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Georgiou LA, Scarbrough BE. PSA screening for prostate cancer in the United States: 30 years of controversy. J Public Health Policy 2024; 45:552-561. [PMID: 39090221 DOI: 10.1057/s41271-024-00502-4] [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] [Accepted: 06/25/2024] [Indexed: 08/04/2024]
Abstract
In 1994, the United States approved the Prostate-Specific Antigen (PSA) test as a screening tool for prostate cancer. It did so despite the test's inherent weakness: not being prostate cancer specific. Subsequent randomized trials yielded conflicting results as to its benefits. Medical guideline organizations are concerned that PSA screening results in the diagnosis and treatment of clinically indolent prostate cancer. Nevertheless, PSA screening is prevalent in North America and Europe with PSA screening increasing in other regions. We provide a critical review of the major factors that led to the prevalence of PSA screening in the United States despite the debate about its benefits. Public advocacy in favor of the test and failure of the medical community to appreciate its inherent weakness led to widespread adoption. These factors persist today. Other countries need to carefully analyze the utility of the PSA test before adopting it.
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Affiliation(s)
- Loukas A Georgiou
- Kentucky College of Osteopathic Medicine, University of Pikeville, 147 Sycamore St., Pikeville, KY, 41501, USA.
| | - Brent E Scarbrough
- Ross University School of Medicine, 10315 USA Today Way, Miramar, FL, 33025, USA
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Dave P, Carlsson SV, Watts K. Randomized trials of PSA screening. Urol Oncol 2024:S1078-1439(24)00487-3. [PMID: 38926075 DOI: 10.1016/j.urolonc.2024.05.014] [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: 11/04/2023] [Revised: 02/02/2024] [Accepted: 05/18/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The role of prostate-specific antigen (PSA) testing in prostate cancer (PCa) screening has evolved over recent decades with multiple randomized controlled trials (RCTs) spurring guideline changes. At present, controversy exists due to the indolent nature of many prostate cancers and associated risks of overdiagnosis and overtreatment. This review examines major RCTs evaluating PSA screening to inform clinical practices. METHODS AND MATERIALS We summarize findings from primary RCTs investigating PSA screening's impact on PCa mortality and incidence: the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, the European Randomized Study of Screening for Prostate Cancer (ERSPC), and the Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP). RESULTS The PLCO Trial randomized men to annual PSA and DRE screening or usual care, reporting no significant difference in PCa mortality between groups at 17 years (RR 0.93, [95% CI: 0.81-1.08]), yet significantly increased detection and concomitant decreased detection in Gleason 6 (RR 1.17, [95% CI: 1.11-1.23]) and 8-10 disease (RR 0.89, [95% CI: 0.80-0.99]) in the screening group, respectively. The ESPRC Trial randomized men across seven European countries to PSA screening every 2-4 years or usual care, noting a 20% reduction in PCa mortality at 9 years (RR 0.81, [95% CI: 0.65-0.98]) and significant decrease in metastatic disease at 12 years (RR 0.70, [95% CI: 0.60-0.82]). The CAP Trial assessed a single PSA screening test's impact on PCa mortality yielding no significant difference in PCa mortality at 10 years (RR 0.96, [95% CI: 0.85-1.08]). Limitations amongst studies included high contamination between study arms and low compliance with study protocols. CONCLUSIONS While the CAP and initial PLCO trials showed no significant reduction in PCa mortality, the ERSPC demonstrated a 21% reduction at 13 years, with further benefits at extended follow-up. Differences in outcomes are attributed to variations in trial design, contamination, adherence rates, and PSA thresholds. Future studies are needed focus on optimizing screening intervals, targeting high-risk populations, and incorporating non-invasive diagnostic tools to improve screening efficacy and reduce associated harms.
