Screening Test For Prostate Cancer Research Articles

Abstract 7: Berg Interrogative Biology™ platform unravels novel biomarkers FLNB and LY9 in combination with PSA enhances specificity in serum of patients with prostate cancer.

Abstract Prostate Specific Antigen (PSA) test is the predominant screening test for prostate cancer. Utility is limited by the low predictive power to differentiate patients with indolent tumors from aggressive disease with potential for metastasis. Identification of potential biomarkers to increase prediction of patient population with propensity for progression to metastatic disease remains the overarching unmet need in prostate cancer screening. This study reports the identification of a panel of potential biomarkers using the Berg Interrogative Biology™ platform, a novel non-hypothesis driven approach to characterize disease specific molecular signatures for the identification of physiological drivers of disease etiology. Filamin B (FLNB) and lymphocyte antigen 9 (LY9) were two of several markers identified from a high confidence causal network of prostate cancer model using the Berg Interrogative Biology™ platform. Both FLNB and LY9 were validated in a small case-control retrospective study in human serum samples of patients with prostate cancer and age-matched normal controls. The utility of FLNB and LY9 as potential biomarkers in prostate cancer was determined by comparing the serum levels to that of PSA to establish benchmark comparison. Statistically significant elevation of the PSA, FLNB, and LY9 concentrations was detected in the prostate cancer group compared to the age-matched normal control group. Statistical analyses were performed to determine the sensitivity and specificity of the molecular markers by ROC curve analysis. The predictive power of FLNB or LY9 alone was comparable to that of the PSA test. The combination of FLNB and LY9 with PSA out-performed PSA alone with AUC=0.975 in the study. The study provides data in support of FLNB and LY9 as biomarkers with potential to improve screening outcomes when used in combination with PSA. Efforts are currently underway in large patient cohorts to validate the clinical utility of FLNB and LY9 as candidate biomarkers for use in the screening of prostate cancer with correlate to the Gleason score to enable more instructive data to the practitioner. Citation Format: Rangaprasad Sarangarajan, Joyce Chan, Eric Grund, Vivek K. Vishnudas, Shen Luan, Viatcheslav R. Akmaev, Niven R. Narain. Berg Interrogative Biology™ platform unravels novel biomarkers FLNB and LY9 in combination with PSA enhances specificity in serum of patients with prostate cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 7. doi:10.1158/1538-7445.AM2013-7

Association between race and follow‐up diagnostic care after a positive prostate cancer screening test in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial

Follow-through of a positive screening test is necessary to reap the potential benefits of cancer screening. Racial variation in follow-through diagnostic care may underlie a proportion of the known disparity in prostate cancer mortality. The authors used data from the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial to determine whether race is associated with the use of follow-up diagnostic testing after a positive initial screening evaluation. Men who had a prostate-specific antigen (PSA) level >4 ng/mL at any time during the study were included. The proportion of men who underwent follow-up evaluation with a repeat PSA, a prostate biopsy, or either test within 9 months was determined, and the authors tested for differences in follow-through according to race using mixed-effects multivariate models with a random effect for accrual site to account for clustering. Models were stratified according to age (<65 years and ≥65 years). Among 6294 men who had a PSA elevation during the study period, 70% underwent a repeat PSA or prostate biopsy within 9 months. Non-Hispanic black men aged <65 years had 45% lower odds of undergoing a repeat PSA test or prostate biopsy compared with non-Hispanic white men (odds ratio, 0.55; 95% confidence interval, 0.37-0.82), whereas there was no racial difference in follow-through among older men. The current results suggest that limitations in access to care among non-Hispanic black men under the age of Medicare eligibility may underlie the paradoxically low use of follow-through diagnostic care among non-Hispanic black men in the United States.

