Screen Men For Prostate Cancer Research Articles

Update from the ReIMAGINE Prostate Cancer Screening Study NCT04063566: Inviting Men for Prostate Cancer Screening Using Magnetic Resonance Imaging

ReIMAGINE Screening is a single-centre study assessing the feasibility of biparametric magnetic resonance imaging as a screening tool for prostate cancer. The study outcomes will take us a step towards more accurate and less harmful prostate cancer screening.

Effect of Educational Program based on the Theory of Planned Behavior on Prostate Cancer Screening: A Randomized Clinical Trial.

Background and Aims:Prostate cancer screening applied for early diagnosis of prostate cancer. But it is not usually pursued by men. This study was conducted to determine the effect of educational program based on the Theory of Planned Behavior (TPB) on prostate cancer screening.Methods:A randomized clinical trial was carried out on 68 middle-aged men referring to community houses in Iran. Samples were selected consecutively considering the inclusion criteria. Then block randomization was used to assign the participants into two groups. Data collection included demographic characteristics, knowledge and construct of TPB (Attitude towards the behavior, Subjective norms, Perceived behavioral control, behavioral intention) and behavior. The participants in the intervention group attended a theory based program 4 session twice per week. The participants were evaluated before and two month after the intervention. P <0.05 was considered statistically significant.Results:After the 2 months intervention, the pretest-posttest changes in the intervention group compared to the control group were in the Knowledge 9.26 ± 3.5 vs. 0.03 ± 1.68, Attitude 11.46 ± 3.5 vs. -0.16 ± 1.39, Subjective norms 3.16 ± 2.6 vs. 0.29 ± 1.3, Behavioral control 6.76 ± 4 vs. 0.12 ± 1.60 and Behavioral intention 1.4 ± 1.54 vs. 0.00 ± 1.00 (P < 0.05). While none of the subjects in control group performed the prostate screening, 10 people (33.2%) performed it in the intervention group. (P < 0.001).Conclusions:Educational program based on TPB has a positive effect on prostate cancer screening. It is recommended to set up regular training programs based on TPB to encourage middle-aged men for prostate cancer screening.

Accountable care organizations and the use of prostate cancer screening and breast cancer screening.

e18308 Background: Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a non-recommended test, would be unaffected by ACO assignment. Methods: Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in women aged &lt; 75, (evidence-based cancer screening), and PCa-S in men &lt; 75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria following the review of guideline recommendations. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiary-level file. Propensity-score weighting was performed to balance out patient and sociodemographic covariates. Results: Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included 52,987 and 526,063 women for BCa-S; 86,936 and 814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p &lt; 0.001) Conclusions: The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-à-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model.

MP32-08 ACCOUNTABLE CARE ORGANIZATIONS AND THE USE OF PROSTATE CANCER SCREENING

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II1 Apr 2017MP32-08 ACCOUNTABLE CARE ORGANIZATIONS AND THE USE OF PROSTATE CANCER SCREENING Christian P. Meyer, Anna Krasnova, Jesse D. Sammon, Philipp Gild, Nicolas von Landenberg, Stuart R. Lipsitz, Joel S. Weissman, Felix K.H. Chun, Margit Fisch, Maxine Sun, and Quoc-Dien Trinh Christian P. MeyerChristian P. Meyer More articles by this author , Anna KrasnovaAnna Krasnova More articles by this author , Jesse D. SammonJesse D. Sammon More articles by this author , Philipp GildPhilipp Gild More articles by this author , Nicolas von LandenbergNicolas von Landenberg More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Joel S. WeissmanJoel S. Weissman More articles by this author , Felix K.H. ChunFelix K.H. Chun More articles by this author , Margit FischMargit Fisch More articles by this author , Maxine SunMaxine Sun More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.983AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a non-recommended test, would be unaffected by ACO assignment. METHODS Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in those aged <75, (evidence-based cancer screening), and PCa-S in those <75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiary-level file. RESULTS Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included, 52,987/526,063 women for BCa-S, and 86,936/814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p<.001). CONCLUSIONS The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-a-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e411 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christian P. Meyer More articles by this author Anna Krasnova More articles by this author Jesse D. Sammon More articles by this author Philipp Gild More articles by this author Nicolas von Landenberg More articles by this author Stuart R. Lipsitz More articles by this author Joel S. Weissman More articles by this author Felix K.H. Chun More articles by this author Margit Fisch More articles by this author Maxine Sun More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate Health Index—improving screening in men with family history

Although the optimal protocol of screening men for prostate cancer remains undefined, the Prostate Health Index—phi—might provide an additional tool to improve risk stratification, especially for men with a positive family history.