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Affiliation(s)
- Priya Dave
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Sigrid V Carlsson
- Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden
| | - Kara Watts
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
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Braga R, Araújo N, Costa A, Lopes C, Silva I, Correia R, Carneiro F, Braga I, Pacheco-Figueiredo L, Oliveira J, Morais S, Tedim Cruz V, Pereira S, Lunet N. Association between sociodemographic and clinical features, health behaviors, and health literacy of patients with prostate cancer and prostate cancer prognostic stage. Eur J Cancer Prev 2024; 33:243-251. [PMID: 37997910 DOI: 10.1097/cej.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Patient characteristics may influence access and acceptance of Prostate Specific Antigen test, and therefore, the timing of prostate cancer (PCa) diagnosis. A group of 361 patients from a cohort (n = 451) diagnosed with PCa in 2018-2020 at the Portuguese Institute of Oncology of Porto was evaluated before treatment, using a structured interview, the Medical Term Recognition Test, and the EORTC Quality of Life Questionnaire QLQ-PR25. PCa prognostic stages (I, II, III, IV) were attributed according to the American Joint Committee on Cancer eighth edition. Multinomial logistic regression was used to compute the odds ratio and 95% confidence interval (OR [95% CI]), considering PCa stage II, the most frequent, as reference. Older age (OR = 4.21 [2.24-7.93]), living outside the Porto Metropolitan Area while having low income (OR = 6.25 [1.53-25.62]), and erectile dysfunction (OR = 2.22 [0.99-4.99]) were associated with stage III, while urination during the night (OR = 3.02 [1.42-6.41]) was associated with stage IV. Urine leakage was less frequent in stage III (OR = 0.23 [0.08-0.68]), and living with a partner (OR = 0.41 [0.19-0.88]) and family history of cancer (OR = 0.25 [0.07-0.86]) in stage IV. Health literacy was not associated with PCa stage but lower education was less frequent in stage I (OR = 0.27 [0.11-0.69]). Patient sociodemographic and clinical characteristics should be considered as targets to improve PCa early detection and prognosis.
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Affiliation(s)
- Raquel Braga
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Unidade de Saúde Familiar Lagoa, Unidade Local de Saúde de Matosinhos, Matosinhos
| | - Natália Araújo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
| | - Adriana Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
| | - Catarina Lopes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
| | - Isa Silva
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
| | - Rita Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
| | | | - Isaac Braga
- Instituto Português de Oncologia do Porto, Porto
| | | | | | - Samantha Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
| | - Vítor Tedim Cruz
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Escola de Medicina, Universidade do Minho, Braga
| | - Susana Pereira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Instituto Português de Oncologia do Porto, Porto
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto
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Tesfai A, Norori N, Harding TA, Wong YH, Hobbs MD. Variation in harms and benefits of prostate-specific antigen screening for prostate cancer by socio-clinical risk factors: A rapid review. BJUI COMPASS 2024; 5:417-432. [PMID: 38751945 PMCID: PMC11090766 DOI: 10.1002/bco2.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/25/2023] [Indexed: 05/18/2024] Open
Abstract
Objective To analyse the latest evidence on the relative harms and benefits of screening and diagnostic pathways with close examination of (i) men aged 50 years or older, (ii) men whose ethnicity places them at higher risk and (iii) men with a family history. Methods We conducted a literature search using PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) databases and other sources, from January 1990 to 25 January 2023. Two independent reviewers selected for randomised controlled trials (RCTs) and cohort studies which met our inclusion criteria. Results Twenty-eight articles were selected, from six trials, including the Göteborg trial-reported separately from European Randomised Study of Screening for Prostate Cancer (ERSPC). Prostate-specific antigen (PSA)-based screening led to the increased detection of low-grade cancer and reduction of advanced/metastatic disease but had contradictory effects on prostate cancer (PCa)-specific mortality (no difference or reduced), possibly due to issues of contamination or compliance. Screening men from a relatively young age (50-55) reduced risk of PCa-specific mortality in a subanalysis of an 18-year follow-up study and in a 17-year cohort study from the main Göteborg trial. Moreover, one Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial analysis reported a trend of reduced risk of PCa-specific mortality for men with a family history who were screened. [Correction added on 05 March 2024, after first online publication: "Cancer Screening Trial" has been added to the preceding sentence.] However, we did not find relevant studies for ethnicity. Conclusion Under current UK practice, the choice to conduct a PSA test relies on a shared decision-making approach guided by known risk factors. However, we found there was a lack of strong evidence on the harms and benefits of PSA screening by socio-clinical risk factors and suggest further research is required to understand the long-term impact of screening on high-risk populations in the current diagnostic setting.