Abstract B14: Predicting prostate cancer: a novel, non-invasive approach

Abstract Introduction: Current approaches to the detection of prostate cancer require improvement. PSA and other methods fall short in discriminating between benign and malignant prostates, as well as defining the nature of disease. We hypothesize that multiple markers, in non-invasive samples, can better detect prostate cancer and improve patient outcomes. Methods: Discriminating mRNA markers in prostatic tissues were identified, and quantified using standard assays, to complement the non-coding gene PCA3. Complementary metabolomic analysis of ejaculate was performed using 500 MHz 1H-NMR spectroscopy. Results: In 100 patients, RT-PCR for PCA3 and Hepsin from ejaculate in combination with serum PSA provided improved prediction compared with PSA alone. Further mRNA markers marginally improved these results. Metabolomic analysis of ejaculate was initially confounded by contributions from buffer solution. Appropriate exclusion of confounders provided improved insight into sample and disease pathophysiology, and was combined with the molecular analysis. Preliminary results have indicated that combining molecular and metabolomic data promise to improve detection rates. Results from this combined data analysis will be presented. Furthermore, patients with initially negative prostate biopsies have been monitored for disease progression, with a number changing status over time. These findings have been analyzed and will also be presented. Conclusion: Our results suggest that there is potential for non-invasive detection of prostate cancer. Current methods of detection are improved by combining clinical, genetic and metabolic markers from excreted biofluids. Further insight is provided into the pathophysiology of prostate cancer, which will further advance integration with imaging, as well as advancing the development of an accurate, non-invasive screening test for prostate cancer. Citation Format: Matthew J. Roberts, Horst J. Schirra, Martin F. Lavin, Robert A. Gardiner. Predicting prostate cancer: A novel, noninvasive approach. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B14.

The Impact of Anatomical Radical Retropubic Prostatectomy on Cancer Control: The 30-Year Anniversary

Radical prostatectomy has decreased prostate cancer specific mortality in men with clinically localized prostate cancer. We report oncological outcomes of the longest running series of nerve sparing radical retropubic prostatectomy on the 30th anniversary of the inaugural operation. A total of 4,478 men underwent anatomical radical retropubic prostatectomy, as performed by a single surgeon (PCW), at the Johns Hopkins Medical Institutions from 1982 to 2011, without neoadjuvant or adjuvant therapy. During a median followup of 10 years (range 1 to 29), we examined progression-free, metastasis-free and cancer specific survival. The overall 25-year progression-free, metastasis-free and cancer specific survival rates were 68%, 84% and 86%, respectively, although there were significant differences in treatment outcomes between men treated in the pre-PSA and PSA eras. In each era, there were significant differences in progression-free, metastasis-free and cancer specific survival by D'Amico risk groups. In multivariable models considering prostatectomy features, pathological stage and grade were significantly associated with the risk of metastatic progression and disease specific mortality. Excellent prostate cancer specific survival was demonstrated up to 30 years after surgery. Clinical risk categories and pathological tumor features were significant predictors of long-term disease specific outcomes, supporting their ongoing use in risk stratification and management decisions. Anatomical radical retropubic prostatectomy continues to represent the gold standard in the surgical management of clinically localized prostate cancer to which alternate treatment options should be compared.

Design of a prostate cancer patient navigation intervention for a Veterans Affairs hospital

BackgroundPatient navigation programs have been launched nationwide in an attempt to reduce racial/ethnic and socio-demographic disparities in cancer care, but few have evaluated outcomes in the prostate cancer setting. The National Cancer Institute-funded Chicago Patient Navigation Research Program (C-PNRP) aims to implement and evaluate the efficacy of a patient navigation intervention for predominantly low-income minority patients with an abnormal prostate cancer screening test at a Veterans Affairs (VA) hospital in Chicago.Methods/DesignFrom 2006 through 2010, C-PNRP implemented a quasi-experimental intervention whereby trained social worker and lay health navigators worked with veterans with an abnormal prostate screen to proactively identify and resolve personal and systems barriers to care. Men were enrolled at a VA urology clinic and were selected to receive navigated versus usual care based on clinic day. Patient navigators performed activities to facilitate timely follow-up such as appointment reminders, transportation coordination, cancer education, scheduling assistance, and social support as needed. Primary outcome measures included time (days) from abnormal screening to diagnosis and time from diagnosis to treatment initiation. Secondary outcomes included psychosocial and demographic predictors of non-compliance and patient satisfaction. Dates of screening, follow-up visits, and treatment were obtained through chart audit, and questionnaires were administered at baseline, after diagnosis, and after treatment initiation. At the VA, 546 patients were enrolled in the study (245 in the navigated arm, 245 in the records-based control arm, and 56 in a subsample of surveyed control subjects).DiscussionGiven increasing concerns about balancing better health outcomes with lower costs, careful examination of interventions aimed at reducing healthcare disparities attain critical importance. While analysis of the C-PNRP data is underway, the design of this patient navigation intervention will inform other patient navigation programs addressing strategies to improve prostate cancer outcomes among vulnerable populations.

