Prostate Cancer Screening In Men Research Articles

Prostate cancer characteristics in Black septuagenarian men

Prostate cancer is the most common (non‐cutaneous) cancer and the second leading cause of cancer death in US men. Both Black men and men 70–80 years old are at high risk for high‐grade prostate cancer. Despite that some groups recommend against PSA‐ and DRE‐based prostate cancer screening in men 70 years of age and older without regard to high‐risk factors. The authors present results of a study of prostate biopsy characteristics of men 70–80 years of age to determine whether they harbor a concerning incidence of high‐grade prostate cancer and should be offered screening.

Multiparametric Magnetic Resonance Imaging in Prostate Cancer Screening at the Age of 45 Years: Results from the First Screening Round of the PROBASE Trial

BackgroundMagnetic resonance imaging (MRI) has been suggested as a tool for guiding biopsy recommendations in prostate cancer (PC) screening. ObjectiveTo determine the performance of multiparametric MRI (mpMRI) in young men at age 45 yr who participated in a PC screening trial (PROBASE) on the basis of baseline prostate-specific antigen (PSA). Design, setting, and participantsParticipants with confirmed PSA ≥3 ng/ml were offered mpMRI followed by MRI/transrectal ultrasound fusion biopsy (FBx) with targeted and systematic cores. mpMRI scans from the first screening round for men randomised to an immediate PSA test in PROBASE were evaluated by local readers and then by two reference radiologists (experience >10 000 prostate MRI examinations) blinded to the histopathology. The PROBASE trial is registered as ISRCTN37591328 Outcome measurements and statistical analysisThe local and reference Prostate Imaging-Data and Reporting System (PI-RADS) scores were compared, and the sensitivity, negative predictive value (NPV), and accuracy were calculated for both readings for different cutoffs (PI-RADS 3 vs 4). Results and limitationsOf 186 participants, 114 underwent mpMRI and FBx. PC was detected in 47 (41%), of whom 33 (29%) had clinically significant PC (csPC; International Society of Urological Pathology grade group ≥2). Interobserver reliability between local and reference PI-RADS scores was moderate (k = 0.41). At a cutoff of PI-RADS 4, reference reading showed better performance for csPC detection (sensitivity 79%, NPV 91%, accuracy of 85%) than local reading (sensitivity 55%, NPV 80%, accuracy 68%). Reference reading did not miss any PC cases for a cutoff of PI-RADS <3. If PI-RADS ≥4 were to be used as a biopsy cutoff, mpMRI would reduce negative biopsies by 68% and avoid detection of nonsignificant PC in 71% of cases. ConclusionsProstate MRI in a young screening population is difficult to read. The MRI accuracy of for csPC detection is highly dependent on reader experience, and double reading might be advisable. More data are needed before MRI is included in PC screening for men at age 45 yr. Patient summaryMeasurement of prostate specific antigen (PSA) is an effective screening test for early detection of prostate cancer (PC) and can reduce PC-specific deaths, but it can also lead to unnecessary biopsies and treatment. Magnetic resonance imaging (MRI) after a positive PSA test has been proposed as a way to reduce the number of biopsies, with biopsy only recommended for men with suspicious MRI findings. Our results indicate that MRI accuracy is moderate for men aged 45 years but can be increased by a second reading of the images by expert radiologists. For broad application of MRI in routine screening, double reading may be advisable.

The profile study: Prostate cancer screening in men of Black African and African Caribbean ancestry—Early results.