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Down L, Barlow M, Bailey SER, Mounce LTA, Merriel SWD, Watson J, Martins T. Association between patient ethnicity and prostate cancer diagnosis following a prostate-specific antigen test: a cohort study of 730,000 men in primary care in the UK. BMC Med 2024; 22:82. [PMID: 38424555 PMCID: PMC10905783 DOI: 10.1186/s12916-024-03283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Black men have higher prostate-specific antigen (PSA) levels and higher prostate cancer incidence and mortality than White men, while Asian men tend to have lower prostate cancer incidence and mortality than White men. Much of the evidence comes from the USA, and information from UK populations is limited. METHODS This retrospective cohort study used data on patients registered at general practices in England contributing to the Clinical Practice Research Datalink (CPRD) Aurum dataset. Those eligible were men aged 40 and over with a record of ethnicity and a PSA test result recorded between 2010 and 2017 with no prior cancer diagnosis. The aim was to assess the incidence of prostate cancer following a raised PSA test result in men from different ethnic groups. Additionally, incidence of advanced prostate cancer was investigated. Cancer incidence was estimated from multi-level logistic regression models adjusting for potential confounding factors. RESULTS 730,515 men with a PSA test were included (88.9% White). Black men and men with mixed ethnicity had higher PSA values, particularly for those aged above 60 years. In the year following a raised PSA result (using age-specific thresholds), Black men had the highest prostate cancer incidence at 24.7% (95% CI 23.3%, 26.2%); Asian men had the lowest at 13.4% (12.2%, 14.7%); incidence for White men was 19.8% (19.4%, 20.2%). The peak incidence of prostate cancer for all groups was in men aged 70-79. Incidence of prostate cancer diagnosed at an advanced stage was similar between Black and White men. CONCLUSIONS More prostate cancer was diagnosed in Black men with a raised PSA result, but rates of advanced prostate cancer were not higher in this group. In this large primary care-based cohort, the incidence of prostate cancer in men with elevated PSA levels increases with increasing age, even when using age-adjusted thresholds, with Black men significantly more likely to be diagnosed compared to White or Asian men. The incidence of advanced stage prostate cancer at diagnosis was similar for Black and White men with a raised PSA result, but lower for Asian men.
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Affiliation(s)
- Liz Down
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Melissa Barlow
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah E R Bailey
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Luke T A Mounce
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Samuel W D Merriel
- Centre for Primary Care & Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jessica Watson
- Centre for Academic Primary Care (CAPC), Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Tanimola Martins
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Ruan X, Zhang N, Wang D, Huang J, Huang J, Huang D, Chun TTS, Ho BSH, Ng ATL, Tsu JHL, Zhan Y, Na R. The Impact of Prostate-Specific Antigen Screening on Prostate Cancer Incidence and Mortality in China: 13-Year Prospective Population-Based Cohort Study. JMIR Public Health Surveill 2024; 10:e47161. [PMID: 38236627 PMCID: PMC10835592 DOI: 10.2196/47161] [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: 03/10/2023] [Revised: 09/18/2023] [Accepted: 12/14/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The status of prostate-specific antigen (PSA) screening is unclear in China. Evidence regarding the optimal frequency and interval of serial screening for prostate cancer (PCa) is disputable. OBJECTIVE This study aimed to depict the status of PSA screening and to explore the optimal screening frequency for PCa in China. METHODS A 13-year prospective cohort study was conducted using the Chinese Electronic Health Records Research in Yinzhou study's data set. A total of 420,941 male participants aged ≥45 years were included between January 2009 and June 2022. Diagnosis of PCa, cancer-specific death, and all-cause death were obtained from the electronic health records and vital statistic system. Hazard ratios (HRs) with 95% CIs were estimated using Cox