Personal History Of Prostate Cancer Research Articles

Evaluating genetic screening/counseling for patients diagnosed with prostate cancer who meet hereditary risk assessment based on NCCN Guidelines.

e17117 Background: Prostate cancer is most common cancer among men and is the second leading cause of cancer deaths in American men. Genetic predisposition to cancer is increasingly noted as a cause in many cancers including prostate cancer. Genetic testing and counseling are recommended in certain groups of men; Men with or without a personal history of prostate cancer who have a family history of prostate, breast, colon, ovarian, or pancreatic cancers, especially if any of these were diagnosed under age 50 and those with metastatic prostate cancer. A recent study of 3,600 men with prostate cancer found that 17% had inherited genetic mutations that may have contributed to their cancer. Of those men, 31% of the mutations were in the BRCA genes. Because of this, familiarity and understanding of the most current clinical guidelines for genetic risk assessment are of great importance in the survivorship care of men with prostate cancer. The National Comprehensive Cancer Network (NCCN) guidelines recommends genetic assessment/counseling for genetic/familial high-risk individuals diagnosed with prostate cancer. This retrospective study reports on adherence to genetic screening based on NCCN guidelines for newly diagnosed Prostate cancer patients who were receiving treatment at Northeast Georgia Medical Center (NGMC). Methods: We obtained data using EPIC database from NGMC electronic medical records to identify patients who were diagnosed between 1/1/20-12/31/20. Data included patients who were high risk and fit the criteria for genetic testing based on NCCN as well as identifying patients who were sent for genetic testing/counsellng. The dataset was de-identified and analyzed using appropriate descriptive statistical testing. Results: A total of 42 cases for prostate cancer were reviewed. All 42 of the cases were under the age of 60 at diagnosis. A total of 13 of the cases meet the genetic/familial high-risk assessment based on NCCN guidelines. Of the 13 of the cases, only 1 case was referred for genetic counseling which was 7.6% compliance with NCCN guidelines for genetic counseling/referral. In terms of high-penetrance prostate cancer risk screening, none of the 13 cases (0%) meeting genetic/familial high-risk were screened. Based on our findings, there was poor adherence in genetic testing/counseling in high risk patients with prostate cancer at NGMC. Conclusions: This study points out poor adherence to NCCN guideline directed genetic counseling/testing in high risk patients with prostate cancer. Based on findings, it is clear that high importance should be placed on awareness on the current guidelines in relation to gene testing for patients who are high risk as this would play an important role in identifying family members who at risk and ensure early screening.

MP39-05 PREDICTORS OF FINANCIAL TOXICITY AMONG UNITED STATES PROSTATE CANCER SURVIVORS: RESULTS FROM A NATIONAL SURVEY

You have accessJournal of UrologyCME1 Apr 2023MP39-05 PREDICTORS OF FINANCIAL TOXICITY AMONG UNITED STATES PROSTATE CANCER SURVIVORS: RESULTS FROM A NATIONAL SURVEY Benjamin V. Stone, Muhieddine Labban, Dejan K. Filipas, Edoardo Beatrici, Nicola Frego, Zhiyu (Jason) Qian, Sandeep S. Voleti, Stuart R. Lipsitz, Adam S. Kibel, Quoc-Dien Trinh, and Alexander P. Cole Benjamin V. StoneBenjamin V. Stone More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Dejan K. FilipasDejan K. Filipas More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Nicola FregoNicola Frego More articles by this author , Zhiyu (Jason) QianZhiyu (Jason) Qian More articles by this author , Sandeep S. VoletiSandeep S. Voleti More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Alexander P. ColeAlexander P. Cole More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite increasing evidence of financial toxicity (FT) associated with treatment for prostate cancer, little is known about the risk factors and types of financial burden facing prostate cancer survivors. METHODS: The Cancer Self-Administered Questionnaire component of the Medical Expenditure Panel Survey was administered in 2011, 2016, and 2017. Men with a history of prostate cancer were identified and those with non-prostate malignancies other than non-melanoma skin cancer were excluded. The proportion of men reporting catastrophic healthcare expenditures (out-of-pocket spending >10% of household income) and subjective measures of FT (categorized in Table 1) were assessed. Multivariable logistic regression was used to identify independent predictors of FT. RESULTS: Among men with a personal history of prostate cancer, 8% reported catastrophic healthcare expenditures. This corresponds to a weighted national estimate of 187,963 men who experience catastrophic expenditures. Overall, 16% of men reported subjective worry about being able to pay for their medical bills, and 15% reported work changes due to their cancer diagnosis. Other forms of FT are summarized in Table 1. After adjusting for covariates in Table 2, the only significant predictor of catastrophic expenditures was low income. Older age was associated with decreased odds of subjective worry about medical bills (OR 0.90, 95% CI 0.83 – 0.98, p=0.017). Only 12% of men reported their doctor discussed the costs of care in detail, and 10% reported they discussed the costs of care briefly. CONCLUSIONS: Prostate cancer survivorship is associated with substantial objective and subjective measures of financial toxicity. Nearly 1 in 10 survivors experience catastrophic healthcare expenditures and an even larger number report subjective worry about job loss and other forms of FT. Patients rarely discuss costs with their physicians. Despite high rates of insurance coverage, prostate cancer survivors remain vulnerable to excessive costs of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e536 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin V. Stone More articles by this author Muhieddine Labban More articles by this author Dejan K. Filipas More articles by this author Edoardo Beatrici More articles by this author Nicola Frego More articles by this author Zhiyu (Jason) Qian More articles by this author Sandeep S. Voleti More articles by this author Stuart R. Lipsitz More articles by this author Adam S. Kibel More articles by this author Quoc-Dien Trinh More articles by this author Alexander P. Cole More articles by this author Expand All Advertisement PDF downloadLoading ...

