Benefits Of Prostate Cancer Screening Research Articles

Prostate cancer risk, screening and management in patients with germline BRCA1/2 mutations.

Mutations in the BRCA1 and BRCA2 tumour suppressor genesare associated with prostate cancer risk; however, optimal screening protocols for individuals with these mutations have been a subject of debate. Several prospective studies of prostate cancer incidence and screening among BRCA1/2 mutation carriers have indicated at least a twofold to fourfold increase in prostate cancer risk among carriers of BRCA2 mutations compared with the general population. Moreover, BRCA2 mutations are associated with more aggressive, high-grade disease characteristics at diagnosis, more aggressive clinical behaviour and greater prostate cancer-specific mortality. The risk for BRCA1 mutations seems to be attenuated compared with BRCA2. Prostate-specific antigen (PSA) measurement or prostate magnetic resonance imaging (MRI) alone is an imperfect indicator of clinically significant prostate cancer; therefore, BRCA1/2 mutation carriers might benefit from refined risk stratification strategies. However, the long-term impact of prostate cancer screening is unknown, and the optimal management of BRCA1/2 carriers with prostate cancer has not been defined. Whether timely localized therapy can improve overall survival in the screened population is uncertain. Long-term results of prospective studies are awaited to confirm the optimal screening strategies and benefits of prostate cancer screening among BRCA1/2 mutation carriers, and whether these approaches ultimately have a positive impact on survival and quality of life in these patients.

Including Information on Overdiagnosis in Shared Decision Making: A Review of Prostate Cancer Screening Decision Aids.

Background. Overdiagnosis is an accepted harm of cancer screening, but studies of prostate cancer screening decision aids have not examined provision of information important in communicating the risk of overdiagnosis, including overdiagnosis frequency, competing mortality risk, and the high prevalence of indolent cancers in the population. Methods. We undertook a comprehensive review of all publicly available decision aids for prostate cancer screening, published in (or translated to) the English language, without date restrictions. We included all decision aids from a recent systematic review and screened excluded studies to identify further relevant decision aids. We used a Google search to identify further decision aids not published in peer reviewed medical literature. Two reviewers independently screened the decision aids and extracted information on communication of overdiagnosis. Disagreements were resolved through discussion or by consulting a third author. Results. Forty-one decision aids were included out of the 80 records identified through the search. Most decision aids (n = 32, 79%) did not use the term overdiagnosis but included a description of it (n = 38, 92%). Few (n = 7, 17%) reported the frequency of overdiagnosis. Little more than half presented the benefits of prostate cancer screening before the harms (n = 22, 54%) and only 16, (39%) presented information on competing risks of mortality. Only 2 (n = 2, 5%) reported the prevalence of undiagnosed prostate cancer in the general population. Conclusion. Most patient decision aids for prostate cancer screening lacked important information on overdiagnosis. Specific guidance is needed on how to communicate the risks of overdiagnosis in decision aids, including appropriate content, terminology and graphical display.HighlightsMost patient decision aids for prostate cancer screening lacks important information on overdiagnosis.Specific guidance is needed on how to communicate the risks of overdiagnosis.

Diagnostic Value of Magnetic Resonance Susceptibility-Weighted Imaging Scanning in Different Types of Early Prostate Cancer.

To investigate the cost of MRI-sensitive imaging (SWI) for early-stage prostate cancer. In 2019, the research group included a total of 60 leukemia patients, all of whom were diagnosed with prostate-specific antigen (PSA). According to the range of PSA values, they were group A (18 cases), group A 0-44 mg/ml (18 cases), and group B 4-1010 mg/ml (26 cases). 10 mg/ml was divided into C group (16 cases). Another 60 patients with benign prostatic hyperplasia treated at the same time served as a control group. All patients underwent sensitive MRI scanning, followed by diagnostic and clinical evaluation of weighted MRI scanning to diagnose various types of prostate cancer. The results showed that there was no difference in Ve levels among the three groups (P > 0.05); the SUSE score and Ktrans and Kep levels of the patients in group C were higher in groups B, A, and A (P < 0.05). In patients with early leukemia, SUSE score was significantly correlated with Ktrans and Kep levels (P < 0.05), but not with Ve and P > 0.05 levels. Magnetic resonance imaging can be used to diagnose prostate cancer. It can differentiate and diagnose different types of prostate cancer early. This is important for evaluating the benefits of prostate cancer screening and treatment.

