Screening Men Research Articles

Prostate Cancer Screening in Men 75 Years Old or Older: An Assessment of Self-Reported Health Status and Life Expectancy

Opinions vary regarding the appropriate age at which to stop prostate specific antigen screening. Some groups recommend screening men with a greater than 10-year life expectancy while the United States Preventive Services Task Force recommends against screening men 75 years old or older. In this study we evaluated the influence of health status and life expectancy on prostate specific antigen screening in older men in the United States before the 2008 United States Preventive Services Task Force guidelines. The study cohort comprised 718 men age 75 years or older without a history of prostate cancer who responded to the 2005 National Health Interview Survey, representing an estimated 4.47 million noninstitutionalized men in the United States. Life expectancy was estimated from age and self-reported health status. Overall 19% of the men were 85 years old or older and 27% reported fair or poor health. In the previous 2 years 52% had a prostate specific antigen screening test. After adjustment for age, race, education and physician access, men with fair or poor health were less likely to receive prostate specific antigen screening than those with excellent or very good health (adjusted OR 0.51, 95% CI 0.33-0.80, p = 0.003). Overall 42% of the men predicted to live less than 5 years and 65% of those predicted to live more than 10 years reported having recent prostate specific antigen screening. Before the United States Preventive Services Task Force recommendation, health status and life expectancy were used to select older men for prostate specific antigen screening. However, many men expected to live less than 5 years were screened. A strict age cutoff of 75 years reduces over screening but also prohibits screening in healthy older men with a long life expectancy who may benefit from screening.

Developing a screening instrument and at-risk profile for nonsuicidal self-injurious behavior in college women and men.

Archival data (N = 1,048 women, 1,136 men) from a mental health survey of college students were used to investigate incidence of nonsuicidal self-injury (NSSI), including cutting. Significant levels (defined as 4-5 lifetime incidents) were found in 9.3% of women and 5.3% of men. The Counseling Center Assessment for Psychological Symptoms (a global symptom inventory) and an assessment of trauma had been field tested with this sample. We randomly partitioned half of these data into a holdout sample and used the remainder to develop an NSSI screening inventory that included (a) 5 women's screening items, including 1 item to assess trauma experienced; (b) 11 men's screening items; and (c) 12 items common to men and women, including depression, dissociation, anger, unwanted thoughts, nightmares or flashbacks, and having witnessed trauma. Logistic regression and receiver-operating characteristic curve analysis suggested the inventory significantly discriminated NSSI men and women in the holdout sample, p < .001. Cutoff scores were identified to correctly classify about 48% of the true positive male and female NSSI cases, with false positive rates of 13.2% and 8.4% for women and men, respectively.

Public Survey and Survival Data Do Not Support Recommendations to Discontinue Prostate-specific Antigen Screening in Men at Age 75

To evaluate the US Preventative Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75. Public survey: A cohort of 340 patients was surveyed at our PSA screening clinic and stratified by awareness of the recommendation and education level. Age (< 75, >or= 75), race, health insurance status, knowledge of prostate cancer, and opinion on screening discontinuation at age 75 was evaluated between groups. Disease risk and survival analysis: A cohort of 4196 men who underwent radical prostatectomy between 1988 and 2008 was stratified into age groups: < 65, 65-74, and >or= 75. Associations between clinicopathologic variables, disease risk, and survival were compared between age groups using univariate and multivariate analysis. Approximately 78% of men surveyed disagreed with the USPSTF recommendation. The number of men who disagreed was not significantly different between awareness groups (P = .962). Awareness of new screening guidelines showed a significant difference (P = .006) between education groups. Age >or= 75 years was predictive of high-risk disease based on D'Amico's criteria (odds ratio = 2.72, P = .003). Kaplan-Meier and Cox regression analyses showed an association of men aged >or= 75 years with higher rate of PSA recurrence, distant metastasis, and disease specific death compared with the age groups of < 65 and 65-74 (P <.05). Men presenting to our PSA screening clinic disagreed with discontinuation of screening at age 75. Men aged >or= 75 years had higher risk disease and poorer survival. The USPSTF recommendation was supported neither by public opinion nor disease risk and survival results.

The Frequency of Osteoporosis Screening in Men With Inflammatory Bowel Disease

Osteoporosis is underdiagnosed in men, and osteoporosis-related fractures carry high morbidity and mortality. Recent recommendations on osteoporosis screening in men from the American College of Physicians state that screening and risk factor assessment need to occur earlier in men at high risk. Men with inflammatory bowel disease are at high risk for osteoporosis and fragility fractures due to corticosteroid use, malabsorption from intestinal resection, potential vitamin D deficiency, and fluctuations in weight. This study examines the rate of corticosteroid use, vitamin D screening, and bone mineral density screening of men with inflammatory bowel disease in a gastroenterology practice. The vast majority of men with inflammatory bowel disease are at high risk for osteoporosis. Screening and risk factor assessment should be emphasized.