Hereditary cancer risk assessment in the community urology practice setting.

278 Background: Professional guidelines recommend hereditary cancer risk assessment (HCRA) for men with prostate cancer to inform both risk of cancer (primary or subsequent) and treatment decisions. The objectives of the study were to evaluate the feasibility of integrating a HCRA protocol in urology practice for patients with prostate cancer and determine the response of providers and patients to the HCRA protocol. Methods: This prospective study was divided into 4 segments: process integration (4 wks.), practice (4 wks.), post-integration (8 wks.), and follow up (10 wks.). Study site staff were trained to perform HCRA for men with prostate cancer (integration). The sites then incorporated recommendations from the integration process into their normal practice workflow (practice). During the post-integration period, the HCRA process was implemented with eligible patients consented to participate. Eligible patients were ≥18 years old, had a personal history of prostate cancer, and met National Comprehensive Cancer Network guidelines for genetic testing (2.2018). Patients and providers completed surveys regarding testing ≥ 8 weeks of test delivery or 1 week of end of data collection period, respectively (follow up). Results: In the 8 weeks prior to the study, 4.2% of patients completed testing at the study sites. During the study, 8.4% of patients completed testing, about 1/2 of eligible patients screened. Of all patients who completed testing and consented for their results to be summarized (N = 182), 10.4% (N = 19) tested positive for a single pathogenic variant (PV; monoallelic MUTYH N = 4; BRCA2 N = 3; ATM, BRCA1, BRIP1, CHEK2, HOXB13 N = 2 each; RAD51C, RAD51D N = 1 each). Not all men who tested positive or a PV reported a family history of cancer and not all PVs detected were in known prostate cancer risk genes. During follow up, most providers (61.0%) felt HCRA was as important as other assessments regularly performed and 68.3% planned to continue to use the HCRA process. In contrast, only 9.8% of providers did not believe HCRA was as important and 12.2% did not plan to continue to use the process. Of the patients that responded to the survey (N = 166), most had shared (62.0%) or planned to share (25.3%) their results with family members post-testing. Conclusions: Urologists and patients responded favorably to HCRA protocol integration. Based on this study, education around and incorporation of an HCRA process in a community urology practice setting for men with prostate cancer appears effective at increasing appropriate uptake of genetic testing. Clinical trial information: NCT04015102.

Family history and pathogenic/likely pathogenic germline variants in prostate cancer patients.

Recent literature highlights the importance of germline genetic testing in prostate cancer (PCa) patients. Surprisingly, a literature review indicates that family history (FH) records are incomplete in the major published studies from prostate cancer patients. Prospective family history data were gathered from 496 men in a single institution with a personal history of PCa who underwent germline genetic testing using a panel of at least 79 genes. Comprehensive first degree FH were obtained in all PCa of patients and analysis of prevalent FH was assessed at the time of sample collection. Pathogenic/likely pathogenic variants (PV/LPVs) were not associated with age at diagnosis, race, or presence of metastasis. One or more first degree relatives (FDR) with any cancer was not predictive for germline PV/LPVs for men with PCa (p = .96). Separate analysis of patients with one or more FDR with breast, prostate, ovarian, or pancreatic cancer revealed that only FDR with breast or ovarian cancer was predictive for PV/LPVs (p = .028, p = .015 respectively). Patients with a FDR with breast cancer had 1.8 increased risk of PV/LPVs, and patients with a FDR with ovarian cancer had 2.9 increased risk of PV/LPV. In men with a personal history of PCa, germline PV/LPVs were associated with a FDR with breast or ovarian cancer. Notably having FDRs with PCa does not predict for PV/LPVs. These data emphasize the contribution of FH in a data set with complete ascertainment of FH.

Family history and pathogenic/likely pathogenic germline variants in prostate cancer patients.