Attitude Toward Prostate Cancer Screening in Hong Kong: The Importance of Perceived Consequence and Anticipated Regret.

There are long-standing debates about the benefits of prostate cancer screening. Conflicting trial results and inconsistent recommendations regarding prostate cancer screening in clinical guidelines highlight the importance of patient factors that influence decision making in prostate cancer screening. Attitude is an important factor associated with cancer screening. However, attitudes toward prostate cancer screening among Chinese men are still poorly understood. The objective of the study was to evaluate attitudes toward prostate cancer screening and their association with prostate cancer screening intention among Chinese men. In this community-based study, 340 males were randomly recruited. Three distinct concepts related to prostate cancer screening attitudes were evaluated, including perceived consequences of screening, moral obligation, and anticipated regret. The intention to have prostate cancer screening was asked. Only 5.00% of the study participants had prostate cancer screening before, while 69.71% have an intention to undergo screening in the future. Participants with a high level of anticipated regret also had a high likelihood to have screening in the future, with an adjusted odds ratio (aOR) of 1.82. Participants who had favorable attitudes toward the consequence of participating in prostate cancer screening had a high likelihood to undergo screening, with an aOR of 1.22. Participants who were more concerned about pain and invasion of privacy were less likely to have an intention to have prostate cancer screening, with aORs of 0.53 and 0.57, respectively. To enhance screening intention, public health programs should include components related to anticipated regrets and perceived consequences.

The comparative effectiveness of mpMRI and MRI-guided biopsy vs regular biopsy in a population-based PSA testing: a modeling study

The benefit of prostate cancer screening is counterbalanced by the risk of overdiagnosis and overtreatment. The use of a multi-parametric magnetic resonance imaging (mpMRI) test after a positive prostate-specific antigen (PSA) test followed by magnetic resonance imaging-guided biopsy (MRIGB) may reduce these harms. The aim of this study was to determine the effects of mpMRI and MRIGB vs the regular screening pathway in a population-based prostate cancer screening setting. A micro-simulation model was used to predict the effects of regular PSA screening (men with elevated PSA followed by TRUSGB) and MRI based screening (men with elevated PSA followed by mpMRI and MRIGB). We predicted reduction of overdiagnosis, harm-benefit ratio (overdiagnosis per cancer death averted), reduction in number of biopsies, detection of clinically significant cancer, prostate cancer death averted, life-years gained (LYG), and quality adjusted life years (QALYs) gained for both strategies. A univariate sensitivity analysis and threshold analysis were performed to assess uncertainty around the test sensitivity parameters used in the MRI strategy.In the MRI pathway, we predicted a 43% reduction in the risk of overdiagnosis, compared to the regular pathway. Similarly a lower harm-benefit ratio (overdiagnosis per cancer death averted) was predicted for this strategy compared to the regular screening pathway (1.0 vs 1.8 respectively). Prostate cancer mortality reduction, LY and QALYs gained were also slightly increased in the MRI pathway than the regular screening pathway. Furthermore, 30% of men with a positive PSA test could avoid a biopsy as compared to the regular screening pathway. Compared to regular PSA screening, the use of mpMRI as a triage test followed by MRIGB can substantially reduce the risk of overdiagnosis and improve the harm-benefit balance, while maximizing prostate cancer mortality reduction and QALYs gained.

Merging new-age biomarkers and nanodiagnostics for precision prostate cancer management.

