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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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Abstract
Following detection of high levels of serum prostate-specific antigen, many men are advised to have transrectal ultrasound-guided biopsy in an attempt to locate a cancer. This nontargeted approach lacks accuracy and carries a small risk of potentially life-threatening sepsis. Worse still, it can detect clinically insignificant cancer cells, which are unlikely to be the origin of advanced-stage disease. The detection of these indolent cancer cells has led to overdiagnosis, one of the major problems of contemporary medicine, whereby many men with clinically insignificant disease are advised to undergo unnecessary radical surgery or radiotherapy. Advances in imaging and biomarker discovery have led to a revolution in prostate cancer diagnosis, and nontargeted prostate biopsies should become obsolete. In this Perspective article, we describe the current diagnostic pathway for prostate cancer, which relies on nontargeted biopsies, and the problems linked to this pathway. We then discuss the utility of prebiopsy multiparametric MRI and novel tumour markers. Finally, we comment on how the incorporation of these advances into a new diagnostic pathway will affect the current risk-stratification system and explore future challenges.
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Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding the United States Preventative Services Task Force recommendation against PSA screening. Urol Oncol 2018; 36:500.e21-500.e27. [DOI: 10.1016/j.urolonc.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/25/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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da Rocha Araujo FAG, Barroso UDO. Prostate cancer screening: Beliefs and practices of the Brazilian physicians with different specialties. J Eval Clin Pract 2018; 24:508-513. [PMID: 29484794 DOI: 10.1111/jep.12901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 02/02/2018] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Prostate cancer (PC) presents with a high prevalence, but a low mortality. The evaluation of the risk-benefit ratio of current screening methods has led to conflicting results, which are reflected in some contradictory recommendations proposed by scientific and governmental entities. In this context of uncertainty, our objective is to verify the practices and beliefs of Brazilian physicians of different specialties regarding screening for PC. METHODS A cross-sectional study was conducted through a self-administered questionnaire survey during the main events of the target specialties (general practitioner, geriatrics, and urology) during the year 2016. We evaluated the practices on 6 main points of conduct in PC screening: previous discussion to informed decision, exams indicated, age of onset with and without additional risk factors, repeat interval, and age when screening is suspended. Responses were analysed with descriptive statistics and correlation, using the Statistical Package for the Social Sciences program (IBM SPSS Statistics version 20, 2010). RESULTS The screening recommendation for PC differs significantly among specialists in association with previous discussion of benefits/harm (P = 0.026), exams used (P < 0.001), age of beginning screening with and without additional risk (P < 0.001), and age of suspension of the screening program (P < 0.001). CONCLUSIONS Our findings indicate that there is a significant difference of conduct between doctors in different specialties. To the best of the author's knowledge, this is the first study that directly compares the practices of these different specialists in relation to the main points involved in screening for PC.
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Affiliation(s)
| | - Ubirajara de Oliveira Barroso
- Department of Surgical Specialties, Medical School, Federal University of Bahia, Salvador, Bahia, Brazil.,Department of Master's and Doctorate in Medicine and Human Health, Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil
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Wallis C, Cheung D, Klotz L, Chalasani V, Leao R, Garisto J, Morton G, Nam R, Tannock I, Satkunasivam R. Personal prostate-specific antigen screening and treatment choices for localized prostate cancer among expert physicians. Can Urol Assoc J 2018; 12:E59-E63. [PMID: 29381460 DOI: 10.5489/cuaj.4736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to determine the personal practices of urologists, radiation oncologists, and medical oncologists regarding prostate cancer screening and treatment using the physician surrogate method, which seeks to identify acceptable healthcare interventions by ascertaining interventions physicians select for themselves. METHODS A hierarchical, contingent survey was developed through a consensus involving urologists, medical oncologists, and radiation oncologists. It was piloted at the University of Toronto and then circulated to urologists, radiation oncologists, and medical oncologists through professional medical societies in the U.S., Canada, Central and South America, Australia, and New Zealand. The primary outcome was physicians' personal choices regarding prostate-specific antigen (PSA) screening and the secondary outcome was treatment selection among those diagnosed with prostate cancer. RESULTS A total of 869 respondents provided consent and completed the survey. Of these, there were 719 urologists, 89 radiation oncologists, nine medical oncologists, and 53 undisclosed specialists. Most (784 of 869 respondents; 90%) endorsed past or future screening for themselves (among male physicians) or for relatives (among female physicians). Among urologists and radiation oncologists making prostate cancer treatment decisions, there was a significant correlation between physician specialty and the treatment selected (Phi coefficient=0.61; p=0.001). CONCLUSIONS Physicians who routinely treat prostate cancer are likely to undertake prostate cancer screening themselves or recommend it for immediate family members. Treatment choice is influenced by the well-recognized specialty bias.
