Prostate cancer screening: where are we now?

Attributes Used for Cancer Screening Discrete Choice Experiments: A Systematic Review

BACKGROUND

Evidence from discrete choice experiments can be used to enrich understanding of preferences, inform the (re)design of screening programmes and/or improve communication within public campaigns about the benefits and harms of screening. However, reviews of screening discrete choice experiments highlight significant discrepancies between stated choices and real choices, particularly regarding willingness to undergo cancer screening. The identification and selection of attributes and associated levels is a fundamental component of designing a discrete choice experiment. Misspecification or misinterpretation of attributes may lead to non-compensatory behaviours, attribute non-attendance and responses that lack external validity.

OBJECTIVES

We aimed to synthesise evidence on attribute development, alongside an in-depth review of included attributes and methodological challenges, to provide a resource for researchers undertaking future studies in cancer screening.

METHODS

A systematic review was conducted to identify discrete choice experiments estimating preferences towards cancer screening, dated between 1990 and December 2020. Data were synthesised narratively. In-depth analysis of attributes led to classification into four categories: test specific, service delivery, outcomes and monetary. Attribute significance and relative importance were also analysed. The International Society for Pharmacoeconomics and Outcomes Research conjoint analysis checklist was used to assess the quality of reporting.

RESULTS

Forty-nine studies were included at full text. They covered a range of cancer sites: over half (26/49) examined colorectal screening. Most studies elicited general public preferences (34/49). In total, 280 attributes were included, 90% (252/280) of which were significant. Overall, test sensitivity and mortality reduction were most frequently found to be the most important to respondents.

CONCLUSIONS

Improvements in reporting the identification, selection and construction of attributes used within cancer screening discrete choice experiments are needed. This review also highlights the importance of considering the complexity of choice tasks when considering risk information or compound attributes. Patient and public involvement and stakeholder engagement are recommended to optimise understanding of unavoidably complex choice tasks throughout the design process. To ensure quality and maximise comparability across studies, further research is needed to develop a risk-of-bias measure for discrete choice experiments.

Characteristics Associated with the Use of Diagnostic Prostate Biopsy and Biopsy Outcomes in Australian Men

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.

Changements dans les pratiques de dépistage de l'antigène prostatique spécifique en Ontario entre 2003 et 2012

Objectifs

La présente étude analyse les changements survenus entre 2003 et 2012 dans les pratiques de dépistage de l'antigène prostatique spécifique (APS) chez les hommes âgés de 35 ans et plus en Ontario. Nous établissons des facteurs associés aux tests de l'APS, examinons si les directives de dépistage relatives à l'âge sont respectées et si les tests sont réalisés de manière opportuniste. Sont également étudiés la relation entre le revenu, le niveau d'éducation et le suivi régulier auprès d'un médecin ainsi qu'une estimation de la prévalence des tests de dépistage de l'APS en 2012.

Méthodologie

Nous avons utilisé des données provenant de l'Enquête sur la santé des collectivités canadiennes (ESCC) pour estimer la proportion d'hommes ayant passé un test de dépistage de l'APS en 2003, que nous avons ensuite comparée à une estimation similaire (population semblable) datant de 2012. Nous avons également étudié les liens entre le recours au dépistage et des facteurs sociodémographiques. Nous avons élaboré des analyses de tableau de contingence afin de caractériser les changements ainsi qu'une analyse de régression logistique afin d'évaluer les différences, tout en rendant compte de l'éventuel rôle confusionnel d'autres facteurs.

Résultats

Entre 2003 et 2012, une augmentation du recours au test de l'APS a été observée chez les hommes de 35 à 49 ans et chez ceux de 75 ans et plus. En 2003, 18 % des hommes de 35 à 49 ans et 74 % des hommes de 75 ans et plus ont dit avoir déjà passé un test de l'APS. En 2012, ces chiffres avaient augmenté de 20 % chez les répondants de 35 à 49 ans et de 84 % chez ceux de 75 ans et plus. L'analyse de régression logistique a révélé qu'en 2012 un homme dans la tranche d'âge de 70 à 74 ans affichait la plus haute probabilité d'avoir passé un test de l'APS comparativement à un homme du groupe des 35 à 49 ans (rapport des cotes [RC] = 25,9; intervalle de confiance [IC] = 19,9 - 33,8).

Conclusion

En Ontario, des tests de l'APS semblent être menés de manière opportuniste, touchant alors des groupes non recommandés par les directives de la province. En effet, on observe une augmentation marquée du recours au dépistage chez les personnes non comprises dans les tranches d'âge énoncées par les directives ontariennes en matière de dépistage de l'ASP, c'est-à-dire de 35 à 49 ans et 75 ans et plus. Il semble que la plupart des tests de dépistage de l'ASP en Ontario soient opportunistes et que les directives relatives à l'âge soient peu respectées.

Changes in the uptake of screening for prostate cancer with prostate-specific antigen in Ontario between 2003 to 2012

Objectives

This study investigates change in prostate-specific antigen (PSA) screening uptake in Ontario among men 35 years of age and older, between 2003 and 2012. We identify factors related to PSA testing, and examine the degree to which age guidelines for PSA testing are being followed or if PSA screening is opportunistic in nature. The relationship of income, education and having a regular physician and an estimation of PSA testing prevalence in 2012 is also studied.

Methods

Data from the Canadian Community Health Survey (CCHS) were used to estimate the proportion of men who had a PSA test in 2003 and then compared to a similar estimate (in similar population) in 2012. We also examined associations with PSA uptake to socio-demographic factors. Contingency table analyses were performed to characterize the changes; logistic regression was also used to evaluate the differences, while taking into account the possible confounding role of other factors.

Results

We found among men aged 35-49 years and 75+, there was an increase in PSA utilization between 2003 and 2012. In 2003, 18% of men 35-49 years, and 74% of men aged 75+ reported ever having a PSA test. These figures increased to 20% of men aged 35-49 years, and 84% of men aged 75+ years in 2012. Logistic regression showed that a man in the 70-74 age category in 2012 had the highest likelihood of having had a PSA test compared to men in the age range of 35-49 years (odds ratio (OR)=25.9; confidence interval (CI)= 19.9-33.8).

Conclusion

In Ontario, PSA testing is seemingly opportunistic in nature and occurring in groups not recommended for testing by the Ontario guidelines. There is a marked increase in PSA utilization in age ranges outside of the current Ontario PSA testing guidelines (35-49 and 75+). It would appear that most PSA testing in Ontario is opportunistic and adherence to age guidelines is limited.