The accurate identification and stratified treatment of clinically significant early-stage prostate cancer have been ongoing concerns since the outcomes of large international prostate cancer screening trials were reported. The controversy surrounding clinical and cost benefits of prostate cancer screening has highlighted the lack of strategies for discriminating high-risk disease (that requires early treatment) from low-risk disease (that could be managed using watchful waiting or active surveillance). Advances in molecular subtyping and multiomics nanotechnology-based prostate cancer risk delineation can enable refinement of prostate cancer molecular taxonomy into clinically meaningful and treatable subtypes. Furthermore, the presence of intertumoural and intratumoural heterogeneity in prostate cancer warrants the development of novel nanodiagnostic technologies to identify clinically significant prostate cancer in a rapid, cost-effective and accurate manner. Circulating and urinary next-generation prostate cancer biomarkers for disease molecular subtyping and the newest complementary nanodiagnostic platforms for enhanced biomarker detection are promising tools for precision prostate cancer management. However, challenges in merging both aspects and clinical translation still need to be overcome.

Shared development of prostate cancer education materialElaboración compartida de material educativo sobre el cáncer de próstata

RESUMOObjetivoApresentar o processo de construção compartilhada de material educativo sobre câncer de próstata.MétodosFoi desenvolvida uma pesquisa participante com uma amostra de conveniência que incluiu, inicialmente, 15 homens e uma mulher (média de idade: 52 anos), todos trabalhadores da mesma empresa, para subsidiar a elaboração de um material educativo. A primeira versão foi avaliada por oito especialistas (cinco especialistas em detecção precoce do câncer, um em urologia e dois em comunicação social) e um grupo diferente de 21 participantes (18 homens e três mulheres; média de idade: 41 anos). O material elaborado abordou riscos e benefícios do rastreamento do câncer de próstata.ResultadosOs participantes desconheciam a orientação do Ministério da Saúde contra o rastreamento do câncer de próstata e houve debate sobre dúvidas e percepções relativas ao tema. O produto final, que gerou uma publicação do Instituto Nacional de Câncer José Alencar Gomes da Silva, foi avaliado por participantes e especialistas.ConclusõesA participação dos homens na elaboração e na avaliação do material confirmou a necessidade imperiosa de difundir informações sobre riscos e potenciais danos associados ao rastreamento desse câncer. O material educativo não deve ser visto como peça isolada, mas como recurso complementar para ações educativas em saúde de caráter participativo, crítico e criativo.

Results of Prostate Cancer Screening in a Unique Cohort at 19 yr of Follow-up

We assessed the effect of screening in the European Randomized study of Screening for Prostate Cancer (ERSPC) Rotterdam pilot 1 study cohort with men randomized in 1991–1992. A total of 1134 men were randomized on a 1:1 basis to a screening (S) and control (C) arm after prostate-specific antigen (PSA) testing (PSA ≥10.0ng/ml was excluded from randomization). Further PSA testing was offered to all men in the S-arm with 4-yr intervals starting at age 55yr and screened up to the age of 74yr. Overall, a PSA level of ≥3.0ng/ml triggered biopsy. At time of analysis, 63% of men had died. Overall relative risk of metastatic (M+) disease and prostate cancer (PCa) death was 0.46 (95% confidence interval [CI]: 0.19–1.11) and 0.48 (95% CI: 0.17–1.36), respectively, in favor of screening. This ERSPC Rotterdam pilot 1 study cohort, screened in a period without noteworthy contamination, shows that PSA-based screening could result in considerable reductions of M+ disease and mortality which if confirmed in larger datasets should trigger further discussion on pros/cons of PCa screening. Patient summaryIn a cohort with 19yr of follow-up, we found indications for a more substantial reduction in metastatic disease and cancer-specific mortality in favor of prostate cancer screening than previously reported. If confirmed in larger cohorts, these findings should be considered in the ongoing discussion on harms and benefits of prostate cancer screening.

Prostate-Specimen Antigen (PSA) Screening and Shared Decision Making Among Deaf and Hearing Male Patients.