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Oct 2012Editorial Comment Ayman S. Moussa Ayman S. MoussaAyman S. Moussa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.06.137AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 188(4), p. 1150 References 1 : Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol2002; 167: 966. Link, Google Scholar 2 : Measurement of prostate specific antigen in serum as a screening test for prostate cancer. N Engl J Med1991; 324: 1156. Google Scholar Urology Department, Cairo-Beni-Suif University, Cairo, Egypt© 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 188Issue 4October 2012Page: 1150 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ayman S. Moussa More articles by this author Expand All Advertisement PDF DownloadLoading ...

Use of low free to total PSA ratio in prostate cancer screening: detection rates, clinical and pathological findings in Brazilian men with serum PSA levels &lt;4.0 ng/mL

What's known on the subject? and What does the study add? In spite of its low specificity, PSA is the most widely used screening test for prostate cancer (PCa), and is considered the main cause of the stage migration recently observed. The ratio of free to total PSA (%fPSA) has been shown to increase PSA accuracy in cancer detection; however, few screening studies have systematically evaluated its role in cancer detection rates in men with PSA levels <4.0 ng/mL and normal DRE. The present study supports a possible role of %fPSA as an adjunct to screening in men with total PSA 2.5-4.0 ng/mL and normal DRE, with a marked increase in cancer detection rates in a large Brazilian PCa screening study. We believe that %fPSA maybe a useful refinement to biopsy indications in men with low PSA levels. • To evaluate the role of the free to total prostate-specific antigen ratio (%fPSA) in identifying prostate cancer (PCa) in men with a prostate-specific antigen (PSA) level of 2.5-3.9 ng/mL and a normal digital rectal examination (DRE). • A prospective PCa screening study was conducted, which included 17571 men aged ≥ 45 years, across six Brazilian states, where men were recalled for further evaluation in the case of either a suspicious DRE and/or PSA ≥ 4.0 ng/mL, or PSA 2.5-3.9 ng/mL and %fPSA ≤ 15. • We evaluated the impact of a %fPSA ≤ 15 on cancer detection rates and the clinical and pathological stage of tumours in men with a normal DRE and PSA 2.5-3.9 ng/mL. • When suspicious DRE and/or PSA ≥ 4.0 ng/mL were considered as criteria to prompt further evaluation, the cancer detection rate was 3.1%. When %fPSA ≤ 15 in men with total PSA levels of 2.5-3.9 ng/mL were considered as criteria, the PCa detection rate increased to 3.7%. Considering %fPSA ≤ 15 in men with PSA 2.5-3.9 ng/mL and normal DRE, the positive predictive value of biopsy was 31.1%. • Clinical stage was more favourable among men with PSA 2.5-3.9 ng/mL, normal DRE, and %fPSA ≤ 15 compared with men with normal DRE and PSA ≥ 4.0 ng/mL (P= 0.02). • Among those who underwent radical prostatectomy, pathological stage and the proportion of insignificant tumours were similar between men with PSA 2.5-3.9 ng/mL, normal DRE findings and %fPSA ≤ 15, and men with PSA ≥ 4.0 ng/mL. • The use of %fPSA ≤ 15 as a biopsy indication in men with normal DRE and PSA 2.5-4.0 ng/mL in a PCa screening programme, increased cancer detection rates. Tumours in this subset of patients had similar pathological characteristics. • Using %fPSA ≤ 15 to indicate biopsy in men with PSA 2.5-3.9 ng/mL is a useful adjunct to PCa screening.

The Search for Diagnostic Markers in Sepsis

The Search for Diagnostic Markers in Sepsis

Other methods for improved prostate cancer detection?