143 Background: Recent literature highlights the importance of germline genetic testing in prostate cancer (PCa) patients. Surprisingly, a literature review indicates that family history records are incomplete in published studies. Methods: Prospective and complete family history data were gathered from 496 men in a single institution with a personal history of PCa who underwent germline genetic testing using a panel of at least 79 genes (Invitae testing) from 2016-2020. Comprehensive FH were obtained in all PCa patients in this database and analysis of prevalent FH was assessed at the time of sample collection. Age, race, metastastes at any time, and Gleason score were also ascertained. MUTYH heterozygotes were not considered pathogenic. Results: Pathogenic/likely pathogenic variants (PV/LPVs) were not associated with age at diagnosis, race, or presence of metastasis. Men with Gleason scores 8-10 at time of diagnosis were more likely to have PV/LPV ( P= 0.004). One or more first degree relatives (FDR) with any cancer with was not predictive for germline PV/LPVs for men with PCa ( P= 0.96). Analysis of patients with one or more FDR with breast, prostate, ovarian, or pancreatic cancer revealed that only FDR with breast cancer ( P = 0.028) or ovarian cancer ( P = 0.015) was predictive for PV/LPVs. Though one or more FDR with prostate cancer did not predict a PV/LPV in the overall panel, further analysis indicate that a history of a FDR with PCa was predictive for PV/LPV in a DNA damage repair (DDR) gene ( P= 0.044). Conclusions: In men with a personal history of PCa, germline PV/LPVs were associated with a FDR with breast or ovarian cancer. A FDR with PCa was predictive for PV/LPV in DDR genes. These data emphasize the contribution of FH to germline genetic testing results in a cohort with complete ascertainment of cancer in first degree relatives.

Abstract PO-169: Racial distribution of neighborhood social deprivation in a retrospective cohort of prostate cancer survivors

Abstract Background: Cancer incidence and mortality rates vary across geographic areas; however, a better understanding of neighborhood level variables is needed to increase the precision of cancer control interventions that target geographic determinants of cancer health disparities. The purpose of this study is to characterize the distribution of neighborhood deprivation features in a cohort of racially diverse prostate cancer survivors based on social determinants (e.g., race) and clinical characteristics (e.g., Gleason score, tumor stage). Methods: A retrospective cohort of prostate cancer patients who were treated with radical prostatectomy from 2011 to 2019 was established using the tumor registry at the Hollings Cancer Center at the Medical University of South Carolina. Data on clinical variables (e.g., stage, grade) and social determinants (e.g., race) were abstracted from electronic medical records. Residential addresses were geocoded and neighborhood-level social deprivation measures (income, education, employment, housing, household characteristics, transportation and demographics) from the 2011-2015 American Community Survey five-year estimates were used to generate a composite Social Deprivation Index (SDI) using factor analysis. Next, descriptive, bivariate and correlation analyses were conducted to characterize SDI and examine the association between social determinants, clinical characteristics, and SDI. Results: The study sample included 249 men (168 white men and 81 African American men) who had an average age of 66 years (+6.6). The mean for SDI was 44.5 (+27.4) and the range was 97 (1-98). White men that were married were 88.7% while African American men that were married were 77.8% (p: 0.02). Men who lived in neighborhoods that had a high level of social deprivation (i.e., SDI score of 48 to 98) were 121 (48.6%). There were significant racial differences in SDI between African American and white men. The mean SDI score was 58.5 (+26.9) among African American men compared to 37.8 (+25.0) among white men (p<0.01). In the logistic regression model, African American men had a significantly greater likelihood of living in a socially deprived neighborhood compared to white men (OR=4.2, 95% C.I. 2.4-7.5, p<0.01). In addition, men between the ages of 47-67 years were significantly more likely than men ages 68-80 to in a deprived neighborhood (OR=1.8, 95% C.I.=1.1-3.0, p- value=0.02). None of the clinical characteristics were associated significantly with SDI. Conclusion: This study demonstrates that SDI varies considerably among men. Greater efforts may be needed to address neighborhood level factors among African American men who have a personal history of prostate cancer. Citation Format: Oluwole Adeyemi Babatunde, John Pearce, Melanie Jefferson, Lewis Frey, Peggi Angel, Rick Drake, Caitlin Allen, Chanita Hughes- Halbert. Racial distribution of neighborhood social deprivation in a retrospective cohort of prostate cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-169.

Prostate specific antigen utilization trends in an academic hospital in Argentina.