Some deaf men who use American Sign Language (ASL) experience barriers in patient-physician communication which may leave them at disparity for shared decision making compared to hearing men. Transparent communication accessibility is needed between deaf male ASL users and their physicians to maximize the benefit to risk ratio of using the prostate-specific antigen (PSA) as a screening tool for early detection. The objective is to compare shared decision-making outcomes between deaf and hearing males who are (1) age-eligible for PSA screening and (2) younger than 45years old with a family history of cancer. An accessible health survey including questions about PSA test, PCC, modes of communication, and cancer history was administered in ASL to a nationwide sample of deaf adults from February 2017 to April 2018. Two subsamples were created: (1) 45- to 69-year-old men who were age-eligible for PSA testing and (2) 18- to 44-year-old men with a family history of cancer. Age-eligible and younger deaf men with a family history of cancer are at disparity for shared decision making compared to their hearing peers. Regardless of age and PSA testing status, deaf men felt significantly less engaged in shared decision making with their health care providers compared to hearing men. Participation in shared decision making requires not only accessible communication but also cultural competency in working with deaf patients. This is critical in the shared decision-making era in maximizing the benefit of prostate cancer screening in deaf male patient population.

Quando o antígeno específico da próstata nos leva ao Balint: um relato de caso

O benefício do rastreio do câncer da próstata na redução da mortalidade continua controverso. O risco de intervenção médica excessiva, diagnóstica e terapêutica, é significativo, pelo que não devem ser descurados os princípios éticos da prevenção quaternária. A decisão deverá ser sempre partilhada. Mas, para que isto aconteça, é fundamental uma boa comunicação/relação médico-doente. O caso que se descreve aborda estes e demais aspectos, pondo em causa a não utilidade do rastreio. Trata-se de um homem jovem com adenocarcinoma da próstata metastizado que, anos antes, já apresentava uma elevação do antígeno específico da próstata (PSA) que não foi valorizada. Um doente por si só já difícil e cujo diagnóstico desafiou ainda mais a tentativa de criação de uma relação empática. Obstáculo que acabou por ser ultrapassado com sucesso depois do médico de família participar num grupo Balint.

Cost-effectiveness of prostate cancer screening: a systematic review of decision-analytical models

BackgroundThere is ongoing debate about the harms and benefits of a national prostate cancer screening programme. Several model-based cost-effectiveness analyses have been developed to determine whether the benefits of prostate cancer screening outweigh the costs and harms caused by over-detection and over-treatment, and the different approaches may impact results.MethodsTo identify models of prostate cancer used to assess the cost-effectiveness of prostate cancer screening strategies, a systematic review of articles published since 2006 was conducted using the NHS Economic Evaluation Database, Medline, EMBASE and HTA databases. The NICE website, UK National Screening website, reference lists from relevant studies were also searched and experts contacted. Key model features, inputs, and cost-effectiveness recommendations were extracted.ResultsTen studies were included. Four of the studies identified some screening strategies to be potentially cost-effective at a PSA threshold of 3.0 ng/ml, including single screen at 55 years, annual or two yearly screens starting at 55 years old, and delayed radical treatment. Prostate cancer screening was modelled using both individual and cohort level models. Model pathways to reflect cancer progression varied widely, Gleason grade was not always considered and clinical verification was rarely outlined. Where quality of life was considered, the methods used did not follow recommended practice and key issues of overdiagnosis and overtreatment were not addressed by all studies.ConclusionThe cost-effectiveness of prostate cancer screening is unclear. There was no consensus on the optimal model type or approach to model prostate cancer progression. Due to limited data availability, individual patient-level modelling is unlikely to increase the accuracy of cost-effectiveness results compared with cohort-level modelling, but is more suitable when assessing adaptive screening strategies. Modelling prostate cancer is challenging and the justification for the data used and the approach to modelling natural disease progression was lacking. Country-specific data are required and recommended methods used to incorporate quality of life. Influence of data inputs on cost-effectiveness results need to be comprehensively assessed and the model structure and assumptions verified by clinical experts.

Similar perspectives on prostate cancer screening value and new guidelines across patient demographic and PSA level subgroups: A qualitative study.