306 Background: Heritable risk factors account for a significant proportion of prostate cancer (PrCa) risk, of which only a minority are high risk Mendelian traits. Men of Black African and African Caribbean ancestry are at higher risk of developing PrCa in their lifetime (1 in 4) compared with the general population in the United Kingdom (1 in 8). PROFILE is a multi-cohort study of targeted screening for groups of men at higher risk of developing PrCa: 1) men of European ancestry with family history of PrCa, 2) men of black African and African Caribbean ancestry regardless of family history and 3) men with known rarer higher risk gene mutations for PrCa. This abstract concentrates on group 2. The aim is to investigate the role of targeted PrCa screening in men at higher genetic risk and its association with specific genetic profiles and biomarkers. Methods: Healthy men aged 40-69 are invited to participate. Inclusion Criteria: Both parents and all four grandparents must be of either black African or African Caribbean ancestry. Arm 1: PSA only – once PSA is below an age-related threshold (aged 40-49 and PSA ≥0ng/ml, aged 50-69 PSA &gt;/= 2ng/ml) they continue on the study with annual PSA, only triggering a prostate MRI and Biopsy if the PSA is above the threshold. Arm 2: Regardless of PSA men opt for prostate mpMRI and biopsy. Polygenic risk score (PRS) calculated based on 230 SNPs including latest AA specific variants. Results: Arm 1: 121 enrolled PSA only (this has triggered 8 biopsies with 3 cancers). Arm 2: 58 enrolled MRI and biopsy, 58 MRIs and 36 biopsies carried out, PrCa detected in 15 men (42%). 22% are Gleason score ≥7. Association between PRS and MRI/Biopsy results will be presented. Conclusions: We will continue to perform MRI and biopsies on men, we will also carry out polygenic risk scores on these men to verify whether a genetic PRS can help guide enhanced screening for certain men in the population. Although data are early, a significant proportion of biopsies are positive for PrCa that needs radical treatment. Clinical trial information: NCT02543905 .

Knowledge, beliefs and intentions of African men in the Free State about prostate cancer screening.

African men are less likely to participate in prostate cancer (PCa) screening, which may be beneficial to some of them. Gaps in knowledge, cultural factors and beliefs are associated with their screening intentions. To determine the knowledge, cultural factors and screening intentions of African males regarding PCa screening. The study was conducted among African men attending randomly selected primary healthcare clinics in the Free State province. An analytical, cross-sectional survey using self-administered questionnaires developed in line with the Theory of Planned Behaviour constructs. Of the 389 respondents, 18.3% had ever been screened for PCa with prostate-specific antigen (PSA) testing and 6.2% by digital rectal examination (DRE). About a quarter (24.4%) of the respondents had knowledge scores ≥ 50%. Factors associated with greater intent to screen for PCa were lower degree of fear/apprehension of PCa screening (mean score = 2.03; p < 0.001), higher perceived benefits of PCa screening (mean score = 2.69; p = 0.002), lower perceived situational barriers to PCa screening (mean score = 2.03; p = 0.006) and higher perceived risk of getting PCa (mean score = 2.66; p = 0.024). The observed low level of knowledge and practice of PCa screening among the respondents could be enhanced through PCa awareness strategies targeted at these men or those that could influence their decision making, especially healthcare providers. Factors that enhance screening intentions should be promoted. This study improves on the scarce literature on factors associated with African men's PCa screening intention.

Changes in use of low-value services during the COVID-19 pandemic.

The COVID-19 pandemic led to a significant disruption, then recovery, of health care services use. Prior research has not examined the relative rates of resumption of high-value and low-value care. We examined the use of 6 common low-value services that received a D grade from the US Preventive Services Task Force compared with clinically comparable high-value services in a large commercially insured population nationwide from before the pandemic to April 1, 2021. We found that, overall, low-value services and high-value services were disrupted similarly. In aggregate, low-value care declined to 56.2% and high-value care to 53.2% in the initial month of the pandemic (April 2020) relative to baseline (number of visits in 2019 normalized by relevant enrolled population), then rebounded to 83.1% of baseline for low-value services and 95.0% of baseline for high-value services by January 2021. Substantial heterogeneity appeared across clinical contexts, such as prostate cancer screening for men 70 years and older rebounding to 111.8% of baseline and asymptomatic chronic obstructive pulmonary disease screening remaining at 38.5% of baseline in January 2021. This suggests that although, on average, resuming lower-value services may have been perceived to be a lesser priority by providers and patients, the pandemic may have had heterogeneous effects on consumer and provider decision-making along the dimension of clinical value. This enhances our understanding of how disruptions affect the relationship between clinical value and usage of different services and suggests the need for more targeted interventions to reduce low-value care.

