Prostate-specific Antigen Screening In Men Research Articles

MP77-09 CHANGES IN PROSTATE SPECIFIC ANTIGEN UNITED STATES PREVENTIVE SERVICES TASK FORCE GUIDELINES AND THROUGH THE COVID-19 PANDEMIC

You have accessJournal of UrologyCME1 Apr 2023MP77-09 CHANGES IN PROSTATE SPECIFIC ANTIGEN SCREENING FOLLOWING THE 2018 UNITED STATES PREVENTIVE SERVICES TASK FORCE GUIDELINES AND THROUGH THE COVID-19 PANDEMIC Zhiyu (Jason) Qian, Xi Chen, Alexander P. Cole, Hari S. Iyer, Muhieddine Labban, Benjamin V. Stone, Dejan Fillipas, Edoardo Beatrici, Firas Abdollah, Adam S. Kibel, Stuart R. Lipsitz, and Quoc-Dien Trinh Zhiyu (Jason) QianZhiyu (Jason) Qian More articles by this author , Xi ChenXi Chen More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , Hari S. IyerHari S. Iyer More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Benjamin V. StoneBenjamin V. Stone More articles by this author , Dejan FillipasDejan Fillipas More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 2018, The US Preventive Services Task Force (USPSTF) changed its recommendations for prostate specific antigen (PSA) screening from “non-recommended” to “shared decision-making among men aged 55-69”. Thereafter, COVID-19 Pandemic disrupted cancer care with evidence suggesting overall reduced access to and utilization of health care services including preventive screening. We aim to examine the impacts of both events on PSA screening for men aged 55-69. METHODS: We analyzed 2013, 2015, 2018, 2019, and 2021 National Health Interview Survey data. Men >54 who reported PSA testing within 12 months preceding survey were considered to have undergone screening. Adjusted difference in differences (DID) analyses were performed to compare changes in screening in men aged 55-69 with reference to men >70 between 2015 and 2019 (pre- and post- 2018 USPSTF recommendation) and between 2019 and 2021 (pre- and post-Pandemic). RESULTS: A total of 24,308 men were included. PSA screening prevalence was 35.4% (95%CI: 33.7%, 37.1%), 32.1% (95%CI: 30.3%, 33.9%), 33.3% (95%CI: 31.6%, 34.9%), 37.2% (95%CI: 35.7%, 38.8%), and 34.9% (95%CI: 33.3%, 36.5%) respectively for included years. From 2015 to 2019, PSA screening increased 4.6% among men aged 55-69 (95%CI: 1.7, 7.5%) and increased 6.5% among men >70 (95%CI: 2.7, 10.4%). From 2019 to 2021, PSA screening decreased 3.1% among men aged 55-69 (95%CI: 0.58%, 5.8%); PSA screening also decreased 0.8% among older men but did not reach significance (95%CI: -2.6%, 4.2%). DID analysis did not show difference in changes between men aged 55-69 in reference to men >70 from both 2015 to 2019 (DID=-1.9%, 95%CI, -6.7%, 2.9%) and 2019 to 2021 (DID=-2.3%, 95%CI, -6.5%, 1.9%). CONCLUSIONS: We saw an increase in PSA screening after 2018 USPSTF recommendations among its target population – men aged 55-69 and also among older men >70. In contrast, the period from 2019 to 2021 saw a significant decrease in PSA screening in those aged 55-69. The lack of significant DID between groups as well as the downward trend of PSA screening in men >70 together suggest an overall trend of decrease in PSA screening post-Pandemic. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1105 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zhiyu (Jason) Qian More articles by this author Xi Chen More articles by this author Alexander P. Cole More articles by this author Hari S. Iyer More articles by this author Muhieddine Labban More articles by this author Benjamin V. Stone More articles by this author Dejan Fillipas More articles by this author Edoardo Beatrici More articles by this author Firas Abdollah More articles by this author Adam S. Kibel More articles by this author Stuart R. Lipsitz More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

Association of Prostate-Specific Antigen Screening Rates and Subsequent Metastatic Prostate Cancer Incidence in a National Healthcare System