Although prostate cancer (PC) screening with prostate-specific antigen (PSA) determination could decrease mortality, concerns about the potential risk of overdiagnosis led to recommendations against this preventive practice. The objective of this study was to describe the trend in PSA determinations in men between 40 and 79 years old, affiliated to a Health Maintenance Organization (HMO) of an academic hospital in the city of Buenos Aires, Argentina, and its association with the recommendations stated by the U.S. Preventive Task Force (USPSTF) and the Instituto Nacional del Cáncer in Argentina. We analyzed a time series of aggregated data. We calculated the annual age-standardized rates of accumulated determinations of PSA for every 100 affiliates without a personal history of PC. Additionally, we compared trends by age groups every 10 years. We used Joinpoint and MS Excel programs. Between 2006 and 2011 there was a growing trend in the number of PSA determinations, with an annual average of + 1.2% (95% CI, -1.0 to +3.5). Between 2011 and 2015, the number of determinations began to decrease, with a percentage annual average of -4.1% (-6.9 to -1.1). We found a gradual decrease in PSA utilization in men between 40 and 79 years old after the 2012 USPSTF recommendation against prostate cancer screening.

Abstract 4227: Salvage genetic testing on buccal swab samples using liquid in situ amplification identifies genetic mutations from previous test failures

Abstract Background: NCCN guidelines version 2.2019 address BRCA1/2 testing for men with a personal history of prostate cancer limited to Gleason ≥7 and specific family history features. Inherited genetic mutations have been identified in up to 12% of metastatic prostate cancer, primarily in DNA repair genes. Here we report liquid in situ amplification (LISA) technique followed by hereditary testing on buccal swab samples that had previously failed to yield a genetic testing result. Methods: Previously failed buccal swab samples from another CLIA-certified laboratory were re-prepared using LISA. Qubit quantification following LISA revealed goodDNA concentrations even for these poor-quality swab samples ranging from 5 to 70 ng/uL, which is sufficient for next-generation sequencing analysis (NGS). Coding regions of ATM, BRCA1, BRCA2, CHEK2, PALB2, and RAD51D genes were amplified by a panel of specific primer pools followed by massively parallel sequencing for the identification of germline mutations. Minimal sequencing coverage was set as 50X, and pathogenic, likely pathogenic, and variants of unknown significance (VUS) were classified and reported. Results: Buccal swab samples from 29 men with at least intermediate-risk prostate cancer were received as low-yield, low-quality DNA (n=12), pre-cut swabs in preservation solution (n=6), and aged swab samples (n=11). LISA and subsequent NGS testing was able to salvage results for 24/29 (82.8%) (failed samples included 4 aged swab and 1 pre-cut swab). 1 patient had a pathogenic BRCA1 mutation (c.4309delT) and 3 patients had VUS (BRCA1 c.4776C>G, BRCA1 c.1846_1848delTCT, and RAD51D c.268G>A). The remaining 20/29 (69.0%) samples have either benign or likely benign variants. Conclusions: LISA applied to these previously failed samples was able to salvage results for over 80% of cases, including the identification of a pathogenic BRCA1 mutation which led cascade hereditary testing for immediate family members. It also provided confirmation for nearly 70% of cases about the absence of hereditary risk for the genes on the panel. Citation Format: Glen J. Weiss, Andrew Ford, Charmaine Brown, Elizabeth Caver, Matthew Vallejo, Claribel Adeyemi, Forrest Collins, Chen-Hsiung Yeh. Salvage genetic testing on buccal swab samples using liquid in situ amplification identifies genetic mutations from previous test failures [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4227.

Prospective evaluation of a new patient decision aid to enhance prostate cancer screening decision-making.

87 Background: We previously developed screening nomograms to predict 15-year risk of all-cause mortality, prostate cancer diagnosis, and prostate cancer mortality, and incorporated them into a graphical patient decision aid (PtDA). Our objective was to prospectively recruit primary care patients interested in shared-decision making regarding prostate specific antigen (PSA) screening and assess the impact of individualized counseling using our new PtDA. Methods: 50 patients from one internal medicine practice were enrolled in a single-arm sequential trial design, with face-to-face clinician counseling and questionnaires. Eligibility criteria included men age 50-69 years old and life expectancy > 10 years. Patients were excluded for a personal history of prostate cancer or PSA screening within the prior year. Participants completed baseline questionnaires regarding prior PSA testing, demographic information, health literacy, and the Control Preferences Scale (CPS). They then received standardized counseling (based on large trial and epidemiologic data) regarding PSA screening, followed by individualized counseling using our new PtDA. Participants then made a screening decision, and completed a post decision questionnaire including a Decisional Conflict Scale. Results: The median age was 60 (IQR 54; 65). 41 (82%) had a prior PSA test, while 9 (18%) had not. 42 (84%) of participants received some education beyond high school, 41 (82%) demonstrated high health literacy, and 45 (90%) desired to have an active role in decision-making based on the CPS. After undergoing counseling, 34 (68%) participants chose to undergo initial or repeat PSA screening, 8 (16%) chose against future screening, and 8 (16%) remained uncertain. 45 (90%) participants found individualized counseling using the PtDA more useful than standardized counseling. Finally, patients reported reduced decisional conflict compared to historical controls (P < 0.001). Conclusions: Our process of standardized counseling followed by individualized counseling using our new PtDA was effective in reducing decisional conflict. The majority of participants found the PtDA more useful for decision making than standardized counseling. Clinical trial information: NCT03387527.

