Perspectives on prostate cancer screening with PSA – a focus group study with men in Norway aged 54–85 years

Critical Appraisal of Prostate-specific Antigen in Prostate Cancer Screening: 20 Years Later

Relationship Among Initial Serum Prostate Specific Antigen, Prostate Specific Antigen Progression and Prostate Cancer Detection at Repeat Screening Visits

-2]Proenzyme Prostate Specific Antigen is More Accurate Than Total and Free Prostate Specific Antigen in Differentiating Prostate Cancer From Benign Disease in a Prospective Prostate Cancer Screening Study

Prostate Specific Antigen and Human Glandular Kallikrein 2 in Early Detection of Prostate Cancer

The Impact of Recent Screening Recommendations on Prostate Cancer Screening in a Large Health Care System

At present, increased early detection of prostate cancer appears to be the most feasible way to reduce cancer-related mortality. As a result significant efforts have been made to identify more men with curable cancer. This article reviews the role of serum prostate-specific antigen in an early detection or screening strategy and describes efforts to enhance the specificity of prostate-specific antigen testing.

ObjectivesTo assess the feasibility and uptake of a community‐based prostate cancer (PCa) screening programme selecting men according to their genetic risk of PCa. To assess the uptake of PCa screening investigations by men invited for screening. The uptake of the pilot study would guide the opening of the larger BARCODE1 study recruiting 5000 men.Subjects and MethodsHealthy males aged 55–69 years were invited to participate via their general practitioners (GPs). Saliva samples were collected via mailed collection kits. After DNA extraction, genotyping was conducted using a study specific assay. Genetic risk was based on genotyping 130 germline PCa risk single nucleotide polymorphisms (SNPs). A polygenic risk score (PRS) was calculated for each participant using the sum of weighted alleles for 130 SNPs. Study participants with a PRS lying above the 90th centile value were invited for PCa screening by prostate magnetic resonance imaging (MRI) and biopsy.ResultsInvitation letters were sent to 1434 men. The overall study uptake was 26% (375/1436) and 87% of responders were eligible for study entry. DNA genotyping data were available for 297 men and 25 were invited for screening. After exclusions due to medical comorbidity/invitations declined, 18 of 25 men (72%) underwent MRI and biopsy of the prostate. There were seven diagnoses of PCa (38.9%). All cancers were low‐risk and were managed with active surveillance.ConclusionThe BARCODE1 Pilot has shown this community study in the UK to be feasible, with an overall uptake of 26%. The main BARCODE1 study is now open and will recruit 5000 men. The results of BARCODE1 will be important in defining the role of genetic profiling in targeted PCa population screening. Patient SummaryWhat is the paper about?Very few prostate cancer screening programmes currently exist anywhere in the world. Our pilot study investigated if men in the UK would find it acceptable to have a genetic test based on a saliva sample to examine their risk of prostate cancer development. This test would guide whether men are offered prostate cancer screening tests.What does it mean for patients?We found that the study design was acceptable: 26% of men invited to take part agreed to have the test. The majority of men who were found to have an increased genetic risk of prostate cancer underwent further tests offered (prostate MRI scan and biopsy). We have now expanded the study to enrol 5000 men. The BARCODE1 study will be important in examining whether this approach could be used for large‐scale population prostate cancer screening.

This study analyzed data from a community-based prostate cancer (PCa) education and screening program (Prostate Outreach Project; POP) to enhance PCa-related knowledge among medically underserved Asian American men. It also examined PCa screening history, clinical abnormalities based on prostate-specific antigen (PSA) tests and digital rectal examination (DRE) results, and follow-up and PCa diagnosis rates. Participants-521 Asian men (251 Vietnamese, 142 Chinese, and 128 South Asians)-were offered PCa screening using PSA tests and/or DRE and an educational session on PCa. Of these men, 277 completed PCa-related knowledge surveys before and after viewing an educational video. Significant between-group differences in PCa-related knowledge were found at pre-assessment (p < 0.001) but not at post-assessment (p = 0.11), at which time all groups showed improved PCa-related knowledge. Most participants (77.9%) had never received PCa screening, but Vietnamese men had the lowest previous screening rate (17.3%). Chinese men had elevated PSA values and the highest abnormal DRE rates. Of the 125 men with abnormal screening outcomes, only 15.2% had adequate follow-up. Of the 144 men diagnosed with PCa in POP, 11.1% were Asians (seven Chinese, six Vietnamese, and three South Asian). Despite the ethnic heterogeneity among Asian men, a community outreach program may successfully enhance their PCa-related knowledge.