BackgroundIn 2012, the United States Preventive Services Task Force (USPSTF) recommended against prostate‐specific antigen (PSA)‐based prostate cancer screening for all men.ObjectiveTo inform educational materials addressing patient questions and concerns about the 2012 USPSTF guidelines, we sought to: (i) characterize patient perceptions about prostate cancer screening benefits, harms and recommendations against screening, and (ii) compare perceptions across race, age and PSA level subgroups.MethodsWe conducted qualitative interviews with a sample of 26 men from the Minneapolis Veterans Affairs Health Care System, stratified by race (African American, other), age (50‐69, 70‐84) and PSA level (documented PSA level ≥4 in Veterans Health Administration electronic medical records vs no such documentation). We used an inductive approach informed by grounded theory to analyse transcribed interviews.ResultsMost men in all subgroups expressed misperceptions about the benefits of prostate cancer screening and had difficulty identifying harms associated with screening. In all subgroups, reactions to recommendations against screening ranged from unconditionally receptive to highly resistant. Some men in every subgroup initially resistant to the idea said they would accept a recommendation to discontinue screening from their provider.ConclusionsGiven the similarity of perceptions and reactions across subgroups, materials targeted by race, age and PSA level may not be necessary. Efforts to inform decision making about prostate cancer screening should address misperceptions about benefits and lack of awareness of harms. Provider perspectives and recommendations may play a pivotal role in shaping patient reactions to new guidelines.

Facilitating Shared Decision Making About Prostate Cancer Screening Among African American Men.

To describe the development and implementation of a prostate cancer screening intervention and risk assessment decision tool. . Community health promotion with pre- and post-education knowledge questionnaires. . Two predominantly African American churches in different suburban communities in Southern California. . A convenience sample of 50 African American men aged from 30-75 years. . A Prostate Cancer Screening Decision Aid was developed and used in conjunction with an educational intervention for African American men in two suburban communities in Southern California. The educational intervention was implemented in local African American churches. The intervention included a PowerPoint® presentation with a four-minute video. Men completed pre- and post-education knowledge questionnaires and a risk assessment decision tool. . Prostate cancer knowledge, awareness of prostate cancer personal risks and benefits of prostate cancer screening, information needed for initiating discussions with provider, and intention to participate in shared decision making with healthcare providers. . An 8% increase in knowledge was calculated when comparing pre- and post- education responses. Awareness of personal risks, having the information needed to initiate a discussion with a healthcare provider, intention to participate in shared decision making within six months, prostate cancer knowledge, and having had participated in screening increased. . The intervention was successful in increasing knowledge and awareness of personal risks and providing tools to facilitate shared decision making with healthcare providers. . Nurses can play a meaningful role in collaborating with community lay leaders to develop and implement effective health promotion interventions for African Americans.

Association Between Older Age and Increasing Gleason Score

IntroductionIn order to help inform the discussion about the risks versus benefits of prostate cancer screening among older men, we determined whether advanced age is associated with a higher probability of harboring high-grade or high-risk disease. Patients and MethodsThe Surveillance, Epidemiology, and End Results (SEER) database was used to identify 383,039 men diagnosed with prostate cancer in 2004-2011. The percentage of patients diagnosed with low-, intermediate-, or high-risk disease or a Gleason score of 6, 7, or 8 to 10 was calculated by age range. As a secondary analysis, we examined whether this relationship was different in 2010-2011 versus 2007-2008 (before and after the 2009 publication of screening trials). ResultsThe probability of Gleason score 8 to 10 or high-risk disease increased significantly with increasing age. The percentage of Gleason score 8 to 10 disease among men ages 50 to 54, 70 to 74, and 80 to 84 years was 8.9%, 16.2%, and 28.5%, respectively, and the percentage of high-risk disease was 14.3%, 22.4%, and 38.7% (P < .001). There were similar relationships among men with stage T1c disease. In addition, older men experienced a significant increase in the relative probability of high-risk or high-grade disease from 2007-2008 to 2010-2011. ConclusionIn this large US-based cohort, older men had a much higher probability of high-grade or high-risk prostate cancer. Physicians and patients should take into account the higher risk of more aggressive or advanced disease in older men when discussing the risks and benefits of prostate-specific antigen screening with healthy older men with a substantial life expectancy.