Multiple Insulinomas, a Rare Clinical Problem, Possible Case of Occult MEN I

ABSTRACT A 22 years old under graduate with recurrent hypoglycemia was found to have an insulinoma after investigations. Diagnosis of insulinoma had been made by elevated C-peptide and insulin concentration with simultaneous hypoglycemia with blood glucose 35 mg/dl. Preoperative computed tomography localized a single tumor (7 mm x 7 mm x 7 mm) in the body of pancreas. On surgical exploration with intraoperative ultrasound localization a tumor was found in the body of pancreas and enucleated. Repeat intraoperative ultrasonography showed no residual disease, but palpation localized a second lesion in the body of pancreas and that was enucleated. Patient made a complete recovery. Screening for MEN I indicated that patient has several features of MEN I which remains occult at present. This case highlights a rare clinical problem of multiple insulinomas and also importance of intraoperative palpation.

Does Opioid Use for Pain Management Warrant Routine Bone Mass Density Screening in Men?

Background: Although opioids are known to inhibit testosterone production and bone formation, no prior study has investigated the relationship between opioid use in male subjects and bone mass density measurements. Method: Eighty-one male patients who had been using opioids for a period of time from a few weeks to 20 years were included in this study. Blood samples were obtained to examine the total testosterone level of these subjects and each patient also had a bone mass density scan. This study was done retrospectively using lab values collected during the normal care of the patient. No extra measures were done relative to this study and all patient identifiers were removed from the data prior to analysis. Accordingly, there was no need here for an IRB or patient consent. Results: Fifty percent of hypogonadal men had bone mass densities in the osteoporotic or osteopenic range. Forty-two percent of the men who had total testosterone levels within the normal range also had bone mass densities within these ranges. Other factors may also influence the bone mass density results. For example, in this study 52% of the patients disclosed that they smoke. Conclusion: Of this population almost half of the men had bone mass densities in the osteopenic/osteoporotic ranges, regardless of their total testosterone blood level. Therefore, monitoring the total testosterone blood level is not a reliable method to determine the risk for developing opioid-associated osteoporosis. Further investigations should be done to help evaluate whether routine bone mass density screenings for men prescribed opioids for chronic pain management may be warranted. Key words: Opioid, OPIAD, hypogonadal, bone mass density

Guideline Supports Screening Men for Osteoporosis

Guideline Supports Screening Men for Osteoporosis

A Structural Approach to Examining Prostate Cancer Risk for Rural Southern African American Men

Physical, cultural, and social factors influence health risk and behavior, but few have explored how the environmental context affects African American men's prostate cancer screening and treatment. This paper describes a structural analysis of data from eight focus groups of rural, southern African American men (n=66). A structural approach highlights the interrelationships between individuals, the health service system, and community factors that directly and indirectly affect screening and treatment for prostate cancer. The availability of accurate and timely health information and health services, social norms regarding health and professional help-seeking, and the sociopolitical context shaped men's screening and treatment behaviors. These proximal and distal health factors affected men's prostate cancer knowledge, perceived risk, willingness to seek care and trust in the health service system. The findings suggest that prostate cancer screening and treatment occurs in a larger structural context that has important implications for help-seeking and health promotion.

Population-Based Outreach for Chlamydia Screening in Men: Results From a Randomized Trial

To evaluate the feasibility and efficacy of population-based outreach strategies to improve genital Chlamydia trachomatis (CT) screening in men. In a randomized trial, male enrollees ages 21-25 (n = 8820) were selected from the automated files of Group Health Cooperative and randomized to: a letter + test-request card for a CT urine home sampling kit (arm 1, n = 2940); a letter + mail-back sampling kit (arm 2, n = 2940); or a usual care control (arm 3, n = 2940). One reminder was sent to arms 1 and 2. The outcome was CT testing rates in the 4 months postrandomization. 105 of 2940 (3.6%) men in arm 1 and 230 of 2940 (7.8%) in arm 2 returned mailed specimens. All 335 respondents were sexually experienced, 43% had >2 sex partners in the past year, and 80% reported no genitourinary symptoms. Compared to arm 3, the relative risk of being tested was 5.6 (95% confidence interval (CI) 3.6-8.7) for arm 1 and 11.1 (95% CI 7.3-16.9) for arm 2. Arm 2 was significantly more likely to be tested than arm 1. CT prevalence for mailed-back specimens was 1.0% (1 of 105) for arm 1 and 2.6% (6 of 230) for arm 2; 70% of all positive intervention tests were from mailed samples. Both strategies resulted in significantly higher CT testing than usual care, but the intervention response rate was low (5.7% overall). Direct kit mailing performed best. In US populations, the value of mailed outreach strategies to men must be considered in the context of other CT screening priorities.