<h3>Purpose/Objective(s)</h3> There is substantial controversy about the benefit of prostate-specific antigen (PSA) screening. PSA screening rates have declined since 2008 due to changing practice guidelines and conflicting clinical trial results regarding the benefit of screening. Since then, the incidence of metastatic prostate cancer (mPCa) has risen; however, there is no direct epidemiologic evidence of a correlation between population PSA screening rates and subsequent mPCa rates. <h3>Materials/Methods</h3> We used data from the United States Veterans Healthcare Administration (VHA) to calculate yearly PSA screening rates, long-term non-screening rates (no PSA measured in prior three years), and age-adjusted mPCa incidence rates from 2005 to 2019. Rates are reported per 100,000 men and were aggregated by race, age group, and VHA facility (128 facilities). We used random effects linear regression to examine the influence of yearly facility-level PSA screening rates from 2010-2013 on subsequent facility-level mPCa incidence from 2014-2019, adjusting for population demographics. <h3>Results</h3> The cohort included 4.7 million men in 2005 and increased to 5.4 million in 2019. PSA screening rates declined from a high of 50.8% in 2008 to 37% in 2019, with declines in all age and race groups; the long-term non-screening rate similarly increased in this period. mPCa incidence increased from a low of 4.6 in 2008 to 7.9 in 2019, driven by increases in the 55-69 and 70+ year old age groups. Lower facility-level PSA screening rates were associated with higher subsequent mPCa incidence (0.87 unit increase in 2014-2019 mPCa incidence rate per 10% decrease in 2010-2013 PSA screening rate, 95% confidence interval [CI] 0.58 to 1.15, p<0.001). Similarly, higher long-term non-screening rates were associated with higher subsequent mPCa incidence (1.61 unit increase in 2014-2019 mPCa incidence rate per 10% increase in 2010-2013 long-term non-screening rate, 95% CI 1.14 to 2.08, p<0.001). <h3>Conclusion</h3> From 2008 to 2019, PSA screening rates declined and long-term non-screening rates increased in the national VHA system. Lower facility-level PSA screening rates were associated with higher subsequent rates of mPCa. These data can be used to inform shared decision making about the potential benefits of PSA screening in men who wish to reduce their risk of prostate cancer metastases.

MP58-20 USE OF LOW-VALUE PROSTATE-SPECIFIC ANTIGEN SCREENING AMONG YOUNG MEN WITH PRIVATE INSURANCE

You have accessJournal of UrologyCME1 May 2022MP58-20 USE OF LOW-VALUE PROSTATE-SPECIFIC ANTIGEN SCREENING AMONG YOUNG MEN WITH PRIVATE INSURANCE Jeffrey Vehawn, Suzanne Lange, Mouneeb Choudry, Jacob Ambrose, Benjamin Haaland, Jonathan Chipman, Heidi A. Hanson, and Brock O'Neil Jeffrey VehawnJeffrey Vehawn More articles by this author , Suzanne LangeSuzanne Lange More articles by this author , Mouneeb ChoudryMouneeb Choudry More articles by this author , Jacob AmbroseJacob Ambrose More articles by this author , Benjamin HaalandBenjamin Haaland More articles by this author , Jonathan ChipmanJonathan Chipman More articles by this author , Heidi A. HansonHeidi A. Hanson More articles by this author , and Brock O'NeilBrock O'Neil More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Debate remains about the value of Prostate-specific antigen (PSA) based prostate cancer screening among men aged 55-69 (USPSTF Grade C). However, no professional society or guideline recommends PSA based prostate cancer screening in men younger than age 40. This study aims to understand the risk of PSA testing exposure in young men, and we hypothesize that substantial low-value testing occurs in this population. METHODS: We performed a retrospective analysis of claims data from the MarketScan database to identify men aged 18 to 39 without prostate cancer who received a PSA test from 2008 to 2017. For the primary analysis, men were required to be continuously in the database for least 5 years. Age groups were stratified to include: men less than 25, 25-29, 30-34, and 35-39 years.Secondary analysis did not limit subjects to those with 5 years of continuous data and explored the association of Charlson Comorbidity Index (CCI), lower urinary tract symptoms, erectile dysfunction, depression/anxiety, prostate cancer screening, infertility, and hypogonadism with PSA testing in young men. We used logistic regression to determine which of the factors were associated with PSA testing in young men. RESULTS: We identified claims for 40,164,773 adult men who met study criteria. Of these men, 3,230,748 were continuously in the Marketscan database for at least 5 years. The cumulative risk for receiving a PSA over 5 years for men under 40 is 2.5%. Stratified by age, men aged 35-39 are at highest risk. Logistic multivariable regression showed that, relative to all men between 18 and 40, patients in this age group who received a PSA were more likely to be diagnosed with hypogonadism (OR 20.55, 95% CI 20.39-20.71) or lower urinary tract symptoms (OR 9.34, 95% CI 9.26-9.41). Higher CCIs appeared to correlate with a decreased rate of PSA testing. This population was not significantly more likely to be diagnosed with infertility, depression, or anxiety. CONCLUSIONS: PSA screening for men under 40 is not uncommon, especially when associated with concomitant genitourinary symptoms. At a population level, this represents substantial low-value testing. Interventions aimed at clarifying the relationship between common urologic conditions and prostate cancer, the extremely low incidence of prostate cancer in this age group, and the lack of guidelines supporting this practice may help decrease low-value PSA testing. Source of Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number K08CA234431. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1000 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Vehawn More articles by this author Suzanne Lange More articles by this author Mouneeb Choudry More articles by this author Jacob Ambrose More articles by this author Benjamin Haaland More articles by this author Jonathan Chipman More articles by this author Heidi A. Hanson More articles by this author Brock O'Neil More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comparison of prostate specific antigen testing in men aged 55 to 69 with and without a history of cancer.