A Rare Germline HOXB13 Variant Contributes to Risk of Prostate Cancer in Men of African Ancestry

A rare African ancestry–specific germline deletion variant in HOXB13 (X285K, rs77179853) was recently reported in Martinican men with early-onset prostate cancer. Given the role of HOXB13 germline variation in prostate cancer, we investigated the association between HOXB13 X285K and prostate cancer risk in a large sample of 22 361 African ancestry men, including 11 688 prostate cancer cases. The risk allele was present only in men of West African ancestry, with an allele frequency in men that ranged from 0.40% in Ghana and 0.31% in Nigeria to 0% in Uganda and South Africa, with a range of frequencies in men with admixed African ancestry from North America and Europe (0–0.26%). HOXB13 X285K was associated with 2.4-fold increased odds of prostate cancer (95% confidence interval [CI] = 1.5-3.9, p = 2 × 10−4), with greater risk observed for more aggressive and advanced disease (Gleason ≥8: odds ratio [OR] = 4.7, 95% CI = 2.3–9.5, p = 2 × 10−5; stage T3/T4: OR = 4.5, 95% CI = 2.0–10.0, p = 2 × 10−4; metastatic disease: OR = 5.1, 95% CI = 1.9–13.7, p = 0.001). We estimated that the allele arose in West Africa 1500–4600 yr ago. Further analysis is needed to understand how the HOXB13 X285K variant impacts the HOXB13 protein and function in the prostate. Understanding who carries this mutation may inform prostate cancer screening in men of West African ancestry. Patient summaryA rare African ancestry–specific germline deletion in HOXB13, found only in men of West African ancestry, was reported to be associated with an increased risk of overall and advanced prostate cancer. Understanding who carries this mutation may help inform screening for prostate cancer in men of West African ancestry.

Initial Findings from a High Genetic Risk Prostate Cancer Clinic

To improve prostate cancer screening for high-risk men, we developed an early detection clinic for patients at high genetic risk of developing prostate cancer. Despite the rapidly growing understanding of germline variants in driving aggressive prostate cancer and the increased availability of genetic testing, there is little evidence surrounding how best to screen these men. We are reporting on the first 45 patients enrolled, men between the ages of 35-75, primarily with known pathogenic germline variants in prostate cancer susceptibility genes. Screening consists of an intake lifestyle survey, PSA, DRE, and SelectMDx urine assay. A biopsy was recommended for any of the following indications: 1) abnormal DRE, 2) PSA above threshold, or 3) SelectMDx above threshold. The primary outcomes were number needed to screen, and number needed to biopsy to diagnose a patient with prostate cancer. Patients enrolled in the clinic included those with BRCA1 (n=7), BRCA2 (n=16), Lynch Syndrome (n=6), and CHEK2 (n = 4) known pathogenic germline variants. The median age and PSA were 58 (range 35-71) and 1.4 ng/ml (range 0.1-11.4 ng/ml), respectively. 12 patients underwent a prostate needle biopsy and there were 4positive biopsies for prostate cancer. These early data support the feasibility of opening a dedicated clinic for men at high genetic risk of prostate cancer. This early report on the initial enrollment of our long-term study will help optimize early detection protocols and provide evidence for personalized prostate cancer screening in men with key pathogenic germline variants.

Abstract 2605: A natural history study of men with high-risk genetics for prostate cancer (PCa) using multiparametric MRI (mpMRI)

Abstract Introduction: The understanding of molecular genetics in PCa provides insight into disease progression and treatment. Less is known about PCa development in men with known high-risk germline pathogenic/likely pathogenic variants in PCa related genes, particularly DNA damage repair (DDR). mpMRI can localize and detect PCa lesions in this population. We are conducting a multicenter natural history study of male participants (prts) with documented germline variant(s) in BRCA1, BRCA2, MLH1, MSH2, MSH6, PMS2, EPCAM, HOXB13, ATM, NBN, TP53, CHEK2, PALB2, RAD51D, BRIP1, or FANCA who do not have a PCa diagnosis using mpMRI (NCT03805919). Methods: Up to 500 men, 30-75 years old (y/o) will undergo mpMRI evaluation at baseline and every 2 years (yrs). Prts are followed at 12-mo intervals to determine PSA, PCa diagnosis, and/or disease/survival status until death. Indication for prostate biopsy includes PSA &amp;gt;2.0 for 30 - 49 y/o; &amp;gt;2.5 ng/mL for 50 - 75 y/o and/or PIRADS 3+ MRI lesion or clinical discretion. Tissue obtained will undergo full transcriptome analysis. Results: 100 prts have enrolled. Median age is 47 y/o. Median on-study PSA is 0.87 (0.16-10.05 ng/mL). Median PSA density is 0.029. Gene mutations are BRCA2 (40%), BRCA1 (33%), MSH2 (9%), and CHEK2 (4%). Mutations in ATM, HOXB13, MLH1, MSH6, PMS2, and EPCAM are ≤3%. No significant AEs have been observed. Of 96 prts, 25 (26%), had indication for biopsy [PIRADS 4 lesion: 16 (64%), PIRADS 3 lesion: 4 (16%), elevated PSA: 6 (24%), or clinical indication 1: (4%)]. 22 prostate biopsies were performed and 6 prts were diagnosed with PCa. One prt was upstaged on radical prostatectomy (RP). Conclusions: We found mpMRI-based PCa screening in men with high-risk gene mutations, especially DDR genes, is feasible and can be used to identify clinically significant PCa and monitor for disease progression. Future guidelines should consider age, mutation specificity and mpMRI. Accrual and correlative studies (biomarkers, PBMCs) are on-going. AgeMutationPSA (ng/mL)Biopsy Gleason ScoreTreatment65BRCA22.253+3RP52BRCA10.693+3Active Surveillance (AS)62CHEK22.493+3AS59PMS21.033+3AS59CHEK22.243+4Radiation55BRCA21.683+3RP: 4+4=8 Citation Format: Fatima Karzai, Anna Couvillon, Yolanda McKinney, Katherine Lee-Wisdom, Peter L. Choyke, Veda N. Giri, Todd M. Morgan, Heather H. Cheng, Maria J. Merino, Peter A. Pinto, Baris Turkbey, William L. Dahut. A natural history study of men with high-risk genetics for prostate cancer (PCa) using multiparametric MRI (mpMRI) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2605.