Prostate cancer continues to be a substantial burden on men's health with 238 590 new cases and 29 720 deaths expected in 2013, making it the most commonly diagnosed noncutaneous malignancy and the second leading cause of cancer mortality in men (1).Nonmodifiable risk factors such as age, race, and family history are known to contribute to a man's risk of developing prostate cancer.In this issue of the Journal, Flynn-Evans and colleagues examine the potential role of shiftwork as an additional prostate cancer risk factor (2).Flynn-Evans and colleagues combined the results from three separate National Health and Nutrition Examination Surveys (NHANESs) to determine the impact of work schedule on the serum prostate-specific antigen (PSA) values (total and percentage free) of men aged 40 to 65 years (2).Although an imperfect biomarker, increased total PSA and low percentage free PSA are associated with a higher risk of prostate cancer.Because disruptions in circadian rhythms have been implicated in carcinogenesis, the authors sought to investigate the differences between the serum PSA values of men performing shiftwork (defined by the authors as regular night shifts or a rotating schedule) vs all other schedules (3).NHANES, which provides a representative sample of adult, noninstitutionalized American men, is a unique vehicle with which to perform this study.From the combined results of the 2005 to 2006, 2007 to 2008, and 2009 to 2010 surveys, a total of 2017 men had both occupational and PSA information available for analysis.The authors conclude that current shiftworkers aged 40 to 65 years had a statistically significant positive association with elevated PSA of 4.0 ng/mL or greater compared with nonshiftworkers (2).Flynn-Evans and colleagues (2) provide supportive data for the hypothesis that shiftwork may affect serum PSA values, although with some limitations.Although the NHANES dataset is designed to represent the United States as a whole through extrapolation, the sample size of 2017 is small, and the work described by Flynn-Evans and colleagues required corrective measures to properly weight each of the three NHANESs used.For example, only 3% of men in this study had a total PSA value greater than or equal to 4.0 ng/mL, which was their a priori definition of elevated PSA.Although their multivariable model adjusted for age, body mass index, race/ethnicity, health insurance, average hours of sleep per night, and months on the current job, it did not consider other potential covariables, some of which are available through NHANES.For example, NHANES has been used to show an association between altered PSA levels and some medications, diet, and physical activity (4-7).It is possible to hypothesize that nonmedical determinants of health, such as opportunities to exercise, personal dietary preferences, and the availability of healthy eating choices, could vary based on whether a man is a day worker vs. shiftworker.

Background: In 2010, more than 145,000 new cases of colorectal cancer (CRC) will be diagnosed. While those with localized disease have very high survival rates, those with locally advanced and metastatic disease have poorer outcomes, and many will die of CRC. Incidence and death rates from CRC remain higher for African Americans (AA) as compared to Caucasian Americans (CA). However, CRC screening rates among AA men have lagged behind those of CA men. AA men are also at increased risk for prostate cancer (PCA), and many AA men are motivated to seek PCA risk assessment and screening which is an ideal time to motivate AA men to perform CRC screening. This study was performed to assess self-reported CRC screening rates and predictors among men at high-risk for PCA (AA men and men with a family history of PCA) who are motivated to enroll in a PCA risk assessment program in order to understand CRC screening behaviors and predictors to pursue CRC screening. Methods: The Prostate Cancer Risk Assessment Program (PRAP) at Fox Chase Cancer Center is a PCA screening, risk counseling, and research program for men at high risk for PCA. Eligibility criteria include any man between 35-69 years with (1) at least 1 first-degree relative with PCA, (2) at least 2 second-degree relatives with PCA on the same side of the family or (3) any AA man regardless of family history of PCA. CRC screening information was self-reported by participants on standard PRAP health history questionnaires. Frequency and differences in CRC screening methods (fecal occult blood testing [FOBT], colonoscopy/sigmoidoscopy) by race were assessed using chi-squared tests and predictors of CRC screening was assessed using multivariate logistic regression (SAS version 9.1). Results: 740 PRAP participants were analyzed, of whom 62% were AA. Overall, AA men had statistically significant lower rates of any CRC screening measure compared to CA PRAP participants (46% vs 58% respectively, p=0.0015). Among PRAP participants age &amp;gt;50 years, AA men reported significantly lower FOBT (p=0.03), colonoscopy/ sigmoidoscopy (p=0.01), and any CRC screening test (p=0.04) compared to CA men. On multivariate logistic regression analysis among 704 PRAP participants with complete socioeconomic and demographic data, race remained a significant predictor of any CRC screening test after adjusting for age (p=0.007), but was not significant after adjusting for marital status, education, and income. For colonoscopy/sigmoidoscopy, race remained a significant predictor after adjusting for age (p=0.0013), education (p=0.0085), and marital status (p=0.0013) and was borderline significant after adjusting for income (p=0.051). Conclusion: Even among motivated AA men participating in a PCA screening program, screening for CRC remains suboptimal. These results highlight an opportunity to intervene for AA men seeking PCA screening to discuss and pursue CRC screening to lower mortality from CRC. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B104.

Gleason 6 Prostate Cancer: Translating Biology into Population Health

Mass Screening for Prostate Cancer in Korea: A Population Based Study

A Multicenter Study of [-2]Pro-Prostate Specific Antigen Combined With Prostate Specific Antigen and Free Prostate Specific Antigen for Prostate Cancer Detection in the 2.0 to 10.0 ng/ml Prostate Specific Antigen Range

Overview of Performance Indicators of Prostate Cancer Screening Trials

PD44-01 THE PROSTATE GENETIC SCORE (PGS) STRATIFIES BASELINE RISK OF PROSTATE CANCER AND IMPROVES PSA PERFORMANCE IN THE PLCO TRIAL