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Affiliation(s)
- Christopher Wallis
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Douglas Cheung
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Venu Chalasani
- Department of Surgery, University of Sydney, Sydney, Australia
| | - Ricardo Leao
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Juan Garisto
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert Nam
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ian Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Raj Satkunasivam
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Elgqvist J. Nanoparticles as Theranostic Vehicles in Experimental and Clinical Applications-Focus on Prostate and Breast Cancer. Int J Mol Sci 2017; 18:E1102. [PMID: 28531102 PMCID: PMC5455010 DOI: 10.3390/ijms18051102] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/13/2017] [Accepted: 05/15/2017] [Indexed: 12/27/2022] Open
Abstract
Prostate and breast cancer are the second most and most commonly diagnosed cancer in men and women worldwide, respectively. The American Cancer Society estimates that during 2016 in the USA around 430,000 individuals were diagnosed with one of these two types of cancers, and approximately 15% of them will die from the disease. In Europe, the rate of incidences and deaths are similar to those in the USA. Several different more or less successful diagnostic and therapeutic approaches have been developed and evaluated in order to tackle this issue and thereby decrease the death rates. By using nanoparticles as vehicles carrying both diagnostic and therapeutic molecular entities, individualized targeted theranostic nanomedicine has emerged as a promising option to increase the sensitivity and the specificity during diagnosis, as well as the likelihood of survival or prolonged survival after therapy. This article presents and discusses important and promising different kinds of nanoparticles, as well as imaging and therapy options, suitable for theranostic applications. The presentation of different nanoparticles and theranostic applications is quite general, but there is a special focus on prostate cancer. Some references and aspects regarding breast cancer are however also presented and discussed. Finally, the prostate cancer case is presented in more detail regarding diagnosis, staging, recurrence, metastases, and treatment options available today, followed by possible ways to move forward applying theranostics for both prostate and breast cancer based on promising experiments performed until today.
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Affiliation(s)
- Jörgen Elgqvist
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
- Department of Physics, University of Gothenburg, 412 96 Gothenburg, Sweden.