Prevalence of Germline Variants in Prostate Cancer and Implications for Current Genetic Testing Guidelines

Prostate cancer is the third leading cause of cancer-related death in men in the United States. Although serious, most of these diagnoses are not terminal. Inherited risk for prostate cancer is associated with aggressive disease and poorer outcomes, indicating a critical need for increased genetic screening to identify disease-causing variants that can pinpoint individuals at increased risk for metastatic castration-resistant prostate cancer. To identify positive (pathogenic, likely pathogenic, and increased risk) germline variants in a large prostate cancer cohort and to evaluate the usefulness of current practice guidelines in recognizing individuals at increased risk for prostate cancer who would benefit from diagnostic genetic testing. Cross-sectional study of data from 3607 men with a personal history of prostate cancer who underwent germline genetic testing between 2013 and 2018 and were unselected for family history, stage of disease, or age at diagnosis. Referral-based testing was performed at a Clinical Laboratory Improvement Amendments/College of American Pathologists-certified diagnostic laboratory. All analysis took place between February 2017 and August 2018. The frequency and distribution of positive germline variants, and the percentage of individuals with prostate cancer who met National Comprehensive Cancer Network (NCCN) guidelines for germline genetic testing. Of 3607 men (mean [SD] age at testing, 67 [9.51] years; mean age at diagnosis, 60 [9.05] years) with a personal diagnosis of prostate cancer who were referred for genetic testing, 620 (17.2%) had positive germline variants, of which only 30.7% were variants in BRCA1/2. Positive variants in HOXB13, a gene associated only with prostate cancer risk, were identified in 30 patients (4.5%). DNA mismatch repair variants with substantial known therapeutic implications were detected in 1.74% of variants in the total population tested. Examination of self-reported family histories indicated that 229 individuals (37%) with positive variants in this cohort would not have been approved for genetic testing using the NCCN genetic/familial breast and ovarian guidelines for patients with prostate cancer. Current NCCN guidelines and Gleason scores cannot reliably stratify patients with prostate cancer for the presence or absence of pathogenic germline variants. Most positive genetic test results identified in this study have important management implications for patients and their families, which underscores the need to revisit current guidelines.

MP82-02 SHARED DECISION MAKING FOR PROSTATE CANCER SCREENING: REALITY OR FARCE?

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2018MP82-02 SHARED DECISION MAKING FOR PROSTATE CANCER SCREENING: REALITY OR FARCE? Daniel Pucheril, Sean A. Fletcher, Sebastian Berg, Alexander P. Cole, Dimitar Zlatev, Steven L. Chang, Jesse Sammon, Mani Menon, Adam S. Kibel, and Quoc-Dien Trinh Daniel PucherilDaniel Pucheril More articles by this author , Sean A. FletcherSean A. Fletcher More articles by this author , Sebastian BergSebastian Berg More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , Dimitar ZlatevDimitar Zlatev More articles by this author , Steven L. ChangSteven L. Chang More articles by this author , Jesse SammonJesse Sammon More articles by this author , Mani MenonMani Menon More articles by this author , Adam S. KibelAdam S. Kibel 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.2018.02.2730AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A core tenant of major cancer society guidelines regarding prostate cancer screening (PSAS) is that providers discuss both the advantages and disadvantages of screening with eligible patients in a shared decision making (SDM) process. We sought to determine contemporary trends of SDM in regards to PSAS. METHODS Consistent with the AUA guidelines for PSAS, data was abstracted from the 2012-2016 Behavioral Risk Factor Surveillance System for men aged 55-69, without a personal history of prostate cancer, and having answered all questions within the PSAS module. PSAS occurred if a man had a PSA test within the last two years for reasons other than "a prostate problem" or "prostate cancer." SDM occurred if the respondent was informed about both advantages and disadvantages of PSAS by a health professional. Descriptive statistics were generated for demographic covariates by year. The Chi-Square test was used to compare the distribution of covariate proportions amongst years. Separate multivariable regression models were built to identify independent predictors of both receipt of PSA screening and SDM. RESULTS A weighted estimate of 56.7 million men (n=138,492) met inclusion criteria. Reported rates of PSAS decreased each year (56.7% in 2012 to 52.6% in 2014 to 49.1% in 2016, p<000.1). There were no significant changes in rates of SDM (p=0.82); in all three years, less than one-third of respondents reported SDM. After controlling for known confounders, possession of a personal physician (OR 2.24,95%CI 2.02-2.48), receipt of information regarding the advantages of PSAS (OR 3.93, 95%CI 3.63-4.26), and receiving a physician recommendation to undergo PSAS (OR 7.78, 95%CI 7.25-8.35) were most strongly associated with odds of undergoing PSAS. Odds of reporting participation in SDM were strongest amongst black respondents (2.09 95%CI 1.92-2.28) and those who received a physician recommendation to undergo PSAS (OR 4.64, 95%CI 4.32-4.99). CONCLUSIONS Despite recommendations that physicians engage patients in a SDM process for PSAS, our findings suggest that less than a third of patients are advised of both the advantages and disadvantages of PSAS. With the likely revision of the USPSTF PSAS recommendation to Grade C, a renewed effort towards SDM is needed. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1105 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Pucheril More articles by this author Sean A. Fletcher More articles by this author Sebastian Berg More articles by this author Alexander P. Cole More articles by this author Dimitar Zlatev More articles by this author Steven L. Chang More articles by this author Jesse Sammon More articles by this author Mani Menon More articles by this author Adam S. Kibel More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Inherited germline mutations in men with prostate cancer.