Predictors of Disparities in Recommendation and Rates of Prostate Cancer Screening

Studies have investigated implications of changes in screening guidelines including disparities in prostate cancer screening across various demographics factors. However, there are only few studies investigating patterns of prostate cancer screening in men before and after implementation of the 2018 USPSTF guideline. Therefore, in the current study, we assessed provider’s recommendations of prostate cancer screening as well as the demographic predictors of screening rates among men without a history of prostate cancer as it relates to the USPSTF guidelines. Many health indicators are collected in non-institutionalized civilian adults by the Center for Disease Control Behavioral Risk Factor Surveillance System (BRFSS), a population-based, cross-sectional survey of US adults. This study, spanning six years from 2013-2018, includes men without history of cancer who had complete data regarding status of PSA test in the past 2 years. Participants also reported being informed about PSA test by their providers and if PSA test was recommended to them. Multivariable logistic regression defined adjusted odds ratios (AOR) and 95% confidence intervals (CI) in a model with recommendation of PSA testing and PSA test within the past 2 years separately as the dependent variable of interest and patients’ race and age as the independent variables. Among 146,038 male participants without a history of cancer, adults ages 70 years and older were more likely to receive PSA screening recommendations relative to adults aged 55-70 (62.5% vs 49.22%, AOR 1.44, 95% CI 1.33-1.55, P<0.001). Adults ages ≥70 years also had higher screening relative to adults ages 55-69 years whether screening was recommended (AOR 1.29, 95% CI 1.19-1.39) or not recommended (AOR 1.54, 95% CI 1.35-1.75) by their providers. Finally, providers were more likely to recommend PSA screening to African Americans (55.55% vs 54.13%, AOR 1.30, 95% CI 1.20-1.42, P<0.001) and less likely to Native Americans (37.95 vs 54.13%, AOR 0.65, 95% CI 0.51-0.82, P<0.001) and Asians (32.42% vs 54.13%, AOR 0.37, 95% CI 0.31-0.45) relative to Whites. Participants ≥70 years old were more likely to get PSA screening recommendations relative to those aged 55-69 years despite the grade D recommendation by USPSTF screening guidelines. In addition, while African American participants were more likely to get PSA screening recommendations and higher PSA screening rates, Native Americans and Asian participants had lower screening and recommendation rates relative to their White counterparts. Our results show that more work needs to be done at the primary care level to reduce rates of PSA screening in the aging population. Our work also shows the need for increased awareness of PSA screening particularly in adults 55-69 years old of Native American or Asian origin.