230 Background: Prostate specific antigen (PSA) screening remains a controversial issue. However, most urological guidelines recommend PSA testing through a shared decision-making process with the patient. The rate of PSA screening in men with a history of cancer compared to men with no cancer history is not well known. We aimed to compare PSA testing in men aged 55-69 years with and without a history of cancer (excluding prostate cancer patients). Methods: Utilizing the National Health Interview Survey (NHIS) a retrospective cross-sectional study between the years 2015 and 2018 was carried out to analyze and compare PSA testing rates in men aged 55-69 years. Multivariable logistic regression model was implemented do demonstrate potential associations with PSA testing. Results: A total of 13,850 men aged 55-69 years included in the NHIS Survey were analyzed. 1519 (10.9%) men had a history of cancer (non-prostate). On multivariable analysis, men who were previously diagnosed with cancer had a higher rate of PSA testing compared to men with no history of cancer (OR: 1.88, 95% CI 1.39-2.54, p &lt; 0.001). Other factors associated with an increased likelihood of undergoing PSA testing included: age, homosexual orientation, and married men. In contrast, current smokers, American Indians and Alaskan Natives and Asians were less likely to undergo PSA testing. Conclusions: Our data suggest that men aged 55-69 with a history of cancer are more likely to undergo PSA testing than men with no cancer history.[Table: see text]

Low-value prostate cancer screening among young men with private insurance.

240 Background: Debate remains about the value of Prostate-specific antigen (PSA) based prostate cancer screening among men aged 55-69 (USPSTF Grade C). However, no professional society or guideline recommends PSA based prostate cancer screening in men younger than age 40. This study aims to understand the risk of PSA testing exposure in young men, and we hypothesize that substantial low-value testing occurs in this population. Methods: We performed a retrospective analysis of claims data from the MarketScan database to identify men aged 18 to 39 without prostate cancer who received a PSA test from 2008 to 2017. For the primary analysis, men were required to be continuously in the database for least 5 years. Age groups were stratified to include: men less than 25, 25-29, 30-34, and 35-39 years. Secondary analysis did not limit subjects to those with 5 years of continuous data and explored the association of Charlson Comorbidity Index (CCI), lower urinary tract symptoms, erectile dysfunction, depression/anxiety, prostate cancer screening, infertility, and hypogonadism with PSA testing in young men. We used logistic regression to determine which of the factors were associated with PSA testing in young men. Results: We identified claims for 40,164,773 adult men who met study criteria. Of these men, 3,230,748 were continuously in the Marketscan database for at least 5 years. The cumulative risk for receiving a PSA over 5 years for men under 40 is 2.5%. Stratified by age, men aged 35-39 are at highest risk (Table). Logistic multivariable regression showed that, relative to all men between 18 and 40, patients in this age group who received a PSA were more likely to be diagnosed with hypogonadism (OR 20.55, 95% CI 20.39-20.71) or lower urinary tract symptoms (OR 9.34, 95% CI 9.26-9.41). Higher CCIs appeared to correlate with a decreased rate of PSA testing. This population was not significantly more likely to be diagnosed with infertility, depression, or anxiety. Conclusions: PSA screening for men under 40 is not uncommon, especially when associated with concomitant genitourinary symptoms. At a population level, this represents substantial low-value testing. Interventions aimed at clarifying the relationship between common urologic conditions and prostate cancer, the extremely low incidence of prostate cancer in this age group, and the lack of guidelines supporting this practice may help decrease low-value PSA testing. Funding: Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number K08CA234431. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.[Table: see text]

Trends in Prostate Specific Antigen (PSA) testing and prostate cancer incidence and mortality in Australia: A critical analysis