357 Background: Recent studies have demonstrated a high prevalence of pathogenic variants (PVs) in genes that confer hereditary cancer risk among men with metastatic prostate cancer (PC); however, PC does not currently receive attention as an indication for genetic testing. We assessed the clinical features of men with PC who received clinical testing as well as the distribution of PVs identified. Methods: Men with PC who underwent testing with a multi-gene hereditary cancer panel (Myriad Genetic Laboratories) from September 2013–September 2017 were included. Clinical information was obtained from provider-completed test request forms. Individuals with PC only were evaluated separately from those who had ≥1 additional malignancy. Personal/family history was evaluated relative to the 2013 NCCN guidelines for hereditary breast and ovarian cancer (HBOC) testing. Results: Overall, 1004 men with a personal history of PC were identified: 606 (60.4%) with only PC and 398 (39.6%) with PC and ≥1 additional malignancy. The most common additional malignancies were breast (136) and colorectal cancer (134). The median age of diagnosis in men with only PC was 59, which is younger than tested men who had an additional malignancy (63) and the SEER data (2009-2013) for all men with PC (66). HBOC testing criteria were met by 78.0% of men, including 68 (6.8%) who met based only on a personal/family history of PC and 330 (32.9%) who met in part due to a personal/family history of PC. PVs were identified in 12.9% of all men: 11.2% of men with PC only and 15.4% of men with PC and a second malignancy (Table). Conclusions: PC patients selected for genetic testing here were younger than men diagnosed with PC from the general population (SEER), and about a third had a diagnosis of an additional malignancy. They also have a high positive mutation rate across a broad spectrum of genes. [Table: see text]

Shared decision making for prostate cancer screening: Reality or farce?

107 Background: A core tenant of major cancer society guidelines regarding prostate cancer screening (PSAS) is that providers discuss both the advantages and disadvantages of screening with eligible patients in a shared decision making (SDM) process. We sought to determine contemporary trends of SDM in regards to PSAS. Methods: Consistent with the AUA guidelines for PSAS, data was abstracted from the 2012-2016 Behavioral Risk Factor Surveillance System for men 55-69, without a personal history of prostate cancer, and having answered all questions within the PSAS module. PSAS occurred if a man had a PSA test within the last two years for reasons other than "a prostate problem” or “prostate cancer”. SDM occurred if the respondent was informed about both advantages and disadvantages of PSAS by a health professional. Descriptive statistics were generated for demographic covariates by year. The Chi-Square test was used to compare the distribution of covariate proportions amongst years. Separate multivariable regression models were built to identify independent predictors of both receipt of PSA screening and SDM. Results: A weighted estimate of 56.7 million men (n = 138,492) met inclusion criteria. Reported rates of PSAS decreased each year (56.7% in 2012 to 52.6% in 2014 to 49.1% in 2016, p &lt; 000.1). There were no significant changes in rates of SDM (p = 0.82); in all three years, less than one-third of respondents reported SDM. After controlling for known confounders, possession of a personal physician (OR 2.24,95%CI 2.02-2.48), receipt of information regarding the advantages of PSAS (OR 3.93, 95%CI 3.63-4.26), and receiving a physician recommendation to undergo PSAS (OR 7.78, 95%CI 7.25-8.35) were most strongly associated with odds of undergoing PSAS. Odds of reporting participation in SDM were strongest amongst black respondents (2.09 95%CI 1.92-2.28) and those who received a physician recommendation to undergo PSAS (OR 4.64, 95%CI 4.32-4.99). Conclusions: Despite recommendations that physicians engage patients in a SDM process, our findings suggest that less than a third of patients are advised of both the advantages and disadvantages of PSAS. With the likely revision of the USPSTF PSAS recommendation to Grade C, a renewed effort towards SDM is needed.