The Utilization and Costs of USPSTF Grade D Services in Medicare, 2007‐2016

Research ObjectiveLow‐value care (LVC), or patient care that offers no net benefit in specific clinical scenarios, leads to unnecessary spending and patient harm in certain circumstances. The U.S. Preventive Services Task Force (USPSTF) Grade D Recommendations exemplify LVC, given the very high certainty that the expected clinical benefits of these services do not exceed the expected harms. We estimate the utilization and related costs of ten USPSTF Grade D Services among U.S. Medicare beneficiaries.Study DesignWe conducted a cross‐sectional analysis of data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of U.S. outpatient visits. NAMCS uses a multistage probability sampling design, and data are abstracted directly from the medical record. Eligible visits included those by beneficiaries 18 years of age or older for whom Medicare was listed as the primary expected payer. Ten USPSTF Grade D Services were selected based on feasibility of case identification using diagnosis codes and recorded symptoms. These included the following: (1) cervical cancer screening for women older than 65, (2) prostate cancer screening for men 75 and older, (3) colonoscopy for adults older than 85, (4) vitamin D screening, (5) screening for cardiovascular disease among low‐risk adults, (6) COPD screening among asymptomatic adults, (7) screening for asymptomatic bacteriuria, (8) vitamin D supplementation for primary prevention of fractures among postmenopausal women, (9) hormone therapy for primary prevention of chronic conditions among postmenopausal women, and (10) vitamin E or beta‐carotene supplements for primary prevention of cardiovascular disease or cancer. The annual volume of these services was determined and then multiplied by per unit costs obtained from separate claims and actuarial sources to calculate annualized costs.Population StudiedOffice‐based visits by Medicare beneficiaries, 2007 to 2016.Principal FindingsFor the 10 services measured, over 30 million were provided to Medicare beneficiaries annually. The direct costs ranged from $649,604,514 to $862,159,707 annually. The three most frequently used services were (1) screening for asymptomatic bacteriuria, (2) vitamin D supplementation, and (3) screening for vitamin D deficiency screening, comprising 83% of the measured services and 46% of the calculated LVC spending. Three services (1) screening for asymptomatic bacteriuria, (2) cervical cancer screening among women older than 65, and (3) colonoscopies among adults older than 85 comprised 53% of measured LVC spending.ConclusionsThe USPSTF provides a D rating for services for which there is a moderate or high certainty that the service has no benefits or that the harms outweigh the benefits. Ten Grade D Services were provided frequently to Medicare beneficiaries, costing nearly $1 billion in Medicare spending annually. The negative clinical impact and total costs associated with the use of D‐rated services are likely larger as these findings do not capture all D‐rated services, as well as the downstream health care utilization after their use.Implications for Policy or PracticeThe implementation of policies that reduce LVC use offers an important opportunity to improve patient‐centered outcomes while safely reducing U.S. health care spending. Resultant savings could be used to expand access to high‐value care using value‐based insurance design.Primary Funding SourceThis study was supported by the Department of Veterans Affairs.