Prostate Cancer Screening in Men with a Family History of Prostate Cancer: The Role of Partners in Influencing Men’s Screening Uptake

To assess the role of the partners, as well as other sociodemographic and psychological factors, in influencing prostate cancer screening uptake among men with a family history of prostate cancer. This was a cross-sectional study of 280 unaffected men with a family history of prostate cancer along with 174 of their partners, using mailed, self-administered questionnaires. The majority of respondents reported having had at least one prostate-specific antigen (PSA) test (78.9%) and/or one digital rectal examination (DRE) (78.0%). Ever having had a PSA test was associated with number of first- and second-degree relatives with prostate cancer (odds ratio [OR] = 1.79; 95% confidence interval [CI] 1.03 to 3.11; P = 0.040) and relationship status. Compared with men who were single, those with partners with high involvement in men's screening had a significantly higher uptake of PSA screening (OR = 3.41; 95% CI 1.12 to 10.44; P = 0.031). Ever having had a DRE was significantly and positively associated with age (OR = 1.09; 95% CI 1.05 to 1.13; P <0.001) and perceived prostate cancer risk (OR = 1.03; 95% CI 1.01 to 1.04; P <0.001), as well as having sons (OR = 2.06; 95% CI 1.06 to 3.97; P = 0.032). Psychological factors are the most important influence on men's uptake of DRE, whereas external factors, including partner's involvement, influence PSA uptake. If prostate cancer screening is ultimately shown to be efficacious for men with a family history of prostate cancer, screening uptake will be maximized in this target group by enlisting the support of partners.

1486: Prevalence of Prostate Specific Antigen Screening in Men > 75 Years at an Academic Medical Center

You have accessJournal of UrologyDiscussed Poster, Wednesday, May 25, 2005, 8:00am - 12:00 pm1 Apr 20051486: Prevalence of Prostate Specific Antigen Screening in Men > 75 Years at an Academic Medical Center Damon J. Dyche, and Badrinath R. Konety Damon J. DycheDamon J. Dyche More articles by this author , and Badrinath R. KonetyBadrinath R. Konety More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35620-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1486: Prevalence of Prostate Specific Antigen Screening in Men > 75 Years at an Academic Medical Center." The Journal of Urology, 173(4S), pp. 402–403 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 402-403 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Damon J. Dyche More articles by this author Badrinath R. Konety More articles by this author Expand All Advertisement PDF DownloadLoading ...

Culture, Black Men, and Prostate Cancer: What is Reality?

The worldwide incidence of prostate cancer is higher among American black men than any other male group. In the United States, lack of participation in screening for prostate cancer by black men is influenced by several cultural factors, including knowledge, health beliefs, barriers, and relationships with primary healthcare providers. We used the qualitative and paralleling descriptive quantitative findings of a mixed-method longitudinal study exploring prostate cancer screening behaviors among 277 black men. Five themes were identified as critical elements affecting men's screening for prostate cancer: lack of knowledge, communication, social support, quality of care, and sexuality. These themes were associated with a sense of disconnectedness by black men from the healthcare system and contributed to nonparticipation in prostate cancer early detection activities. Lack of discussion about the decision to screen for prostate cancer and general lack of culturally appropriate communication with healthcare providers has engendered distrust, created fear, fostered disconnect, and increased the likelihood of nonparticipation in prostate cancer screening among black men.

Familial isolated primary hyperparathyroidism--a multiple endocrine neoplasia type 1 variant?