BackgroundPopulation trends in PSA testing and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA testing, prostate cancer incidence and mortality in Australia and factors that influence them. MethodsWe calculated and described standardised time trends in PSA tests, prostate biopsies, treatment of benign prostatic hypertrophy (BPH) and prostate cancer incidence and mortality in Australia in men aged 45–74, 75–84, and 85 + years. ResultsPSA testing increased from its introduction in 1989 to a peak in 2008 before declining in men aged 45–84 years. Prostate biopsies and cancer incidence fell from 1995 to 2000 in parallel with decrease in trans-urethral resections of the prostate (TURP) and, latterly, changes in pharmaceutical management of BPH. After 2000, changes in biopsies and incidence paralleled changes in PSA screening in men 45–84 years, while in men ≥85 years biopsy rates stabilised, and incidence fell. Prostate cancer mortality in men aged 45–74 years remained low throughout. Mortality in men 75–84 years gradually increased until mid 1990s, then gradually decreased. Mortality in men ≥ 85 years increased until mid 1990s, then stabilised. ConclusionAge specific prostate cancer incidence largely mirrors PSA testing rates. Most deviation from this pattern may be explained by less use of TURP in management of BPH and consequent less incidental cancer detection in TURP tissue specimens. Mortality from prostate cancer initially rose and then fell below what it was when PSA testing began. Its initial rise and fall may be explained by a possible initial tendency to over-attribute deaths of uncertain cause in older men with a diagnosis of prostate cancer to prostate cancer. Decreases in mortality rates were many fold smaller than the increases in incidence, suggesting substantial overdiagnosis of prostate cancer after introduction of PSA testing.

PD48-09 PROSTATE SPECIFIC ANTIGEN (PSA) SCREENING UTILIZATION HAS SIGNIFICANTLY DROPPED OVER THE LAST TWO DECADES, EVEN IN MEN WITH EXTENDED LIFE-EXPECTANCY: A NATIONWIDE ANALYSIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD48)1 Apr 2020PD48-09 PROSTATE SPECIFIC ANTIGEN (PSA) SCREENING UTILIZATION HAS SIGNIFICANTLY DROPPED OVER THE LAST TWO DECADES, EVEN IN MEN WITH EXTENDED LIFE-EXPECTANCY: A NATIONWIDE ANALYSIS Deepansh Dalela*, Jacob Keeley, Akshay Sood, Sohrab Arora, Marcus Jamil, Isaac Palma-Zamora, Chandler Bronkema, Nikola Rakic, Natalija Kovacevic, Wooju Jeong, Craig Rogers, Mani Menon, and Firas Abdollah Deepansh Dalela*Deepansh Dalela* More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Akshay SoodAkshay Sood More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Marcus JamilMarcus Jamil More articles by this author , Isaac Palma-ZamoraIsaac Palma-Zamora More articles by this author , Chandler BronkemaChandler Bronkema More articles by this author , Nikola RakicNikola Rakic More articles by this author , Natalija KovacevicNatalija Kovacevic More articles by this author , Wooju JeongWooju Jeong More articles by this author , Craig RogersCraig Rogers More articles by this author , Mani MenonMani Menon More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000942.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Estimation of life expectancy (LE) is central to assessing the relative benefit of PSA screening among men. While prior research has suggested high prevalence of PSA screening in men with limited LE, limited data exists regarding screening for those with extended LE (who are arguably more likely to benefit from screening). The aim of the current study was to assess temporal trends in screening in US men with limited vs extended LE using a nationally representative dataset. METHODS: Using data from the National Health Institution Survey (NHIS) 2000-2018, men aged >=40 without prior history of prostate cancer who underwent PSA testing in the last 12 months as a part of routine test were considered to have undergone PSA screening. We used the previously validated Schonberg index to assess LE (based on 11 risk factors derived from function, illnesses, behaviors and demographics). Men with score of >10 were considered to have limited LE (i.e. LE <10 years, or >50% risk of 10-year mortality), while those with score of <6 were considered to have extended LE (i.e. LE>15 years, of <50% risk of 15-year mortality). Temporal trends in PSA screening in either group were compared using weighted chi-square tests. RESULTS: Within the study population, a total of 16,132 (weighted n=16,895,262) men were estimated to have extended LE, while 11,861 (weighted n=10,491,734) were included in the limited LE group. There was no significant difference in PSA screening prevalence based on extended (39.8%) vs. limited LE (39.4%) groups (p=0.5). Prevalence of PSA screening decreased over the study duration (Figure 1), even amongst men with extended LE (55.9% in 2003 to 35.5% in 2018; p<0.001). CONCLUSIONS: Our results show an overall drop in the utilization of PSA screening over the last two decades, without a distinction based on LE. It is highly concerning that even in men with an extended LE (i.e. >15 years), only 1 in 3 receive PSA screening, especially given the increased benefit of PSA screening with longer survival, as reported by level-one-evidence. This may be related to difficulties in estimating and/or discussing LE prior to ordering PSA screening, or the ambivalence of national guidelines regarding efficacy of screening, or a combination of both. Source of Funding: HFHS © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e997-e998 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepansh Dalela* More articles by this author Jacob Keeley More articles by this author Akshay Sood More articles by this author Sohrab Arora More articles by this author Marcus Jamil More articles by this author Isaac Palma-Zamora More articles by this author Chandler Bronkema More articles by this author Nikola Rakic More articles by this author Natalija Kovacevic More articles by this author Wooju Jeong More articles by this author Craig Rogers More articles by this author Mani Menon More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostate-specific antigen (PSA) screening rates and factors associated with screening in Eastern Canadian men: Findings from cross-sectional survey data.