Investigators are studying many techniques that may improve prostate cancer detection, including: PSA velocity: This is a measurement of the change in prostate-specific antigen (PSA) level over time. A 2006 study found that men who had a PSA velocity >0.35 ng/mL per year had a higher relative risk of dying from prostate cancer than men who had a PSA velocity <0.35 ng/mL per year. More studies are needed to determine whether a high PSA velocity more accurately detects prostate cancer early. PSA density: PSA density considers the relationship between the level of PSA and the size of the prostate. An elevated PSA level might not be suspicious if a man has a very enlarged prostate; however, cancer might be overlooked in a man with an enlarged prostate. Free versus attached PSA: Often used for men who have higher PSA values, free PSA may help determine what kind of prostate problem a man has. With benign prostate conditions (such as benign prostatic hyperplasia), there is more free PSA, whereas cancer produces more of the attached form. Researchers are looking at other ways to measure PSA and use these measurements to determine whether cancer is present. Alteration of PSA cutoff level: A number of studies have used cutoff levels of 2.5 or 3.0 ng/mL, rather than the current cutoff of 4.0 ng/mL. In such studies, PSA measurements higher than 2.5 or 3.0 ng/mL are considered elevated. Researchers hope that using these lower cutoff levels will increase the chance of detecting prostate cancer; however, this method also may increase overdiagnosis and false-positive test results Other Detection Methods MicroRNA patterns: Researchers have found that the pattern of microRNAs in a cell can differ between healthy cells and cancer cells. Some research also suggests that the microRNA patterns in early-stage prostate cancer and late-stage prostate cancer may be different. Nonmutation gene alterations: Research has already shown that certain genes become hypermethylated and inactivated during the development and progression of prostate cancer. Scientists hope to identify DNA methylation changes and protein modifications that could identify prostate cancer early and help predict tumor behavior. Gene fusions: The gene fusions found in prostate cancer involve members of the ETS family of oncogenes. Researchers are investigating whether diagnostic or prognostic tests based on gene fusions can be developed. PCA3: Also known as DD3, PCA3 is a prostate-specific RNA that is reported to be expressed at high levels in prostate tumor cells. A urine test for this RNA, to be used in addition to current prostate cancer screening tests, is currently under study. Differential detection of metabolites: Molecules produced by the body's metabolic processes, or metabolites, may be able to help distinguish between benign prostate tissue, localized prostate cancer, and metastatic prostate cancer. One such molecule, known as sarcosine, may be associated with prostate cancer's invasiveness and aggressiveness. Investigators are determining whether they can develop a test based on sarcosine. Proteo-imaging: Identifying different patterns of protein expression in healthy prostate tissue versus abnormal prostate tissue may help classify early prostate changes that may one day lead to cancer. Protein patterns in the blood: Unique protein patterns in the blood may indicate the presence of prostate cancer. Researchers are studying these patterns to see whether more aggressive cancers can be distinguished from less aggressive ones.

Predictors of Attendance for Prostate-Specific Antigen Screening Tests and Prostate Biopsy

BackgroundLittle is known about factors influencing men's decisions to undergo screening and diagnostic tests for prostate cancer (PCa). ObjectiveIdentify predictors of attendance for prostate-specific antigen (PSA) testing and prostate biopsy. Design, setting, and participantsLiterature searches and interviews with men undergoing PSA testing and prostate biopsy formed the basis of a self-report questionnaire designed to identify predictors of health behaviour, which was completed by men eligible for PSA invitation and prostate biopsy. Multitrait scaling analyses established the final questionnaire content. This revised instrument was distributed to a new cohort of men before PSA testing and biopsy invitations were received. Ethical committee approval was obtained from Trent Multicentre Research Ethics Committee (MREC/01/4/025 – 21/06/2001). MeasurementsPredictors of health behaviour and attendance rates for PSA test or prostate biopsy were measured. Associations between questionnaire scores and health behaviour (PSA and prostate biopsy attendance) were examined using logistic regression. Results and limitationsThe provisional 49-item health behaviour questionnaire was completed by 468 of 810 men (57.8%). Multitrait scaling refined the questionnaire to 26 items in six scales (A: health benefits, B: threats to health, C: barriers to testing, D: health intentions, E: external influences, F: current general health). A total of 1455 of 2657 men (54.8%) completed the revised instrument before invitations for PSA test or biopsy were received; 395 (43.4%) and 434 (91.6%) attended. Strong associations between men's health intentions (scale D) and PSA and biopsy attendance (odds ratio: 1.56 or 3.67, respectively; p<0.001) were observed with modest associations between the other five scales and attendance for PSA testing. Average questionnaire response rates represent the major limitation of this study. ConclusionsKnowledge and beliefs about PCa and testing predict men's intentions and attendance for PSA testing and prostate biopsy. Understanding men's health behaviour is important for the management of patients seeking PSA testing in general practice.