regression analysis. RESULTS The cumulative rate of ever PSA testing was 17.9% with an average annual percent change (AAPC) of 8.7% (95% CI 3.6%-14.0%) in the past decade in China. People with an older age, a higher BMI, higher waist circumference, tobacco smoking and alcohol drinking behaviors, higher level of physical activity, medication use, and comorbidities were more likely to receive PSA screening, whereas those with a lower education level and a widowed status were less likely to receive the test. People receiving serial screening ≥3 times were at a 67% higher risk of PCa detection (HR 1.67; 95% CI 1.48-1.88) but a 64% lower risk of PCa-specific mortality (HR 0.36; 95% CI 0.18-0.70) and a 28% lower risk of overall mortality (HR 0.72; 95% CI 0.67-0.77). People following a serial screening strategy at least once every 4 years were at a 25% higher risk of PCa detection (HR 1.25; 95% CI 1.13-1.36) but 70% (HR 0.30; 95% CI 0.16-0.57) and 23% (HR 0.77; 95% CI 0.73-0.82) lower risks of PCa-specific and all-cause mortality, respectively. CONCLUSIONS This study reveals a low coverage of PSA screening in China and provides the first evidence of its benefits in the general Chinese population. The findings of this study indicate that receiving serial screening at least once every 4 years is beneficial for overall and PCa-specific survival. Further studies based on a nationwide population and with long-term follow-up are warranted to identify the optimal screening interval in China.
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Affiliation(s)
- Xiaohao Ruan
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dawei Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyi Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinlun Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsun Tsun Stacia Chun
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Brian Sze Ho Ho
- Division of Urology, Department of Surgery, Queen Mary Hospital, Hong Kong, China (Hong Kong)
| | - Ada Tsui-Lin Ng
- Division of Urology, Department of Surgery, Queen Mary Hospital, Hong Kong, China (Hong Kong)
| | - James Hok-Leung Tsu
- Division of Urology, Department of Surgery, Queen Mary Hospital, Hong Kong, China (Hong Kong)
| | - Yongle Zhan
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Rong Na
- Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Thomas ET, Withrow DR, Shine B, Gill P, Perera R, Heneghan C. Trends in diagnostic tests ordered for children: a retrospective analysis of 1.7 million laboratory test requests in Oxfordshire, UK from 2005 to 2019. Arch Dis Child 2023; 109:30-36. [PMID: 37949643 PMCID: PMC10803974 DOI: 10.1136/archdischild-2023-325550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To better understand testing patterns in children, we measured temporal trends in paediatric testing from 2005 to 2019 in Oxfordshire, UK. DESIGN Descriptive study of population-based secondary data. SETTING Oxfordshire University Hospitals National Health Service Trust laboratories. PARTICIPANTS Children aged 0-15 years in Oxfordshire who received at least one blood test. MAIN OUTCOME MEASURES We estimated average annual percentage changes (AAPCs) in test use using joinpoint regression models. Temporal changes in age-adjusted rates in test use were calculated overall and stratified by healthcare setting, sex, and age. RESULTS Between 2005 and 2019, 1 749 425 tests were performed among 113 607 children. Overall test use declined until 2012, when test rates appeared to increase (AAPC 1.5%, 95% CI -0.8% to 3.9%). Most tests were performed in inpatient settings, where testing rates stayed steady (AAPC -0.6%, 95% CI -2.1% to 0.9%). Increases were highest in females, those aged 6-15 years and in the outpatient setting. The greatest increase in testing was for vitamin D (AAPC 26.5%), followed by parathyroid hormone (9.8%), iron studies (9.3%), folate (8.4%), vitamin B12 (8.4%), HbA1c (8.0%), IgA (7.9%) and coeliac (7.7%). CONCLUSIONS After an initial decline, laboratory test use by children in Oxfordshire demonstrated an apparent increase since 2012. Test use increased in outpatient and general practice settings, however remained steady in inpatient settings. Further research should examine the root causes and implications for test increases, and whether these increases are warranted. We encourage clinicians to consider the individual and systemic implications of performing blood tests in children.