Inherited germline mutations in men with prostate cancer.

e16564 Background: Recent studies have demonstrated a high prevalence of pathogenic variants (PVs) in genes that confer hereditary cancer risk among men with metastatic prostate cancer (PC); however, PC does not currently receive attention as an indication for genetic testing. We assessed the clinical features of men with PC who received clinical testing as well as the distribution of PVs identified. Methods: A commercial laboratory database was queried to identify men with PC who underwent testing with a multi-gene hereditary cancer panel from September 2013–September 2016. Clinical information was obtained from provider-completed test request forms. Individuals with PC only were evaluated separately from those who had ≥1 additional malignancy. Personal/family history was evaluated relative to the 2013 NCCN guidelines for hereditary breast and ovarian cancer (HBOC) testing. Results: Overall, 700 men with a personal history of PC were identified: 384 (54.9%) with only PC and 316 (45.1%) with PC and ≥1 additional malignancy. The most common additional malignancies were colorectal (115) and breast cancer (105). The median age of diagnosis in men with only PC was 57.5, which is younger than tested men who had an additional malignancy (62) and the SEER data (2009-2013) for all men with PC (66). HBOC testing criteria were met by 75.9% of men, including 44 (6.3%) who met based only on a personal/family history of PC and 202 (28.9%) who met in part due to a personal/family history of PC. PVs were identified in 14.0% of all men: 11.5% of men with PC only and 17.1% of men with PC and a second malignancy (see Table). Conclusions: PC patients selected for genetic testing here were younger than men diagnosed with PC from the general population (SEER), and almost half had a diagnosis of an additional malignancy. They also have a high positive mutation rate across a broad spectrum of genes. [Table: see text]

A Community Jury on PSA screening: what do well-informed men want the government to do about prostate cancer screening—a qualitative analysis

ObjectiveCancer screening policies and programmes should take account of public values and concerns. This study sought to determine the priorities, values and concerns of men who were ‘fully informed’ about...

Personal History of Prostate Cancer and Increased Risk of Incident Melanoma in the United States

Steroid hormones, particularly androgens, play a major role in prostatic carcinogenesis. Personal history of severe acne, a surrogate for higher androgen activity, has been associated with an increased risk of prostate cancer (PCa), and one recent study indicated that severe teenage acne was a novel risk factor for melanoma. These findings suggest a possible relationship between PCa and risk of melanoma. We prospectively evaluated this association among US men. A total of 42,372 participants in the Health Professionals' Follow-Up Study (HPFS; 1986 to 2010) were included. Biennially self-reported PCa diagnosis was confirmed using pathology reports. Diagnosis of melanoma and nonmelanoma skin cancer (NMSC) was self-reported biennially, and diagnosis of melanoma was pathologically confirmed. We sought to confirm the association in 18,603 participants from the Physicians' Health Study (PHS; 1982 to 1998). We identified 539 melanomas in the HPFS. Personal history of PCa was associated with an increased risk of melanoma (multivariate-adjusted hazard ratio [HR], 1.83; 95% CI, 1.32 to 2.54). Although we also detected a marginally increased risk of NMSC associated with PCa (HR, 1.08; 95% CI, 0.995 to 1.16), the difference in the magnitude of the association between melanoma and NMSC was significant (P for heterogeneity = .002). We did not find an altered risk of melanoma associated with personal history of other cancers. The association between PCa and risk of incident melanoma was confirmed in the PHS (HR, 2.17; 95% CI, 1.12 to 4.21). Personal history of PCa is associated with an increased risk of melanoma, which may not be entirely a result of greater medical scrutiny.

Hospitalization for prostate cancer among the older men in the longitudinal study on aging, 1984-1991.

Factors associated with being hospitalized with indications of prostate cancer were examined. A secondary analysis of the older men in the Longitudinal Study on Aging (LSOA) used baseline (1984) interview data and Medicare hospital claims for 1984 through 1991. The analytic sample consisted of 2254 men who were 70 to 95 years old (mean 75.8 years) at baseline and who were self-respondents to the LSOA. Case-identification involved primary prostate cancer (ICD9-CM code 185) and personal history of prostate cancer (ICD9-CM code V10.46) hospital discharge diagnoses. Multivariable logistic regression techniques were used. There were 154 cases (6.8%) of prostate cancer, including 109 identified by active diagnostic codes only, 15 identified by personal history codes only, and 30 identified by both. No associations with age, race, or ethnicity were observed. Being hospitalized with indications of prostate cancer was more likely in the presence of a history of cancer at any site, urinary control problems, greater body mass, maximum social interaction, or living in core Standard Metropolitan Statistical Area counties. Men who regularly attended religious services, had not seen a physician for 2 years, and did not feel in control of their health were less likely to have been hospitalized with indications of prostate cancer. These data suggest that the traditional associations between prostate cancer and age, race, and ethnicity do not apply to being hospitalized with indications of the disease among older men. However, body mass, history and symptoms, personal beliefs, access, and geographic practice patterns are associated with being hospitalized with indications of prostate cancer.