Abstract A96: The influence of infectious mononucleosis on prostate-specific antigen concentration as a marker of prostate involvement during infection

Abstract Background: Although Epstein-Barr virus (EBV), a common gamma herpesvirus known to contribute to several cancers (e.g., Burkitt's lymphoma), has been detected in prostate tissue, results from the few epidemiologic studies of EBV infection and prostate cancer have been null. One possible reason for these null findings may be that not all EBV infections contribute to prostate cancer risk. For instance, for other proposed EBV-associated conditions, such as multiple sclerosis, infections acquired later in life (e.g., in adolescence or early adulthood) when EBV infection tends to manifest as infectious mononucleosis (IM) have been found to be more important for risk than those acquired earlier in life when EBV infection is typically asymptomatic. To begin to explore the importance of later-onset EBV infections for prostate carcinogenesis, we investigated the extent of prostate pathogenesis during adult-onset IM by measuring prostate specific antigen (PSA) concentration as a marker of prostate infection, inflammation, and cell damage in adult-onset IM cases and controls with stored serum in the Department of Defense Serum repository (DoDSR). Methods: IM cases were men diagnosed with IM in 1998–2003 (n=55) and controls were a sample of men with no IM diagnoses from 1995–2006 (n=255). For each IM case, we selected two archived serum specimens from the DoDSR, one collected after their diagnosis (acute specimen, range: 1 day-3 years after diagnosis) and the first specimen collected immediately before their acute specimen (pre-acute specimen, range: 46 days-4 years before diagnosis). We also selected two specimens for each control, one collected from 1998–2003 (“acute”) and the first specimen collected immediately before their “acute” specimen (“pre-acute”). All specimens were anonymized before release from the DoDSR. We measured PSA in each of these stored specimens by the Access Hybritech PSA assay. We compared the absolute and relative change in PSA between the pre-acute and acute specimens for cases and controls using logistic regression and adjusting for age, race, and time between specimens. Results: IM cases were significantly more likely to have a large increase in PSA between their pre-acute and acute specimens than controls. This finding was observed both when PSA increase was defined as a large absolute (≥0.4 ng/mL; 9.9% versus 2.7%, p=0.033) or relative rise (≥40%; 25.2% versus 8.9%, p=0.0021). Similar results were observed when men with any infectious disease or genitourinary diagnoses between their pre-acute and acute specimens were excluded. Conclusions: Our findings suggest that EBV may infect the prostate and contribute to prostate inflammation and/or cell damage in some men with adult-onset IM. However, another interpretation of our findings that also warrants further investigation is the possibility of systemic inflammation-mediated PSA elevation. This alternate interpretation might have implications not only for a role of later-onset EBV infection in prostate carcinogenesis, but also for the specificity of PSA as a screening test for prostate cancer when used below the currently proposed age for screening initiation of 40 years. Funding: This study was funded by the Patrick C. Walsh Prostate Cancer Research Fund. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A96.

Are United States and Canadian cancer screening rates consistent with guideline information regarding the age of screening initiation?

