ultrasound-guided biopsies were performed by one of 18 clinicians whereas all pathology was assessed by one urological pathologist. Cancer detection rates were 59% for initial biopsies and 32% for repeat biopsies. High-grade cancer (Gleason sum > or =7) accounted for 69 and 38% of tumours diagnosed on initial and repeat biopsy, respectively. The rates of cancer diagnosis and detection of high-grade tumours were both 1.6-fold higher in WA patients compared with those obtained at baseline screening of the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial of US men (P<0.001). These higher than expected rates of cancer detection and high histological grade indicate that urological practice in WA between 1998 and 2004 was significantly more conservative than US practice over this time period, probably leading to underdiagnosis of prostate cancer. Our findings may be relevant to other countries where urological practice differs from that in the United States.

Incidence and pathological characteristics of prostate cancer in Italy: a contribution to the screening debate

BACKGROUND

The scientific, social and financial aspects of prostate cancer (PC) organized or opportunistic screening to identify early PC are hotly debated. The incidence of prostate cancer is lower in Italy than in America and North Europe and data on PC incidence and pathological characteristics are scarce.

METHODS

To determine PC incidence and whether screening would be beneficial, we studied 1008 consecutive symptomatic patients from the Southern Italy who underwent transrectal ultrasonography; 170 of them (age range: 48-93 years; median: 70 years) were at risk and underwent transrectal biopsy.

RESULTS

Adenomatous hyperplasia was detected in 105 patients (62%), PC in 51 (30%), prostate intraepithelial neoplasia (PIN) in 5 (3%) and inflammatory disease in 5 (3%). The median age of patients with PC was 73.5 and tumors were generally well to moderately differentiated (76%, Gleason score < or =7). Prostate cancer (or PIN) was more frequent in patients over 70 (p<0.0001). The Gleason score also increased with age: >7 in 92% and 8% of patients aged >70 and < or =70, respectively (p<0.05).

CONCLUSIONS

On the basis of our results organized or opportunistic PC screening of elderly men does not appear justified because: invasive carcinoma is detected in less than 1/3 of symptomatic "healthy" men; patients became symptomatic when their life expectancy is often less than 10 years; and PC is more frequent and more aggressive after 70 years.

Practice of opportunistic prostate-specific antigen screening in Italy: data from the Health Search database

The effectiveness of prostate-specific antigen (PSA) testing for opportunistic screening of prostate cancer is not yet well established, although this practice seems to be widely accepted. To estimate the opportunistic use of PSA by general practitioners (GPs) in Italy, we conducted a survey by querying the Health Search (HS) database, which collects clinical records from a representative sample of the Italian population. Clinical computerized data from 320 GPs and 221,557 male patients were analysed. Among total requests for PSA, 3% were linked to prostate cancer, 18% to a urological disease or symptom and 79% were not linked to any urological condition (opportunistic screening). Opportunistic screening was used for 31.4% of subjects over 50 with a significant (P<0.0001) difference between geographical areas (36.4% north, 33.5% central regions, 22.9% south and isles). This distribution was very similar to prostate cancer prevalence as it resulted from the HS data. PSA testing practice showed an increase over the years (12.7% of men over 50 in 2000, 14.3% in 2001 and 15.9% in 2002). In conclusion, the practice of opportunistic screening of prostate cancer seems to be extensively adopted by Italian GPs and is becoming more and more popular, although to date it is not supported by strong scientific evidence.

Population-based incidence and mortality cancer trends (1986–1997) from the network of Italian cancer registries

The objective of this study was to analyse incidence and mortality cancer trends in the Italian Network of Cancer Registries (about 8,000,000 inhabitants) during the period 1986-1997. Included were 525,645 newly diagnosed cancers and 269,902 cancer deaths (subjects > 14 years). Joinpoints (points in time where trend significantly changes from linearity) were found and estimated annual percentage changes (EAPC) used to summarize tendencies. Overall cancer incidence increased in both sexes and cancer mortality significantly decreased (since 1991 among men). Lung cancer showed significantly decreasing incidence (EAPC = -1.4%) and mortality (EAPC = -1.6%) among men and increasing trends among women. In women, breast cancer incidence significantly increased (EAPC= +1.7%) and mortality decreased since 1989 (EAPC= -2.0%). Stomach cancer incidence and mortality decreased in both sexes. Prostate incidence sharply increased since 1991 and mortality decreased. Colon cancer incidence increased and rectum mortality decreased significantly in both sexes. Significant increases in incidence were also found for kidney (up to 1991 among men), urinary bladder, skin epithelioma, melanoma, liver (up to 1993 among men), pancreas, mesothelioma, Kaposi's sarcoma (up to 1995 among men), testis, thyroid, non-Hodgkin's lymphomas and multiple myeloma. Mortality significantly decreased for cancers of the oral cavity and pharynx, oesophagus, liver (women), larynx (men), bone, cervix (since 1990), central nervous system, urinary bladder, thyroid, Hodgkin's lymphomas and leukaemias (men). Non-Hodgkin's lymphoma mortality increased in both sexes. In conclusion, most of the changes seen can be explained as the effect of changes in smoking habits and of the extension of secondary prevention activities. The Italian health care system will also have to cope with growing cancer diagnostic and therapeutic needs due to population ageing.

Epidemiology of prostate cancer in the Umbria region of Italy: evidence of opportunistic screening effects

OBJECTIVES

To examine the impact of prostate-specific antigen-based screening on prostate cancer incidence, mortality, and survival in the Umbria region of Italy for the period 1978 to 1999.

METHODS

Incidence rates were derived from an ad hoc survey and from cancer registry records for the period 1978 to 1982 and 1994 to 1999, respectively. The mortality trend was assessed by joinpoint analysis using data from the official publications. The observed, relative, and age-adjusted relative survival rates were also calculated.

RESULTS

The number of newly diagnosed cases in 1997 to 1999 was almost four times greater than in 1978 to 1982, the crude incidence rate was more than three times, and the age-adjusted incidence rate increased by about 125%. No trend was apparent for mortality. The survival rates also showed a large increase. The 5-year relative survival rate was 37% and 74% for 1978 to 1982 and 1994 to 1998 incident cases, respectively. People older than 75 years showed the same striking increase in incidence and survival rates as the younger age groups.

CONCLUSIONS

As in many other developed countries, prostate cancer screening activities are the likely cause of the increase in incidence and survival rates observed in the study area, but a decreasing mortality trend is not yet evident. Opportunistic screening is likely to be performed among all age groups, including the elderly, although the latter are unlikely to benefit from intervention. The evaluation of opportunistic screening is difficult and a lack of evaluation implies a high risk of ineffective interventions and inequality of care.