Clinicians Remain Reluctant to Allow Negative Findings to Influence Practice

RESULTS FROM A RECENT REVIEW of randomized controlled trials suggest that medically treating mild hypertension in individuals with no previous cardiovascular events or cardiovascular disease does not reduce mortality or morbidity. But, as so often happens with negative findings, it remains to be seen whether this evidence will change clinical practice. The review, by the Cochrane Collaboration, is at odds with current guidelines in the United States and Europe that call for medical therapy if lifestyle changes cannot control an individual’s blood pressure. The Cochrane conclusion follows recent actions by the US Preventive Services Task Force (USPSTF), which has questioned whether screening men for prostate cancer, screening women younger than 50 years for breast cancer, and using electrocardiography to predict coronary heart disease events in low-risk asymptomatic adults provide sufficient potential benefits to offset potential harms. In turn, the Cochrane findings and the USPSTF recommendations have met resistance from the professional societies that have published guidelines promoting these practices and the scientists whose research underlies such guidance. Sharon Straus, MD, MSc, who researches knowledge translation, is not surprised by such resistance. “We do have to be aware that sometimes evidence changes over time, and we need to be open to that change. But that is hard to do,” she said. Straus, of the University of Toronto, Toronto, Canada, said it is particularly difficult to introduce negative study findings into prevention and screening protocols because it is hard to visualize such interventions as having risk components. “People think that if they get screened for something, it will be a good thing, and we don’t think that bad things will happen,” Straus said. “And this is what these [negative findings] highlight—the potential for good and harms.”

Screening for prostate cancer with prostate-specific antigen testing: American Society of Clinical Oncology Provisional Clinical Opinion.

An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to the ASCO membership after publication or presentation of potentially practice-changing data from major studies. This PCO addresses the role of prostate-specific antigen (PSA) testing in the screening of men for prostate cancer. Prostate cancer is the second leading cause of cancer deaths among men in the United States. The rationale for screening men for prostate cancer is the potential to reduce the risk of death through early detection. Evidence from a 2011 Agency for Healthcare Research and Quality systematic review primarily informs this PCO on the benefits and harms of PSA-based screening. An update search was conducted to March 16, 2012, for additional evidence related to the topic. In one randomized trial, PSA testing in men who would not otherwise have been screened resulted in reduced death rates from prostate cancer, but it is uncertain whether the size of the effect was worth the harms associated with screening and subsequent unnecessary treatment. Although there are limitations to the existing data, there is evidence to suggest that men with longer life expectancy may benefit from PSA testing. Adverse events associated with prostate biopsy are low for the majority of men; however, several population-based studies have shown increasing rates of infectious complications after prostate biopsy, which is a concern.

Prostate specific antigen reduction following statin therapy: Mechanism of action and review of the literature

Prostate specific antigen (PSA) is a serine protease that is exclusively produced in the prostate, and its detection is the only laboratory test available for screening men for prostate cancer (PC). The interpretation of the assay is difficult since it is specific for prostate tissue and cellular growth, but not for PC. Pharmacologic therapy for hyperlipidemia, such as statins, may influence prostate cellular growth and subsequently PSA levels in patients. Dysregulated cellular growth in the prostate is mediated by inhibiting the rate-limiting pathway step in cholesterol synthesis, thereby decreasing isoprenylate intermediates, decreasing cholesterol rich cellular membrane domains, and down-regulating androgen and estrogen receptors. Statins, with variable efficacy, have been previously shown to inhibit cellular inflammation, angiogenesis, proliferation, migration/adhesion, and invasion, while promoting apoptosis in prostate cells by inhibiting the conversion of HMG-CoA to mevalonate. An individual statin's molecular structure, need for enzymatic conversion, bioavailability, and peripheral tissue concentration may partially account for differing properties. By inhibiting prostatic cellular growth and promoting apoptosis, statins may subsequently decrease PSA levels, an effect recently observed in cohorts. There is scientific and clinical evidence supporting the observations that statins are associated with an overall reduction in serum PSA in men, when used for greater than 6 months, and especially when used for greater than 2 years.