To understand whether US and Canadian breast, colorectal and prostate cancer screening test utilization is consistent with US and Canadian cancer screening guideline information with respect to the age of screening initiation. Cross-sectional, regression discontinuity. Canada and the US. Canadian and American women of ages 30-60 and men of ages 40-60. None. Main Outcomes Measures Mammography, prostate-specific antigen (PSA) and colorectal cancer test use within the past 2 years. We identify US and Canadian compliance with age screening information in a novel manner, by comparing test utilization rates of individuals who are immediately on either side of the guideline recommended initiation ages. US mammography utilization within the last 2 years increased from 33% at age 39 to 48% at age 40 and 60% at age 41. US colorectal cancer test utilization, within the last 2 years, increased from 15% at age 49 to 18% at age 50 and 28% at age 51. US PSA utilization within the last 2 years increased from 37% at age 49 to 44% at age 50 and 54% at age 51. In Canada, mammography utilization within the last 2 years increased from 47% at age 49 to 57% at age 50 and 66% at age 51. American and Canadian cancer screening utilization is generally consistent with each country's guideline recommendations regarding age. US and Canadian differences in screening due to guidelines can potentially explain cross-country differences in breast cancer mortality and affect interpretation of international comparisons of cancer statistics.

MP-03.08 Incorporating Circulating Prostate Cell Detection in a Screening Programme for Prostate Cancer Does not Detect Low Grade Small Volume Tumours

Not all men diagnosed with prostate cancer require treatment, a screening test ideally would detect aggressive faster growing tumors that if treated effectively would decrease morbidity and mortality but not indolent tumors with the resultant over-treatment and adverse implications on the quality of life. We present the use of CPC detection as a complementary prostate cancer screening test to address this problem.

Racial variation in follow-through of a positive screening test for prostate cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO)

Introduction African-American (AA) men are at increased risk for adverse outcomes of prostate cancer (PCa). One potential source of variation in outcome is follow-through on physician recommendations after a positive screening test. We undertook an ad hoc analysis of data from the PLCO screening trial to identify racial variation in the follow-through of a positive screening test (PSA > 4). Methods We included men in the screening arm who had a PSA > 4 at least once. Follow-through, defined as any additional evaluation within 9 months of a PSA > 4, was compared across racial groups using logistic regression, controlling for age, education, PSA, DRE status, family history of prostate cancer, history of prostate cancer screening, prior prostate biopsy, accrual center and prior prostate health problems. Results 6,294 participants met criteria for inclusion: 5,546 White (88.1%), 349 AA (5.5%) and 399 Other (6.3%). Follow-through was high overall (80.4%), but was lower among AA men than Whites (age-adjusted OR 0.72, 95% CI [0.56, 0.93]). Controlling for other patient characteristics, screening history and screening center attenuated this effect (OR 0.87 [0.64, 1.19]). Adding individual covariates to the base model demonstrated that screening center was the only factor that nullified the effect of race on follow-through. Conclusions Among PLCO participants, race group was not an independent predictor of follow-through. Other demographic factors, PCa risk factors, and accrual center explained the racial variation observed on univariate analysis. Further work should focus on how local health services delivery influences racial variation in follow-through of a positive screening test.

Prostate cancer screening and informed decision-making: provider and patient perspectives

The objective was to determine the extent of informed decision making for prostate cancer screening in a defined population. A state-wide population based survey of men aged 50 and above (Behavioral Risk Factor Surveillance System, 2004, Washington state) and a simple random sample of primary care physicians, were conducted in the same geographic area. We examined prostate cancer screening rates among the men (defined as either PSA or digital rectal examination within the past year) and prostate cancer screening practices among the physicians. Screening rates were 56% at ages 50-64, 68% at ages 65-79 and 64% among men age 80 and older. Adjusted analyses indicated that age, income, marital status, possessing health insurance and a personal health care provider, and talking with a provider about prostate cancer screening tests were all positively associated with screening status. In the physician survey, most physicians recommend screening to their average-risk male patients. Three-fourths (74%) of physicians discussed benefits and risks of PSA testing with their patients; but few used educational tools. Only 35% discussed the side effects of prostate cancer treatment with their patients. The rates of screening reported by men were relatively high, given that current recommendations promote informed decision making rather than universal screening. The majority of physicians recommend prostate cancer screening to their patients, with few decision-making tools used. All relevant information may not be provided in the discussion. These results point to the need for increasing informed decision making about prostate cancer screening.