Pre-screening Discussions and Prostate-Specific Antigen Testing for Prostate Cancer Screening.

For many men, the net benefit of prostate cancer screening with prostate-specific antigen (PSA) tests may be small. Many major medical organizations have issued recommendations for prostate cancer screening, stressing the need for shared decision making before ordering a test. The purpose of this study is to better understand associations between discussions about benefits and harms of PSA testing and uptake of the test among men aged ≥40 years. Associations between pre-screening discussions and PSA testing were examined using self-reported data from the 2012 Behavioral Risk Factor Surveillance System. Unadjusted prevalence of PSA testing was estimated and AORs were calculated using logistic regression in 2014. The multivariate analysis showed that men who had ever discussed advantages of PSA testing only or discussed both advantages and disadvantages were more likely, respectively, to report having had a test within the past year than men who had no discussions (p<0.001). In addition, men who had only discussed the disadvantages of PSA testing with their healthcare providers were more likely (AOR=2.75, 95% CI=2.00, 3.79) to report getting tested than men who had no discussions. Discussions of the benefits or harms of PSA testing are positively associated with increased uptake of the test. Given the conflicting recommendations for prostate cancer screening and increasing importance of shared decision making, this study points to the need for understanding how pre-screening discussions are being conducted in clinical practice and the role played by patients' values and preferences in decisions about PSA testing.

A community-based approach to educating black men in underserved communities about the risks and benefits of prostate cancer screening.

99 Background: Black men have the highest incidence of prostate cancer (PCa) and are twice as likely to die of the disease than any other race/ethnic group in the United States. The recent controversy related to PCa screening may disproportionately impact black men who are already at greatest risk from the disease. This project sets out to develop culturally-competent educational and screening programs for men in high-risk populations so they can make an informed decision about PCa screening. Methods: A community-based education and screening program targeted towards black men living in an under-resourced community in Boston, MA was implemented. A mobile PCa screening van was initially employed and stationed at a local community health center (CHC) twice annually. Education about PCa screening was provided by a trained racially-concordant patient navigator (PN). Screening was available on the van by a primary care physician (PCP). In 2013, the pre-screening educational model was incorporated into the clinical practice of a single PCP practicing at the CHC. Every male patient over the age of 40 had an educational consultation about PCa screening with the PN before seeing their PCP. The patient would then discuss screening with the doctor and decide whether to proceed at that visit. Results: From 2004 to 2013, 20 van visits were conducted at the CHC. Two-hundred seven (207) men received PCa screening education; 179 (86.5%) elected to undergo screening. Of the men screened, 26 (14.5%) were referred for further testing as a result of their screening test. From January 2013 to September 2014, 121 men received PCa education; 100 men (82.6%) were screened. Ninety percent had both prostate-specific antigen testing and a digital rectal exam. Conclusions: These data suggest that formal PCa screening education prior to meeting with a physician is welcomed and may be a way to increase baseline screening in high risk populations. This provides an opportunity to develop an individualized prostate health management program based on individual risk profiles and to carefully monitor PSA fluctuations. The ultimate goal is to reduce unnecessary interventions while capturing PCa early in men at greatest risk.

Our Shifting Understanding of Factors Influencing Prostate-Specific Antigen

Our Shifting Understanding of Factors Influencing Prostate-Specific Antigen

Classifying the Reasons Men Consider to be Important in Prostate-Specific Antigen (PSA) Testing Decisions: Evaluating Risks, Lay Beliefs, and Informed Decisions

Despite uncertainty regarding the benefits of prostate cancer screening, many men have had a prostate-specific antigen (PSA) test. This study aims to identify classes of reasons guiding men's decisions about prostate cancer screening and predict reasoning approaches by family history and prior screening behaviour. First-degree relatives of men with prostate cancer (n = 207) and men from the general population (n = 239) of Australia listed reasons they considered when deciding whether to have a PSA test. Responses were coded into 31 distinct categories. Latent class analysis identified three classes. The evaluation of risk information cues class (20.9%) contained a greater number of men with a family history (compared with control and overcome cancer/risk class; 52.7%). Informed decisions and health system class (26.5%) included a lower proportion of men who had had a PSA test and greater proportions of highly educated and married men. Understanding the reasons underlying men's screening decisions may lead to a more effective information provision and decision support.

