MP09-06 THE CHANGE IN PROSTATE CANCER PRESENTATION AND DIAGNOSIS COINCIDING WITH SCREENING RECOMMENDATIONS.

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You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2016MP09-06 THE CHANGE IN PROSTATE CANCER PRESENTATION AND DIAGNOSIS COINCIDING WITH SCREENING RECOMMENDATIONS. Franklin Gaylis, Jenny Choi, Paul Dato, Hilary Prime, Renee Calabrese, Edward Cohen, and A. Karim Kader Franklin GaylisFranklin Gaylis More articles by this author , Jenny ChoiJenny Choi More articles by this author , Paul DatoPaul Dato More articles by this author , Hilary PrimeHilary Prime More articles by this author , Renee CalabreseRenee Calabrese More articles by this author , Edward CohenEdward Cohen More articles by this author , and A. Karim KaderA. Karim Kader More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2293AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The controversy surrounding prostate cancer (PCa) screening resulted in the United States Preventative Services Task Force (USPSTF) and several primary care societies to recommend against this practice. We examined the characteristics of men evaluated in a large urology practice for an elevated prostate specific antigen (PSA) and the subsequent PCa diagnoses since the USPTF recommendation. METHODS Characteristics of all men presenting for an elevated PSA from August 2011 to August 2014 were prospectively collected in a database. Age at the time of biopsy, self-declared race, insurance status, family history, digital rectal examination findings, PSA within 6 months of biopsy, biopsy history, prostate volume, number of cores sampled, pathologic read (number and percent cores positive, Gleason Score [GS]) were all recorded. Kruskall-Wallis rank sum tests were used to compare across all years with post-hoc Dunn's tests for pairwise multiple comparisons using Bonferroni adjustment. RESULTS The number of men referred for elevated PSA dropped from 933 in year 1 to 754 by year 3 (19%) with a concomitant drop in the number of biopsies performed in newly referred men from 461 to 370 (20%). The group's prostate biopsy volume decreased by 15% (1,133 biopsies in year 1 compared to 958 in year 3). Median pre-biopsy PSA increased across all years from 7.0 ng/ml to 8.1 ng/ml (p=0.0006) with a rise in the proportion of men having PSAs > 10 from 28% to 38%. In the post-hoc analysis, median pre-biopsy PSA was significantly different between years 1 and 3 (p=0.0002) and years 2 and 3 (p=0.017) but not years 1 and 2 (p=0.33). The biopsy positivity rate increased slightly from 46% to 50% across all years with a rise in the proportion of men having Gleason Scores (GS) 8 from 21% to 30% (p=0.0001). In the post-hoc analysis, median GS was significantly different between year 1 and year 3 (p<0.0001) and year 2 to year 3 (p=0.0004) but not year 1 to year 2 (p=0.12). A small but noticeable rise in the incidence of metastatic disease was observed: 5.04% (year 1); 5.75% (year 2); 7.71% (year 3). CONCLUSIONS Our findings suggest a significant grade migration coincident with recommendations against PSA screening. While possibly desirable in the short term, should this trend continue we may miss the window of curability for many men. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e95-e96 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Franklin Gaylis More articles by this author Jenny Choi More articles by this author Paul Dato More articles by this author Hilary Prime More articles by this author Renee Calabrese More articles by this author Edward Cohen More articles by this author A. Karim Kader More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...