PD13-03 COMPETING MORTALITY RISKS IN ELDERLY MEN WITH PROSTATE CANCER IN THE UNITED STATES

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I (PD13)1 Apr 2020PD13-03 COMPETING MORTALITY RISKS IN ELDERLY MEN WITH PROSTATE CANCER IN THE UNITED STATES Muhammad Alam*, Daniel Norez, Jatinder Kumar, Karthik Tanneru, Shiva Gautam, Shahriar Koochekpour, Behzad Jazayeri, Soroush Bazargani, Sabine Nguyen, Hariharan Palayapalayam Ganapathi, Mark Bandyk, Joseph Costa, Robert Marino, and KC Balaji Muhammad Alam*Muhammad Alam* More articles by this author , Daniel NorezDaniel Norez More articles by this author , Jatinder KumarJatinder Kumar More articles by this author , Karthik TanneruKarthik Tanneru More articles by this author , Shiva GautamShiva Gautam More articles by this author , Shahriar KoochekpourShahriar Koochekpour More articles by this author , Behzad JazayeriBehzad Jazayeri More articles by this author , Soroush BazarganiSoroush Bazargani More articles by this author , Sabine NguyenSabine Nguyen More articles by this author , Hariharan Palayapalayam GanapathiHariharan Palayapalayam Ganapathi More articles by this author , Mark BandykMark Bandyk More articles by this author , Joseph CostaJoseph Costa More articles by this author , Robert MarinoRobert Marino More articles by this author , and KC BalajiKC Balaji More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000847.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The natural history of prostate cancer (PC) in men of > 70 years of age is not well defined. Although the current recommendation for PC screening is limited to 70 years of age, thousands of American men > 70 years of age are diagnosed annually with PC because of increasing life expectancy and continuing common practice of PC screening in men >70 years of age. In order to facilitate the best management strategies, we carried out competing risks analysis of elderly men diagnosed with PC of either dying from prostate cancer or other causes. METHODS: Data from 42810 patients who were diagnosed with PC from 2004 to 2016 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and stratified according to age into groups: 70 - 74, 75 - 79, 80 – 84, 85 - 89 and ≥90 years. The cause and non-cause mortality rates were calculated using competing risk estimates. RESULTS: Out of the total population studied, 10.1 % were African Americans, 78.4 % were Caucasians and rest other races. The follow up was censored at 10, 8 and 6 years for men 71-84, 85-89 and > 90 years of age respectively. Only 5% of the total population died of PC, 85% were alive and 10% died of other causes. The risks of dying from PC was highest in men with Gleason score (GS) > 7 PC across all age groups. Interestingly, while fewer than 10% of men with GS ≤ 7 died from PC across all age groups and vast majority died of other causes, the PC mortality was about 40% in men with GS > 7, which accounted for about half the deaths in men between 71 and 79 year of age. CONCLUSIONS: The study for the first time demonstrates the competing risks of mortality in elderly men diagnosed with prostate. Because about 40% of men diagnosed with GS > 7 prostate cancer died of the disease, which accounts for half the deaths in men 71 – 79 years of age, active intervention in this age group may be justified to improve clinical outcomes. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e266-e267 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Muhammad Alam* More articles by this author Daniel Norez More articles by this author Jatinder Kumar More articles by this author Karthik Tanneru More articles by this author Shiva Gautam More articles by this author Shahriar Koochekpour More articles by this author Behzad Jazayeri More articles by this author Soroush Bazargani More articles by this author Sabine Nguyen More articles by this author Hariharan Palayapalayam Ganapathi More articles by this author Mark Bandyk More articles by this author Joseph Costa More articles by this author Robert Marino More articles by this author KC Balaji More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostate cancer screening among elderly men in Brazil: should we diagnose or not?

ABSTRACTPurpose:Prostate cancer screening in the elderly is controversial. The Brazilian government and the National Cancer Institute (INCA) do not recommend systematic screening. Our purpose was to assess prevalence and aggressiveness of prostate cancer in men aged 70 years and above, on the first Latin American database to date.Materials and Methods:Cross-sectional study (n=17,571) from 231 municipalities, visited by Mobile Cancer Prevention Units of a prostate-specific antigen (PSA) based opportunistic screening program, between 2004 and 2007. The criteria for biopsy were: PSA>4.0ng/ml, or PSA 2.5-4.0ng/ml with free/total PSA ratio ≤15%, or suspicious digital rectal examination findings. The screened men were stratified in two age groups (45-69 years, and ≥70 years). These groups were compared regarding prostate cancer prevalence and aggressiveness criteria (PSA, Gleason score from biopsy and TNM staging).Results:The prevalence of prostate cancer found was 3.7%. When compared to men aged 45-69 years, individuals aged 70 years and above presented cancer prevalence about three times higher (prevalence ratio 2.9, p<0.01), and greater likelihood to present PSA level above 10.0ng/ml at diagnosis (odds ratio 2.63, p<0.01). The group of elderly men also presented prevalence of histologically aggressive disease (Gleason 8-10) 3.6 times higher (p<0.01), and 5-fold greater prevalence of metastases (PR 4.95, p<0.05).Conclusions:Prostate cancer screening in men aged over 70 may be relevant in Brazil, considering the absence of systematic screening, higher prevalence and higher probability of high-risk disease found in this age range of the population studied.

Prostate Cancer Screening in Men of African Descent: 15-year Results of the Tobago Prostate Cancer Survey