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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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Timmermand OV, Nilsson J, Strand SE, Elgqvist J. High resolution digital autoradiographic and dosimetric analysis of heterogeneous radioactivity distribution in xenografted prostate tumors. Med Phys 2016; 43:6632. [PMID: 27908170 DOI: 10.1118/1.4967877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The first main aim of this study was to illustrate the absorbed dose rate distribution from 177Lu in sections of xenografted prostate cancer (PCa) tumors using high resolution digital autoradiography (DAR) and compare it with hypothetical identical radioactivity distributions of 90Y or 7 MeV alpha-particles. Three dosimetry models based on either dose point kernels or Monte Carlo simulations were used and evaluated. The second and overlapping aim, was to perform DAR imaging and dosimetric analysis of the distribution of radioactivity, and hence the absorbed dose rate, in tumor sections at an early time point after injection during radioimmunotherapy using 177Lu-h11B6, directed against the human kallikrein 2 antigen. METHODS Male immunodeficient BALB/c nude mice, aged 6-8 w, were inoculated by subcutaneous injection of ∼107 LNCaP cells in a 200 μl suspension of a 1:1 mixture of medium and Matrigel. The antibody h11B6 was conjugated with the chelator CHX-A″-DTPA after which conjugated h11B6 was mixed with 177LuCl3. The incubation was performed at room temperature for 2 h, after which the labeling was terminated and the solution was purified on a NAP-5 column. About 20 MBq 177Lu-h11B6 was injected intravenously in the tail vein. At approximately 10 h postinjection (hpi), the mice were sacrificed and one tumor was collected from each of the five animals and cryosectioned into 10 μm thick slices. The tumor slices were measured and imaged using the DAR MicroImager system and the M3Vision software. Then the absorbed dose rate was calculated using a dose point kernel generated with the Monte Carlo code gate v7.0. RESULTS The DAR system produced high resolution images of the radioactivity distribution, close to the resolution of single PCa cells. The DAR images revealed a pronounced heterogeneous radioactivity distribution, i.e., count rate per area, in the tumors, indicated by the normalized intensity variations along cross sections as mean ± SD: 0.15 ± 0.15, 0.20 ± 0.18, 0.12 ± 0.17, 0.15 ± 0.16, and 0.23 ± 0.22, for each tumor section, respectively. The absorbed dose rate distribution for 177Lu at the time of dissection 10 hpi showed a maximum value of 2.9 ± 0.4 Gy/h (mean ± SD), compared to 6.0 ± 0.9 and 159 ± 25 Gy/h for the hypothetical 90Y and 7 MeV alpha-particle cases assuming the same count rate densities. Mean absorbed dose rate values were 0.13, 0.53, and 6.43 Gy/h for 177Lu, 90Y, and alpha-particles, respectively. CONCLUSIONS The initial uptake of 177Lu-h11B6 produces a high absorbed dose rate, which is important for a successful therapeutic outcome. The hypothetical 90Y case indicates a less heterogeneous absorbed dose rate distribution and a higher mean absorbed dose rate compared to 177Lu, although with a potentially increased irradiation of surrounding healthy tissue. The hypothetical alpha-particle case indicates the possibility of a higher maximum absorbed dose rate, although with a more heterogeneous absorbed dose rate distribution.
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Affiliation(s)
- Oskar V Timmermand
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund 22185, Sweden
| | - Jenny Nilsson
- Sahlgrenska Academy, Institute of Clinical Sciences, Department Radiation Physics, University of Gothenburg, Gothenburg 41345, Sweden
| | - Sven-Erik Strand
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Lund University, Lund 22185, Sweden and Faculty of Medicine, Department of Clinical Sciences Lund, Medical Radiation Physics, Lund University, Lund 22185, Sweden
| | - Jörgen Elgqvist
- Faculty of Science, Department of Physics, University of Gothenburg, Gothenburg 41296, Sweden
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Evans-Axelsson S, Timmermand OV, Bjartell A, Strand SE, Elgqvist J. Radioimmunotherapy for Prostate Cancer--Current Status and Future Possibilities. Semin Nucl Med 2016; 46:165-79. [PMID: 26897720 DOI: 10.1053/j.semnuclmed.2015.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prostate cancer (PCa) is one of the most common cancers in men and is the second leading cause of cancer-related deaths in the USA. In the United States, it is the second most frequently diagnosed cancer after skin cancer, and in Europe it is number one. According to the American Cancer Society, approximately 221,000 men in the United States would be diagnosed with PCa during 2015, and approximately 28,000 would die of the disease. According to the International Agency for Research on Cancer, approximately 345,000 men were diagnosed with PCa in Europe during 2012, and despite more emphasis placed on early detection through routine screening, 72,000 men died of the disease. Hence, the need for improved therapy modalities is of utmost importance. And targeted therapies based on radiolabeled specific antibodies or peptides are a very interesting and promising alternative to increase the therapeutic efficacy and overall chance of survival of these patients. There are currently several preclinical and some clinical studies that have been conducted, or are ongoing, to investigate the therapeutic efficacy and toxicity of radioimmunotherapy (RIT) against PCa. One thing that is lacking in a lot of these published studies is the dosimetry data, which are needed to compare results between the studies and the study locations. Given the complicated tumor microenvironment and overall complexity of RIT to PCa, old and new targets and targeting strategies like combination RIT and pretargeting RIT are being improved and assessed along with various therapeutic radionuclides candidates. Given alone or in combination with other therapies, these new and improved strategies and RIT tools further enhance the clinical response to RIT drugs in PCa, making RIT for PCa an increasingly practical clinical tool.