Screening men for prostate cancer in general practice: experiences of men receiving an equivocal PSA (prostate specific antigen) test result

Although there are often clear benefits from health screening strategies there is also evidence that some individuals experience emotional difficulties when participating, these reactions are often as a result of inconclusive or equivocal results from the screening tests. Most of the research literature explores this from a female perspective – there is less evidence of how men experience the uncertainties of screening. This article presents findings from a qualitative research study exploring the experiences of men who received equivocal results when participating in prostate specific antigen (PSA) testing. The men were drawn from a larger clinical trial to identify men with early signs of prostate cancer. In-depth interviews were conducted with seven men from one general practice in the North of England who had received an equivocal result from PSA testing and subsequent prostate biopsy. Phenomenological analysis revealed five inter-related themes in the men's experiences. The theme pre-conceptions centred around men's beliefs about the links between early diagnosis and was linked to their perceptions about responsibility towards their own health. However, men also reported feelings of uncertainty when receiving results that did not definitely indicate they did or did not have prostate cancer. This uncertainty generated reactions of stoicism towards the equivocal result and subsequent participation in further investigations. However, men also reported that participation in PSA screening did make them feel ‘looked after’. These findings are closely comparable with the literature on women's reactions to screening test uncertainty. This is possibly heightened by the lack of clear evidence about the accuracy of PSA testing to detect prostate cancer. These men participated in order to find out if they had prostate cancer or not and seemed unprepared for the possibility of an equivocal result.

Using a Culturally Relevant Theory to Recruit African American Men for Prostate Cancer Screening

The article by Abernethy et al. (2005) presented a successful strategy to recruit African American men for prostate cancer screening (PCS). The authors applied the PEN-3 model (Airhihenbuwa, 1995) of health education, an educational diagnosis of behavior, and cultural appropriateness to recruit African American men for PCS. This application of the PEN-3 model provided a rich context in which to explore ways to recruit African American men not only for prostate cancer but for other health screenings as well. The article describes how the researchers were able to successfully recruit 655 men—more than the proposed number of 450—to participate in PCS. The authors, however, were not specific about the process of recruiting. The article does not describe the length of time it took to approach the churches and the time it took for them to respond favorably to the collaboration. It is important for researchers to describe in detail time frames, because often we believe that gaining entry into a community can be done in a relatively short period of time when in fact it may take 6 months or longer. Researchers must understand this challenge and act accordingly. Recruiting African American men to participate in their study is a remarkable feat and an important story to share with other health professionals. It is widely known that African Americans, in general, do not participate in research studies, and it is especially difficult to recruit African American men. Although African American men have the highest incidence and mortality rates for prostate cancer (American Cancer Society, 2003), they do not participate in health screenings or research studies because of intrusive procedures such as rectal exams, distrust of health care providers, and issues related to masculinity. The article discusses several key issues that interfere with recruitment, but the article was able to outline strategies used to overcome these challenges that might be applied to other populations. First, the authors outline various theories that have been used to under

Detection of Clinically Occult Prostate Cancer

A large number of cases of prostatic carcinoma are discovered unexpectedly by simple prostatectomy performed for presumed benign disease. The ability to discover these cancers preoperatively is an appealing concept, in other words, to screen: the use of a test to detect a disease in an asymptomatic individual. The ideal screening test would be noninvasive, inexpensive, reliable, and reproducible. It would also have a high sensitivity and specificity, neither allowing a disease process to be missed by a falsely negative result nor leading to unnecessary and more invasive studies by a falsely positive one. It has been suggested that an acceptable screening test have a sensitivity of at least 95 per cent and a specificity of 100 per cent. An equally important criterion for a successful screening program for cancer has to do with the biologic potential of the discovered malignancy. The adage is that more men die with prostate cancer than of prostate cancer. However, the biologic potential of prostate cancer has not been fully elucidated, and it is not entirely clear who will benefit from treatment and who should be left alone. At the present time, noninvasive imaging modalities and biochemical markers are not clinically useful in detecting occult prostatic carcinoma. Furthermore, no study has proved that routine screening reduces the mortality rate from prostate cancer. Many authors believe that screening men for prostate cancer should be regarded as investigational and that currently, only screening programs for breast and cervical cancer have been fully demonstrated to be effective. New studies are needed that include control groups who are not subjected to the early diagnostic modality, assessing both the disadvantages of the screening program and the potential benefits.