Objective: To compare all-cause-mortality in screening-detected prostate cancer cases versus non-cases after a median 12.2-year follow-up. Methods: In this prospective, population-based study of 3089 Afro-Caribbean men aged 40–79 years in Tobago, Trinidad and Tobago, West Indies, all men were screened for prostate cancer (serum prostate specific antigen and/or digital rectal exam) one to three times between 1997 and 2007 and followed for mortality to 2012. Among 502 men diagnosed with prostate cancer, 81 younger men underwent radical retropubic prostatectomy. Minimal treatment was available for older men. Survival curves compared all-cause-mortality in cases versus non-cases within 10-year age groups at first screening. Results: There were 350 all-cause-deaths over 34 089 person-years of follow-up. All-cause-survival curves in men aged 60 years or above at first screening did not diverge between cases and non-cases until after 10–12 years of follow-up (p &gt; 0.36). In contrast, among men first screened at age 50–59 years, survival was lower in cases, with survival curves diverging at seven years (p = 0.003). Survival in men aged 50–59 years who underwent prostatectomy was similar to survival in non-cases (p = 0.63). Conclusion: Among men aged 60 years or above, the absence of excess all-cause-mortality among screening-detected prostate cancer cases provides argument against the utility of routine prostate cancer screening in this older population of African descent. However, the significantly poorer survival in men aged 50–59 years with screening-detected prostate cancer, compared with screened men without prostate cancer, along with the potential for prostate cancer treatment to improve survival, supports the continuation of prostate cancer screening in this age group, pending further research to assess the risks and benefits.

Web-Based Versus Usual Care and Other Formats of Decision Aids to Support Prostate Cancer Screening Decisions: Systematic Review and Meta-Analysis.

BackgroundProstate cancer is a leading cause of cancer among men. Because screening for prostate cancer is a controversial issue, many experts in the field have defended the use of shared decision making using validated decision aids, which can be presented in different formats (eg, written, multimedia, Web). Recent studies have concluded that decision aids improve knowledge and reduce decisional conflict.ObjectiveThis meta-analysis aimed to investigate the impact of using Web-based decision aids to support men’s prostate cancer screening decisions in comparison with usual care and other formats of decision aids.MethodsWe searched PubMed, CINAHL, PsycINFO, and Cochrane CENTRAL databases up to November 2016. This search identified randomized controlled trials, which assessed Web-based decision aids for men making a prostate cancer screening decision and reported quality of decision-making outcomes. Two reviewers independently screened citations for inclusion criteria, extracted data, and assessed risk of bias. Using a random-effects model, meta-analyses were conducted pooling results using mean differences (MD), standardized mean differences (SMD), and relative risks (RR).ResultsOf 2406 unique citations, 7 randomized controlled trials met the inclusion criteria. For risk of bias, selective outcome reporting and participant/personnel blinding were mostly rated as unclear due to inadequate reporting. Based on seven items, two studies had high risk of bias for one item. Compared to usual care, Web-based decision aids increased knowledge (SMD 0.46; 95% CI 0.18-0.75), reduced decisional conflict (MD –7.07%; 95% CI –9.44 to –4.71), and reduced the practitioner control role in the decision-making process (RR 0.50; 95% CI 0.31-0.81). Web-based decision aids compared to printed decision aids yielded no differences in knowledge, decisional conflict, and participation in decision or screening behaviors. Compared to video decision aids, Web-based decision aids showed lower average knowledge scores (SMD –0.50; 95% CI –0.88 to –0.12) and a slight decrease in prostate-specific antigen screening (RR 1.12; 95% CI 1.01-1.25).ConclusionsAccording to this analysis, Web-based decision aids performed similarly to alternative formats (ie, printed, video) for the assessed decision-quality outcomes. The low cost, readiness, availability, and anonymity of the Web can be an advantage for increasing access to decision aids that support prostate cancer screening decisions among men.

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

ObjectivesTo report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi‐national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes.Particpants and MethodsMen enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36‐item short‐form health survey (SF‐36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale‐Revised, risk perception and knowledge. The results of the baseline questionnaire are presented.ResultsA total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants’ perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF‐36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status.ConclusionThis is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer‐specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening.

Scrutiny-Dependent Cancer and Self-fulfilling Risk Factors.

Cancer screening is often recommended to patients believed to have a specific risk factor, such as prostate cancer screening for men who have a family history of the disease or melanoma screening f...

A qualitative meta-synthesis examining the role of women in African American men's prostate cancer screening and treatment decision making.