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Affiliation(s)
- Susan Evans-Axelsson
- Department of Translational Medicine, Division of Urological Cancers, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
| | | | - Anders Bjartell
- Department of Translational Medicine, Division of Urological Cancers, Skåne University Hospital, Malmö, Lund University, Lund, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Sven-Erik Strand
- Department of Clinical Sciences, Lund, Division of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Jörgen Elgqvist
- Department of Clinical Sciences, Lund, Division of Medical Radiation Physics, Lund University, Lund, Sweden.
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Snipelisky D, Carter K, Sundsted K, Burton MC. Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting. Int J Prev Med 2016; 7:5. [PMID: 26941906 PMCID: PMC4755253 DOI: 10.4103/2008-7802.173795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 04/17/2015] [Indexed: 11/14/2022] Open
Abstract
Background: Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians’ perspectives of practicing preventive medicine and evaluate which topics are deemed most important. Methods: All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians’ perception of the role of preventive medicine during both acute/routine and yearly visits, physicians’ perception of patients’ response to preventive medicine topics, and which preventive medicine topics are commonly practiced. Results: Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1–5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1–5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force. Conclusions: Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations.
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Affiliation(s)
| | - Kimberly Carter
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karna Sundsted
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Caroline Burton
- Department of Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Rezaee ME, Ward CE, Odom BD, Pollock M. Prostate cancer screening practices and diagnoses in patients age 50 and older, Southeastern Michigan, pre/post 2012. Prev Med 2016; 82:73-6. [PMID: 26592690 DOI: 10.1016/j.ypmed.2015.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Studies investigating the regional impact of the 2012 U.S. Preventive Services Task Force (USPSTF) recommendation against the use of prostate specific antigen (PSA) screening for prostate cancer have been limited. METHODS A retrospective cohort study was conducted on men age 50years and older in Southeastern Michigan pre (n=3647) and post (n=3618) USPSTF recommendation. PSA screening, transrectal ultrasound, and prostate biopsy rates were evaluated pre/post using a generalized piecewise linear model with a Poisson distribution, and log link. A knot was placed at year 2011 to estimate pre/post slope coefficients. Generalized estimating equations were used to estimate the marginal probability of a prostate diagnosis as a logistic function of pre and post-period, and comorbidities. RESULTS PSA utilization significantly increased (β=0.28; 95% CI: 0.25, 0.31) during the pre-period, but significantly decreased in the post-period (β=-0.29; 95% CI: -0.34, -0.25). Prostate biopsies decreased pre (β=-0.16; 95% CI: -0.25, -0.08) and did not change post (β=0.01; 95% CI: -0.09, 0.12). Transrectal ultrasounds were stable pre (β=0.16; 95% CI: -0.03, 0.35) and significantly decreased post (β=-0.27; 95% CI: -0.50, -0.04). Patients in the post-period had a decreased probability of having a diagnosis of prostate cancer (OR: 0.81; 95% CI: 0.74-0.89) compared to the pre-period. CONCLUSION Our study demonstrates how PSA tests are still being frequently used in Southeastern Michigan. Further research is needed to better understand regional variation in prostate cancer screening practices in the U.S.