Predictive Factors for Prostate Cancer in Biopsy of Patients with Prostate-Specific Antigen Levels Equal to or Less Than 4 ng/ml

PurposeThis study was conducted to identify the predictive factors for prostate cancer in patients with prostate-specific antigen (PSA) levels equal to or less than 4 ng/ml.Materials and MethodsA retrospective study of medical records was conducted on 292 patients with initial serum PSA ≤4 ng/ml among 2,305 patients who underwent prostate biopsy from January 2003 to December 2008. Prostate biopsy was performed on patients with PSA ≤4 ng/ml in the case of abnormal findings in the digital rectal examination (DRE) or transrectal ultrasonography (TRUS) or in those with a PSA level higher than the age-adjusted PSA levels. The patients were divided into the group diagnosed with prostate cancer and the non-prostate-cancer group. Subsequently, the variables of the two groups were compared.ResultsThe patients' mean age was significantly higher in the prostate cancer group (n=28) than in the non-prostate-cancer group (n=264; p=0.033). In addition, for the patients with a PSA range of 2.0-2.9 ng/ml, their age (p=0.049) and PSA density (PSAD; p=0.042) were significantly higher and the prostate volume (p=0.028) was significantly smaller in the prostate cancer group than in the non-prostate-cancer group.ConclusionsOf the patients with PSA ≤4 ng/ml, the age of the patients who showed abnormal findings in the DRE or TRUS or who had a PSA level higher than the age-adjusted PSA level was a significant predictive factor for prostate cancer. In particular, for the PSA range of 2.0-2.9 ng/ml, a thorough screening test for prostate cancer was required if the patients had conditions such as higher age, smaller prostate, and higher PSAD.

Deficits and Variations in Patients’ Experience with Making 9 Common Medical Decisions: The DECISIONS Survey

Although many researchers have examined patient involvement and patient-provider interactions within specific clinical environments, no nationally representative data exist to characterize patient perceptions of decision making and patient-provider communications across multiple common medical decisions. To identify deficits and variations in the patient experience of making common medical decisions about initiation of prescription medications for hypertension, hypercholesterolemia, or depression; screening tests for colorectal, breast, or prostate cancer; and surgeries for knee or hip replacement, cataracts, or lower back pain, as well as to identify factors associated with patient confidence in the decisions. National sample of US adults identified by random-digit dialing. Cross-sectional survey conducted from November 2006 to May 2007. Included 2473 English-speaking adults age 40 and older who reported undertaking 1 or more of the above 9 medical actions or discussing doing so with a health care provider within the past 2 years. Patients reported who initiated discussions and made the final decisions, how much discussion of pros and cons occurred, whether they were asked about their preferences, and their confidence that the decision "was the right one." The proportion of patient-driven decisions varied significantly across decisions (range: blood pressure: 16% to knee/hip replacement: 48%). Most patients (78%-85%) reported that providers made a recommendation, and such recommendations generally favored taking medical action. Fewer patients reported that providers asked them about their preferences (range: colon cancer screening: 34% to knee/hip replacement: 80%) or discussed reasons not to take action (range: breast cancer screening: 20% to lower back surgery: 80%). Decision confidence was higher among patients who reported primarily making the decision themselves (odds ratio [OR] = 14.6, P < 0.001) or having been asked for their preference (OR = 1.32, P < 0.01) and was lower among patients whose patient-provider discussions included cons (OR = 0.74, P = 0.008). Recall biases may affect patients' memories of their decision-making processes. DECISIONS participants reported wide variations in the proportion of discussions that included a conversation about reasons not to take action or a conversation about patients' preferences about what they would like to do. These factors appear directly related to patients' confidence that the decision was "right."