Prostate cancer screening: Attitudes and practices of family

Introduction: The utility of prostate cancer screening is controversial. We sought to determine whether Ontario’s family physicians believe it is beneficial and to characterize their screening protocols.Methods: A survey was developed with input from urologists,family physicians and the Ontario Medical Association’s Sectionon General and Family Practice. Questions covered three domains: (1) demographics, (2) beliefs about screening utility and (3) screening practices. All 7302 family physicians in Ontario were invited by email to complete the online survey.Results: A total of 969 physicians completed the survey; 955(52.0% male, 48.0% female) were included. Most (80.97%) useprostate-specific antigen (PSA) and digital rectal examination (DRE) for screening; 9.4% use DRE alone and 7.15% PSA. Of the respondents, 8.3% do not offer prostate cancer screening. Most physicians begin offering screening at age 50 (72.9%) and stop at ages 70 or 80 (68.4%); 17.9% offer lifelong screening. In response to the statement “screening with DRE provides a survival benefit,” 37.6% and 32.6 agreed and disagreed, respectively. For “screening with PSA provides a survival benefit,” 43.3% agreed and 31.0% disagreed. For the statement “the benefits of prostate cancer screening outweigh the risks,” 51.4% agreed and 22.0% disagreed.Discussion: Although 91.7% of respondents offer prostate cancer screening, they are divided over its utility. Only 51.4% were convinced that the benefits outweighed the harms. There is significant variability between physicians’ screening protocols. A limitation of study is the possibility of selection bias. Nevertheless, this is the largest sample of Ontario family physicians ever surveyed about prostate cancer screening and highlights divergent physician practices and a need for more conclusive evidence on screening utility.

PSA-detected prostate cancer in the United States: A population-based study of 70,345 men with AJCC stage T1cN0M0 disease.

50 Background: The U.S. Preventive Services Task Force (USPSTF) recently recommended against prostate-specific antigen (PSA)-based screening for prostate cancer. This recommendation has heightened the debate about risks and benefits of prostate cancer screening, and underscored our limited understanding of PSA-detected prostate cancer. The purpose of this study was to determine the frequency of various risks of prostate cancer based on patient characteristics and PSA levels. Methods: This population-based study used the Surveillance, Epidemiology, and End Results (SEER) program to identify men with AJCC stage T1cN0M0 disease diagnosed between 1/2004 and 12/2008. Multivariate logistic regression was conducted to model the probability of developing low (PSA &lt;10 mg/L and Gleason score ≤6), intermediate (PSA between 10 mg/L to 20 mg/L and/or Gleason score 7), and high risk diseases (PSA ≥20 mg/L, and/or Gleason score ≥8). Results: A total of 70,345 men with PSA-detected T1cN0M0 prostate cancer were evaluated. Among them, 47.6%, 35.9% and16.5% had low, intermediate, or high risk disease, respectively. Odds ratios (OR) of having intermediate or high risk disease in patients ≥75 years old were 4.47 (95% confidence interval (CI) 3.81 to 5.26, p&lt;0.01) and 9.39 (95% CI 7.25 to 12.16, p&lt;0.01), respectively, when compared with patients aged &lt;50. Also, black men had increased ORs for intermediate and high risk disease compared with white men (OR 1.50, 95% CI 1.42 to 1.58, p&lt;0.01 for intermediate risk disease; OR 1.84, 95% CI 1.72 to 19.97, p&lt;0.01 for high risk disease). While men aged &gt;75 accounted for 11.8% of the population at risk, they accounted for 24.3% of intermediate and 26.1% of high risk disease. Conclusions: A substantial number of PSA-detected prostate cancer patients have either intermediate or high risk disease at diagnosis. Men age &gt;75 or of black race have the highest risk of presenting with intermediate or high risk disease.