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Affiliation(s)
- Michael E Rezaee
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States.
| | - Charlotte E Ward
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Brian D Odom
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - Martha Pollock
- Oakland University William Beaumont School of Medicine, Rochester, MI, United States
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Impact of a printed decision aid on patients' intention to undergo prostate cancer screening: a multicentre, pragmatic randomised controlled trial in primary care. Br J Gen Pract 2015; 65:e295-304. [PMID: 25918334 DOI: 10.3399/bjgp15x684817] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Despite recommendations against systematic screening for prostate cancer, 70% of patients still request prostate-specific antigen testing. AIM To assess the impact of a decision aid on patients' intention to undergo prostate cancer screening. DESIGN AND SETTING Randomised controlled trial with two-arm parallel groups in 86 general practices in urban and rural areas in France. METHOD Males aged 50-75 years were randomised to receive either the decision aid (intervention group) or usual care (control group). The primary outcome was the proportion of patients' intending to undergo prostate cancer screening, assessed immediately after reading the decision aid. The reasons underlying their choice were elicited and the proportion of patients citing each reason to undergo, or not undergo, prostate cancer screening were compared between the two arms. RESULTS A total of 1170 patients were randomised (588 in the intervention arm) from November 2012 to February 2013. The proportion of patients who intended to be tested for prostate cancer in the intervention arm (123 patients [20.9%]) was significantly reduced compared with the control arm (57 patients [9.8%]) (difference 11.1%, 95% confidence interval [CI] = 7.0 to 15.2, P<0.0001). In the intervention group, a lower proportion of individuals expressed that cancer screening would protect them from the disease, compared with the control group (P<0.0001), while a greater proportion of individuals stated that prostate cancer screening would not benefit their health (P<0.0001) and may involve procedures with harmful side effects (P = 0.0005). CONCLUSION The decision aid improved participants' informed decision making and reduced their intent to undergo prostate cancer screening.
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Pucheril D, Dalela D, Sammon J, Sood A, Sun M, Trinh QD, Menon M, Abdollah F. The influence of physician recommendation on prostate-specific antigen screening. Urol Oncol 2015. [PMID: 26206103 DOI: 10.1016/j.urolonc.2015.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Prostate-specific antigen (PSA) screening is controversial, and little is known regarding a physician's effect on a patient's decision to undergo screening. This study's objective was to evaluate the effect of a patient's understanding of the risks and benefits of screening compared to the final recommendation of the provider on the patient's decision to undergo PSA screening. MATERIALS AND METHODS Using the 2012 Behavioral Risk Factor Surveillance System, men older than 55 years who did not have a history of prostate cancer/prostate "problem" and who reported a PSA test within the preceding year were considered to have undergone screening. The percentages of men informed and not informed of the risks and benefits of screening and the percentage men receiving recommendations for PSA screening from their provider were reported. Multivariable complex-sample logistic regression calculated the odds of undergoing screening. RESULTS In all, 75% of men were informed of screening benefits; however, 32% were informed of screening risks. After being informed of both, 56% of men opted for PSA screening if the provider recommended it, compared with only 21% when not recommended. Men receiving a recommendation to undergo PSA testing had higher odds of undergoing screening (odds ratio [OR] = 4.98, 95% CI: 4.53-5.48) compared with those who were only informed about screening benefits (OR = 2.40, 95% CI: 2.18-2.65) or risks (OR = 0.92, 95% CI: 0.86-0.98). Significant limitations include recall and nonresponse bias. CONCLUSIONS Patients' decision to undergo or forgo PSA screening is heavily influenced by the recommendation of their physician; it is imperative that physicians are cognizant of their biases and facilitate a shared decision-making process.
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Affiliation(s)
- Daniel Pucheril
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI
| | - Deepansh Dalela
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI
| | - Jesse Sammon
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI
| | - Akshay Sood
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI
| | - Maxine Sun
- Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mani Menon
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI
| | - Firas Abdollah
- VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
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