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Affiliation(s)
- Elizabeth T Thomas
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Diana R Withrow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford, UK
| | - Peter Gill
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Okyere J, Ayebeng C, Owusu BA, Ankomahene B, Dickson KS. Prostate cancer screening uptake in Kenya: An analysis of the demographic and health survey. J Cancer Policy 2023; 37:100427. [PMID: 37327871 DOI: 10.1016/j.jcpo.2023.100427] [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: 02/13/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Prostate cancer (PCa) screening is a cost-effective strategy to promote early detection and treatment. Understanding the determinants of PCa screening uptake would help policy makers to identify high-risk populations and ensure the cost-effectiveness of health promotion interventions. This study aims to estimate the prevalence of PCa screening uptake and assess its associated factors among Kenyan men. METHODS The study relied on data from the 2014 Kenya Demographic and Health Survey. Both descriptive and inferential analyses were performed. Firth logistic regression was employed using the "firthlogit" command in STATA. The adjusted odds ratio and 95% confidence interval were presented. RESULTS Overall, the prevalence of PCa screening uptake was 4.4%. The odds of PCa screening uptake were high among men aged 50-54 [aOR= 2.08; CI= 1.23, 3.52], those who had health insurance coverage [aOR= 1.69; CI= 1.28, 2.23], those who read at least once in a week [aOR= 1.52; CI= 1.10, 2.10], and among those who watched TV at least once in a week [aOR= 1.73; CI= 1.18, 2.52]. Men who resided in the Eastern [aOR= 2.23; CI= 1.39, 3.60], Nyanza [aOR= 2.13; CI= 1.29, 3.53], and Nairobi [aOR= 1.97; CI= 1.01, 3.86] had a higher likelihood of getting screened for PCa. CONCLUSION In conclusion, the uptake of PCa screening in Kenya is low. To ensure the cost-effectiveness of health-promoting interventions that aim to improve PCa screening uptake in Kenya, men without health insurance coverage should be targeted and prioritized. Increasing literacy rate, sensitization via television, and increasing the insurance coverage in the country would significantly contribute to a higher uptake of PCa screening. POLICY SUMMARY To improve the uptake of PCa screening, there would be a need to implement a national advocacy campaign that will sensitize Kenyan men about the need to undergo PCa screening. This national advocacy campaign to increase the uptake of PCa screening in Kenya must leverage mass media platforms.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana; Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Bright Ankomahene
- Department of Geomatics Engineering, College of Engineering, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Martins T, Ukoumunne OC, Lyratzopoulos G, Hamilton W, Abel G. Are There Ethnic Differences in Recorded Features among Patients Subsequently Diagnosed with Cancer? An English Longitudinal Data-Linked Study. Cancers (Basel) 2023; 15:3100. [PMID: 37370710 PMCID: PMC10296232 DOI: 10.3390/cancers15123100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
We investigated ethnic differences in the presenting features recorded in primary care before cancer diagnosis. METHODS English population-based cancer-registry-linked primary care data were analysed. We identified the coded features of six cancers (breast, lung, prostate, colorectal, oesophagogastric, and myeloma) in the year pre-diagnosis. Logistic regression models investigated ethnic differences in first-incident cancer features, adjusted for age, sex, smoking status, deprivation, and comorbidity. RESULTS Of 130,944 patients, 92% were White. In total, 188,487 incident features were recorded in the year pre-diagnosis, with 48% (89,531) as sole features. Compared with White patients, Asian and Black patients with breast, colorectal, and prostate cancer were more likely than White patients to have multiple features; the opposite was seen for the Black and Other ethnic groups with lung or prostate cancer. The proportion with relevant recorded features was broadly similar by ethnicity, with notable cancer-specific exceptions. Asian and Black patients were more likely to have low-risk features (e.g., cough, upper abdominal pain) recorded. Non-White patients were less likely to have alarm features. CONCLUSION The degree to which these differences reflect disease, patient or healthcare factors is unclear. Further research examining the predictive value of cancer features in ethnic minority groups and their association with cancer outcomes is needed.