Being an African American man is a risk factor for prostate cancer, and there is little consensus about the use of screening, early detection, and the efficacy of treatment for the disease. In this context, this systematic review examines the roles women, particularly wives, play in African American men's prostate cancer screening and treatment decision making. We searched OVID Medline (R), CINAHL (EBSCO), PsychInfo (EBSCO), PubMED, Cochrane Library, ERIC (Firstsearch), and Web of Science to identify peer-reviewed articles published between 1980 and 2016 that reported qualitative data about prostate cancer screening, diagnosis, or treatment in African American men. We conducted a systematic review of the literature using study appraisal and narrative synthesis. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for identifying and screening 1425 abstracts and papers, we identified 10 papers that met our criteria. From our thematic meta-synthesis of the findings from these publications, we found that women played 3 key roles in African American men's decision making regarding prostate cancer screening, diagnosis, or treatment: counselor (ie, offering advice or information), coordinator (ie, promoting healthy behaviors and arranging or facilitating appointments), and confidant (ie, providing emotional support and reassurance). Women are often important confidants to whom men express their struggles, fears, and concerns, particularly those related to health, and they help men make appointments and understand medical advice. Better understanding women's supportive roles in promoting positive mental and physical outcomes may be key to developing effective interventions to improve African American men's decision making and satisfaction regarding prostate cancer screening and treatment.

Digital rectal examination for prostate cancer screening performed with colonoscopy for colon cancer screening: 2 for the price of 1

Prostate cancer is the most commonly diagnosed nonskin cancer in American men. There are an estimated 160,000 new cases each year, with cancer-related mortality exceeding 26,000 deaths annually, which exceeds the number of cases of, and is similar to the number of deaths from, colorectal cancer in men. 1 American Cancer Society. American Cancer Society statistics center. Volume 2017. Cancer Statistics Center: American Cancer Society, 2017. Google Scholar Although debates continue, both the American Cancer Society and American Urological Association continue to recommend digital rectal examination (DRE) as an option for prostate cancer screening in men over age 50 to 54. 2 Carter H.B. Albertsen P.C. Barry M.J. et al. Early detection of prostate cancer: AUA Guideline. J Urol. 2013; 190: 419-426 Abstract Full Text Full Text PDF PubMed Scopus (781) Google Scholar , 3 American Cancer Society. Prostate cancer prevention and early detection. Available at: https://www.cancer.org/research/cancer-facts-statistics/cancer-prevention-early-detection.html. Accessed March 28, 2017. Google Scholar Colonoscopy starting at age 50 is one of the recommended screening options for colorectal cancer screening, and it is standard practice for endoscopists to perform a DRE before the start of colonoscope insertion. In most instances, this DRE is largely a simultaneous evaluation and lubrication of the anal canal and does not include a prostate examination. A DRE with prostate examination performed at the time of colonoscopy would simultaneously screen for 2 of the top 3 causes of cancer and cancer-related death in U.S. men. In a similar vein, endoscopic examination of the oropharynx has been proposed in those at high risk for head and neck cancer undergoing upper endoscopy. 4 Emura F. Baron T.H. Gralnek I.M. The pharynx: examination of an area too often ignored during upper endoscopy. Gastrointest Endosc. 2013; 78: 143-149 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar At present, there are no recommendations or guidelines from gastroenterology or endoscopy professional societies to perform DRE for prostate cancer screening at the time of screening colonoscopy.

Prostate Cancer Screening in a New Era of Genetics.

Men who inherit pathogenic germline mutations in BRCA2 and BRCA1 are at increased risk of developing aggressive prostate cancer, and those with germline mutations in other DNA repair genes such as ATM, CHEK2, and MSH2/MSH6 may also have increased risks. Although clinically important, there is lack of specific guidance regarding management strategies for men at increased risk owing to germline mutation status or family history of aggressive prostate cancer. We review prostate cancer genetic risk factors and the ongoing IMPACT (Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in BRCA1/2 mutation carriers and controls) screening study. Pending results of IMPACT and unified guidelines, there are areas of uncertainty and need for further study. Ongoing and future research will be critical for optimizing prostate cancer screening approaches for men at the highest risk for aggressive prostate cancer. In the interim, we propose a practical approach to prostate cancer screening for men with a germline mutation in a known/suspected moderate to high-penetrance cancer predisposition gene (eg, BRCA1/2), and/or men with a first- or second-degree relative with metastatic prostate cancer (regardless of genetic testing): baseline prostate-specific antigen and digital rectal exam by experienced providers at age 40 years or 5 years earlier than age of diagnosis of the youngest first- or second-degree relative with metastatic prostate cancer, whichever is earlier. Then, based on age, digital rectal exam, and prostate-specific antigen, we suggest consideration of magnetic resonance imaging, biopsy, and/or continued monitoring.

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.