Patients’ Knowledge about 9 Common Health Conditions: The DECISIONS Survey

To make informed decisions, patients must have adequate knowledge of key decision-relevant facts. To determine adults' knowledge about information relevant to common types of medication, screening, or surgery decisions they recently made. National sample of US adults identified by random-digit dialing. Cross-sectional survey conducted between November 2006 and May 2007. A total of 2575 English-speaking adults aged 40 y or older who reported having discussed the following medical decisions with a health care provider within the previous 2 y: prescription medications for hypertension, hypercholesterolemia, or depression; screening tests for colorectal, breast, or prostate cancer; or surgeries for knee/hip replacement, cataracts, or lower back pain. Participants answered knowledge questions and rated the importance of their health care provider, family/friends, and the media as sources of information. Accuracy rates varied widely across questions and decision contexts. For example, patients considering cataract surgery were more likely to correctly estimate recovery time than those patients considering lower back pain or knee/hip replacement (78% v. 29% and 39%, P < 0.001). Similarly, participants were more knowledgeable of facts about colorectal cancer screening than those who were asked about breast or prostate cancer. Finally, respondents were consistently more knowledgeable on comparable questions about blood pressure medication than cholesterol medication or antidepressants. The impact of demographic characteristics and sources of information also varied substantially. For example, blacks had lower knowledge than whites about cancer screening decisions (odds ratio [OR] = 0.57; 95% confidence interval [CI] = 0.43, 0.75; P = 0.001) and medication (OR = 0.77; 95% CI = 0.60, 0.97; P = 0.03) even after we controlled for other demographic factors. The same was not true for surgical decisions. The questions did not measure all knowledge relevant to informed decision making, were subject to recall biases, and may have assessed numeracy more than knowledge. Patient knowledge of key facts relevant to recently made medical decisions is often poor and varies systematically by decision type and patient characteristics. Improving patient knowledge about risks, benefits, and characteristics of medical procedures is essential to support informed decision making.

Prostate specific antigen screening for prostate cancer: Knowledge of, attitudes towards, and utilization among primary care physicians

ObjectiveProstate specific antigen (PSA) screening for prostate cancer screening is not uniformly recommended by national organizations or primary care physicians (PCPs). Given this lack of consensus, we sought to identify patterns in physician knowledge of and attitudes towards PSA screening and to determine how these patterns along with patient and provider demographics influence PSA screening practices. MethodsA self-administered questionnaire, which assessed provider's knowledge of prostate cancer, confidence in his/her knowledge, and PSA screening practices, was mailed to PCPs at an academic medical center. Frequencies of responses were summarized and 3 outcome variables (knowledge, confidence, and propensity to screen) were derived. Association of covariates with the outcome variables was determined using multivariable logistic regression. ResultsEight-two (30.4%) physicians completed the survey; 98% identified African-American race as a prostate cancer risk factor, 42% identified digital rectal exam and PSA as the accepted screening method, and 59% underestimated the likelihood of prostate cancer in a man with a PSA level > 4 ng/ml; 19% were confident in their knowledge of prostate cancer; 86% screened fewer than 60% of their male patients over 50. A knowledge score above the median was not associated with a higher propensity to screen (r = 0.06, P = 0.61). Confidence in one's knowledge was correlated with ordering PSA testing (r = 0.33, P < 0.01). Physician (e.g., ethnicity) and patient (e.g., request for PSA testing) related factors, as well as practice guidelines, particularly those of the US Preventative Services Task Force, influenced providers' decision to offer PSA screening. ConclusionsRespondents correctly identified prostate cancer risk factors but were less knowledgeable about prostate cancer screening tests and overall prostate cancer risk. Most respondents were not confident in their knowledge and did not screen men over 50. Multiple patient- and provider-specific factors influence the decision to offer or not offer PSA screening.

Knowledge of prostate cancer screening among native African urban population in Nigeria

Cancer of the prostate a worldwide public health concern. It is the most commonly diagnosed cancer in men and ranked second as the cause of cancer-related deaths. To evaluate the awareness and attitude of the populace to screening for cancer of the prostate. It is a cross-sectional study involving 156 respondents. A structured questionnaire detailing the biodata, the knowledge of cancer of prostate, the practice of screening by prostate specific antigen (PSA) estimation and the readiness to undergo screening by the respondent was used to obtain the set-out objectives. A total of 156 respondents completed the questionnaire and forms the basis of further analysis. The mean age of the respondents is 44.15 (+/- 11.9) years. Majority of the respondents were civil servant (51.9%) followed closely by politicians. About 23.1% of them have no formal education while 53.8% have acquired tertiary education. The result shows that 78.8% have never heard any information on cancer of the prostate and only 5.8% have heard about PSA. None of the respondents have ever had PSA test done, even once. Eighty four per cent of the respondents are ready to pay for prostate cancer screening test by PSA assay. We conclude that there was remarkable lack of awareness of prostate cancer among the Nigerian native African urban populace. Prostate cancer screening and serum PSA test for screening is globally unknown among them.