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Affiliation(s)
- Tanimola Martins
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| | - Obioha C. Ukoumunne
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK;
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, University College London, 1-19 Torrington Place, London WC1E 7HB, UK;
| | - Willie Hamilton
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
| | - Gary Abel
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, College of Medicine and Health, University of Exeter St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK; (W.H.); (G.A.)
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Vickers A, O'Brien F, Montorsi F, Galvin D, Bratt O, Carlsson S, Catto JW, Krilaviciute A, Philbin M, Albers P. Current policies on early detection of prostate cancer create overdiagnosis and inequity with minimal benefit. BMJ 2023; 381:e071082. [PMID: 37197772 DOI: 10.1136/bmj-2022-071082] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Frank O'Brien
- Department of Urology, Cork University Hospital, Ireland
| | | | - David Galvin
- Department of Surgery, University College Dublin, Ireland
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Sigrid Carlsson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - James Wf Catto
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, UK
| | - Agne Krilaviciute
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Peter Albers
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Urology, University Hospital, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany
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Van Poppel H, Albreht T, Basu P, Hogenhout R, Collen S, Roobol M. Serum PSA-based early detection of prostate cancer in Europe and globally: past, present and future. Nat Rev Urol 2022; 19:562-572. [PMID: 35974245 DOI: 10.1038/s41585-022-00638-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Abstract
In the pre-PSA-detection era, a large proportion of men were diagnosed with metastatic prostate cancer and died of the disease; after the introduction of the serum PSA test, randomized controlled prostate cancer screening trials in the USA and Europe were conducted to assess the effect of PSA screening on prostate cancer mortality. Contradictory outcomes of the trials and the accompanying overdiagnosis resulted in recommendations against prostate cancer screening by organizations such as the United States Preventive Services Task Force. These recommendations were followed by a decline in PSA testing and a rise in late-stage diagnosis and prostate cancer mortality. Re-evaluation of the randomized trials, which accounted for contamination, showed that PSA-based screening does indeed reduce prostate cancer mortality; however, the debate about whether to screen or not to screen continues because of the considerable overdiagnosis that occurs using PSA-based screening. Meanwhile, awareness among the population of prostate cancer as a potentially lethal disease stimulates opportunistic screening practices that further increase overdiagnosis without the benefit of mortality reduction. However, in the past decade, new screening tools have been developed that make the classic PSA-only-based screening an outdated strategy. With improved use of PSA, in combination with age, prostate volume and with the application of prostate cancer risk calculators, a risk-adapted strategy enables improved stratification of men with prostate cancer and avoidance of unnecessary diagnostic procedures. This combination used with advanced detection techniques (such as MRI and targeted biopsy), can reduce overdiagnosis. Moreover, new biomarkers are becoming available and will enable further improvements in risk stratification.