Plasma levels of IGF-1, IGF-2, and IGFBP-3 in white and African-American men at increased risk of prostate cancer

Objectives. To further investigate the relationship between the plasma levels of insulin-like growth factor-1 (IGF-1), insulin-like growth factor-2 (IGF-2), insulin-like growth factor binding protein-3 (IGFBP-3), growth hormone, testosterone, and demographic factors, particularly race, within a group of men at increased risk of prostate cancer development. Methods. Enzyme-linked immunosorbent assays or an immunosorbent assay was used to quantitate the plasma levels of IGF-1, IGF-2, IGFBP-3, growth hormone, and testosterone. The study group consisted of 169 men (85 African-American, 84 white) aged 35 to 69 years, with no personal history of prostate cancer, but having at least one first-degree relative diagnosed with the disease, unless they were African-American. The relationships between the plasma levels and the categorical covariates were assessed using the nonparametric Wilcoxon test and between the continuous variables using Spearman’s correlation coefficient. Results. The mean plasma levels of IGFBP-3 were significantly lower in African-American (2657 ng/mL) than in white (2965 ng/mL) men ( P = 0.0062). The plasma levels of IGF-2 were also lower in the African-American (503.5 ng/mL) than in the white (549.1 ng/mL) men ( P = 0.0084). Overall, the IGF-1 plasma levels correlated positively with the IGF-2, IGFBP-3, and growth hormone levels and the IGF-2 plasma levels correlated negatively with the testosterone levels. Conclusions. Our results demonstrate that lower plasma levels of IGFBP-3 and IGF-2 are associated with race in a population of men at increased risk of developing prostate cancer. The ability of these markers to predict earlier disease onset is currently under investigation.

African- American men and intention to adhere to recommended follow-up for an abnormal prostate cancer early detection examination result

Objectives. To assess the intention of African-American men to have the recommended follow-up in the event of an abnormal prostate cancer early detection examination and to identify the variables that help to explain adherence intention. Methods. In the spring of 1995, we selected a random sample of 548 African-American men who were patients at the University of Chicago Health Service. The sample included men who were 40 to 70 years of age, did not have a personal history of prostate cancer, and had a working telephone number. A total of 413 men who completed the telephone survey received an invitation to consider undergoing a prostate cancer early detection examination. The survey provided data on personal background characteristics, knowledge, attitudes, and beliefs related to prostate cancer and early detection. Respondents were asked whether they would choose to have the recommended follow-up in the event of an abnormal early detection examination result. Univariate and multivariate analyses of intention to have follow-up were performed. Results. An intention to have the recommended follow-up was reported by 77% of the survey respondents. The results of multivariate analyses revealed that the intention to have the follow-up was positively associated with education beyond high school (odds ratio [OR] 1.9); perceived self-efficacy related to prostate cancer screening (OR 2.1); the belief that prostate cancer can be cured (OR 3.3); the belief that prostate cancer screening should be done in the absence of prostate problems (OR 2.3); and physician support for prostate cancer screening (OR 2.1). Conclusions. African-American men who have a high school education or less may be at risk of nonadherence to recommended follow-up. Adherence also may be low among men who do not have favorable views of early detection or do not perceive strong physician support for early detection. Research is needed to determine whether intention and other factors predict actual adherence to follow-up in this population group.

Racial differences in insulin-like growth factor binding protein-3 in men at increased risk of prostate cancer

Objectives. To determine the overall plasma levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) in a group of men at higher risk of prostate cancer development and to investigate the relationships between demographics and these levels, particularly with regard to race. Methods. An enzyme-linked immunosorbant assay was used to quantitate plasma levels of IGF-1 and IGFBP-3. The study group consisted of 105 men (63 African American [AA], 42 white), aged 35 to 69 years, with no personal history of prostate cancer, but having at least one first-degree relative diagnosed with the disease, unless they were AA. Differences in plasma levels and categorical covariates were assessed using the nonparametric Wilcoxon test. Associations between plasma levels and the continuous variables were quantified using the nonparametric Spearman correlation coefficient. Results. The mean plasma level of IGF-1 was not significantly different between AA (162.3 ng/mL) and white (172.1 ng/mL) men ( P = 0.415). However, the mean plasma level of IGFBP-3 was lower in AA (2789 ng/mL) than in white (3216 ng/mL) men, and this decrease was highly significant ( P = 0.0045). No correlation between IGFBP-3 plasma level and age was detected in the group as a whole, but an inverse relationship between IGF-1 plasma level and age was evident ( P = 0.0079). Conclusions. Our results demonstrate that IGFBP-3 plasma levels are lower in AA men than in white men. Since IGFBP-3 can control IGF-1 bioavailability, the lowered IGFBP-3 could explain in part the increased risk of prostate cancer in AA men.