Familial isolated primary hyperparathyroidism (FIHP) is defined as hereditary primary hyperparathyroidism without the association of other diseases or tumors. Linkage analyses suggest that different genotypes can lead to the same phenotype of primary hyperparathyroidism. Hereditary syndromes associated with primary hyperparathyroidism are multiple endocrine neoplasia type 1 and type 2 (MEN 1 and MEN 2). In MEN 1, multiple parathyroid adenomas occur in more than 90% of the patients. Therefore, it has been suggested that FIHP could represent a variant or partial expression of MEN 1. We report on a large FIHP kindred with a MEN1 gene mutation. Nineteen family members (aged 10 to 87 years) were screened. Furthermore, statistical comparison by Fisher's exact tests of FIHP families with MEN1 gene mutations and MEN 1 families with two or more endocrinopathies was carried out to investigate genotype-phenotype correlations. Mutational analysis of leucocyte DNA was carried out by direct sequencing of the complete coding region of the MEN1 gene. Screening of MEN 1 manifestations was carried out by determination of serum calcium, phosphate, parathyroid hormone, prolactin, ACTH, cortisol, IGF-I, gastrin, glucose, insulin, glucagon, serum potassium, aldosterone, plasma renin and urinary hydroxyindoleacetic acid. We detected an in-frame deletion mutation in exon 8 of the MEN1 gene resulting in the deletion of one glutamine acid residue at position 363. It was found in eight individuals. Two of these family members (aged 42 and 60 years) were operated for primary hyperparathyroidism, and three (aged 13 to 40 years) showed mild hypercalcemia and parathyroid hormone levels within the upper normal range or slightly elevated, without any clinical symptoms. Two individuals (aged 12 and 19 years) were normocalcemic. One could not be tested. None of them had clinical evidence of other MEN 1 manifestations. Statistical comparison of the mutation types in families with FIHP and families with two or more MEN 1-associated endocrinopathies reported in other studies reveals a significant difference. In families with FIHP, missense/in-frame mutations have been found in 87.5% of cases whereas in families with tumors in various endocrine glands these mutation types occur much less frequently (21-34%, P<0.05). These studies indicate that FIHP can represent a partial MEN 1 variant and is often caused by missense/in-frame mutations.

Presymptomatic DNA screening in families with multiple endocrine neoplasia type 2 and familial medullary thyroid carcinoma.

Missense mutations of the ret proto-oncogene on chromosome 10q11.2 are the underlying cause of hereditary medullary thyroid carcinoma (MTC), either as familial MTC only (FMTC) or as a part of multiple endocrine neoplasia type 2 syndrome (MEN 2). This study presents our experience with direct presymptomatic DNA screening in MEN 2 and FMTC kindreds. Twenty one families with MEN 2 or FMTC were considered in the study. One hundred three individuals had been analyzed; 56 were at risk. The ret mutations were detected by DNA analysis of exons 10, 11, and 16 by using nonradioactive labeling method based on digoxigenin DNA sequencing technique. Serum calcitonin evaluation was carried out in all individuals at risk. Thyroidectomy was performed in those who had to undergo surgery. The ret mutations were identified in all 21 families. In MEN 2A and FMTC families mutations occurred in exons 10 and 11. MEN 2B families had mutations in exon 16. The most frequent mutation in MEN 2A and FMTC affected codon 634. Twenty one gene carriers were identified in unaffected individuals at risk. Ten of 21 gene carriers had elevated calcitonin levels, and 11 had normal levels. MTC or C-cell hyperplasia was found in six gene carriers with pathologic calcitonin values who underwent operation. In a 5-year-old gene carrier with normal calcitonin values C-cell hyperplasia was evident. Direct predictive DNA analysis allows us to identify MEN 2 or FMTC gene carriers and offer them prophylactic treatment.

333 DNA screening in men families and therapeutic consequences

Medullary thyroid carcinoma (MTC) may occur as a part of the inherited cancer syndrome multiple endocrine neoplasia type 2 (MEN 2). MTC is the only malignant and potentially lethal component of the MEN 2 syndrome. The underlying cause of MEN are missense mutations of the RET proto-oncogene located on chromosome 10q 11.2. In MEN 2A the mutations affect one of the cystein residues in exon 10, 11 and 13. In these, the most common mutation is a Cys634 to Arg substitution. In MEN 2B families exclusively methionine mutations in codon 918 (exon 16) has been detected. Direct DNA testing for RET proto-oncogene mutations presents the method of first choice in presymptomatic screening in MEN 2 families. Gene carriers should be offered prophylactic thyroidectomy in the childhood. Non-gene carriers may be excluded from further screening.

Screening for MEN 2 with biochemical and genetic markers.

The term “multiple endocrine neoplasia type 2” (MEN 2) denotes a genetic syndrome characterized by the independent appearance of benign or malignant changes of several endocrine organs (the thyroid, parathyroid, and adrenal glands) as well as occasional changes of neuronal, muscular, and connective tissue. Despite the large number of variations of these manifestations, three different forms have been identified: 1. MEN 2A (Sipple’s syndrome, Sipple 1961), characterized by medullary thyroid carcinoma (MTC) in association with pheochromocytoma and parathyroid hyperplasia. 2. MEN 2B, including MTC, pheochromocytoma and mucosal neuromas, and a marfanoid-like habitus (Williams and Pollock 1966). 3. MTC-only syndrome, a hereditary MTC without the other components of MEN 2A (Farndon et al. 1986). Whether this represents a separate syndrome or merely a variant of MEN 2A in which the genetic component is modified to delay the onset of all manifestations of the MEN 2A syndrome is not clear.

The Tromsø Heart Study: The Consequences of Blood Pressure Screening in Men Aged 20–49 Years

The Tromsø Heart Study: The Consequences of Blood Pressure Screening in Men Aged 20–49 Years