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Affiliation(s)
| | - Tit Albreht
- National Institute of Public Health, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | - Renée Hogenhout
- Erasmus University Medical Center, Cancer Institute, Rotterdam, Netherlands
| | - Sarah Collen
- European Association of Urology, Arnhem, Netherlands
| | - Monique Roobol
- Erasmus University Medical Center, Cancer Institute, Rotterdam, Netherlands
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12
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Clift AK, Hippisley-Cox J, Dodwell D, Lord S, Brady M, Petrou S, Collins GS. Development and validation of clinical prediction models for breast cancer incidence and mortality: a protocol for a dual cohort study. BMJ Open 2022; 12:e050828. [PMID: 35351695 PMCID: PMC8961149 DOI: 10.1136/bmjopen-2021-050828] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 01/07/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Breast cancer is the most common cancer and the leading cause of cancer-related death in women worldwide. Risk prediction models may be useful to guide risk-reducing interventions (such as pharmacological agents) in women at increased risk or inform screening strategies for early detection methods such as screening. METHODS AND ANALYSIS The study will use data for women aged 20-90 years between 2000 and 2020 from QResearch linked at the individual level to hospital episodes, cancer registry and death registry data. It will evaluate a set of modelling approaches to predict the risk of developing breast cancer within the next 10 years, the 'combined' risk of developing a breast cancer and then dying from it within 10 years, and the risk of breast cancer mortality within 10 years of diagnosis. Cox proportional hazards, competing risks, random survival forest, deep learning and XGBoost models will be explored. Models will be developed on the entire dataset, with 'apparent' performance reported, and internal-external cross-validation used to assess performance and geographical and temporal transportability (two 10-year time periods). Random effects meta-analysis will pool discrimination and calibration metric estimates from individual geographical units obtained from internal-external cross-validation. We will then externally validate the models in an independent dataset. Evaluation of performance heterogeneity will be conducted throughout, such as exploring performance across ethnic groups. ETHICS AND DISSEMINATION Ethics approval was granted by the QResearch scientific committee (reference number REC 18/EM/0400: OX129). The results will be written up for submission to peer-reviewed journals.
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Affiliation(s)
- Ashley Kieran Clift
- Cancer Research UK Oxford Centre, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Simon Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - Mike Brady
- Department of Oncology, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
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13
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Thorsen O, Viste E, Lid TG, Kjosavik SR. General practitioners' reflections on using PSA for diagnosis of prostate cancer. A qualitative study. Scand J Prim Health Care 2022; 40:123-128. [PMID: 35412395 PMCID: PMC9090342 DOI: 10.1080/02813432.2022.2057032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate how GPs use the PSA test as a diagnostic tool in daily practice. DESIGN Qualitative study using focus group interviews, the transcripts being analyzed by systemic text condensation. SUBJECTS A total of 17 Norwegian GPs in three CME groups. MAIN OUTCOME MEASURES Exploring GPs' attitudes to national guidelines and the practical use of the PSA test. RESULTS Detecting prostate cancer in general practice is a common and important, but difficult diagnostic issue. Our participants experienced uncertainty regarding the test when to use it, how to interpret the results and when to refer to specialist health services. CONCLUSION The study revealed a general ambivalence to the use of PSA. Many patients present urological problems, and many are afraid of having cancer. PSA is commonly used, but sometimes generates problems rather than solving them. IMPLICATIONS The use of the PSA test should be based on a thorough clinical assessment and in close collaboration with the patient.Key pointsMany patients in general practice present urological problems, and many are afraid of having cancer.GPs have a general ambivalence to the use of PSA when to use it, how to interpret the results and when to refer to specialist health services.The use of PSA sometimes generates problems rather than solving them.
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Affiliation(s)
- Olav Thorsen
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway
- CONTACT Olav Thorsen The General Practice and Care Coordination Research Group, Stavanger University Hospital
| | - Eirik Viste
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Torgeir Gilje Lid
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Svein R. Kjosavik
- The General Practice and Care Coordination Research Group, Stavanger University Hospital, Stavanger, Norway
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Carlsson SV, Murata K, Danila DC, Lilja H. PSA: role in screening and monitoring patients with prostate cancer. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Prostate-specific antigen testing and opportunistic prostate cancer screening - CAP intervention. Br J Gen Pract 2021; 71:157. [PMID: 33771807 DOI: 10.3399/bjgp21x715361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Prostate-specific antigen testing and opportunistic prostate cancer screening - informed consent. Br J Gen Pract 2021; 71:158. [PMID: 33771808 DOI: 10.3399/bjgp21x715373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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