The prostate-specific antigen (PSA) test is used in Canada to detect prostate cancer (PCa) despite mixed recommendations. Complications arising from false-positives are common, posing as a cancer-screening concern. This work estimates some Canadian rates of PSA screening and identifies men at increased odds for PSA screening. The Canadian Community Health Survey (CCHS) from 2009/10 (Atlantic Canada; ATL), 2011/2012 (Ontario; ON), and 2013/2014 (Quebec; QC) were used. Lifetime and recent PSA screening with confidence intervals were constructed to estimate PSA screening in ATL, ON, and QC. Two logistic regression models (for men <50 and ≥50 years of age) were used to determine associations between factors and lifetime PSA screening. PSA screening rates have increased in most age groups for ATL, ON, and QC since 2000/2001. Factors positively associated with lifetime PSA screening in men of all ages were: having a digital rectal exam, having a regular doctor, and having a colorectal exam. Fruit and vegetables consumption and non-smoking status were positively associated with lifetime PSA screening in men <50 years of age. High income and the presence of chronic health conditions were positively associated with lifetime PSA screening in men ≥50 years of age. PSA screening rates have generally increased since 2000/2001 in Canada. Physician-related factors play a role in men at all ages, while different factors are associated in men <50 years of age and men ≥50 years of age. Limitations include the generalizability to all of Canada and the potential for recall bias.

64] The usefulness of prostate-specific antigen screening in men presenting with haematuria in our practice in a District hospital in the UK

ObjectiveTo review the usefulness of prostate-specific antigen (PSA) testing in men presenting to an urgent clinic with haematuria in our practice in a District hospital in the UK.

Prostate-specific antigen velocity in a prospective prostate cancer screening study of men with genetic predisposition

Background:Prostate-specific antigen (PSA) and PSA-velocity (PSAV) have been used to identify men at risk of prostate cancer (PrCa). The IMPACT study is evaluating PSA screening in men with a known genetic predisposition to PrCa due to BRCA1/2 mutations. This analysis evaluates the utility of PSA and PSAV for identifying PrCa and high-grade disease in this cohort.Methods:PSAV was calculated using logistic regression to determine if PSA or PSAV predicted the result of prostate biopsy (PB) in men with elevated PSA values. Cox regression was used to determine whether PSA or PSAV predicted PSA elevation in men with low PSAs. Interaction terms were included in the models to determine whether BRCA status influenced the predictiveness of PSA or PSAV.Results:1634 participants had ⩾3 PSA readings of whom 174 underwent PB and 45 PrCas diagnosed. In men with PSA >3.0 ng ml−l, PSAV was not significantly associated with presence of cancer or high-grade disease. PSAV did not add to PSA for predicting time to an elevated PSA. When comparing BRCA1/2 carriers to non-carriers, we found a significant interaction between BRCA status and last PSA before biopsy (P=0.031) and BRCA2 status and PSAV (P=0.024). However, PSAV was not predictive of biopsy outcome in BRCA2 carriers.Conclusions:PSA is more strongly predictive of PrCa in BRCA carriers than non-carriers. We did not find evidence that PSAV aids decision-making for BRCA carriers over absolute PSA value alone.

PSA Screening for Prostate Cancer in Men under the Age of 65: A Review of Current Practice

Purpose: To review current practice in the use of Prostate Specific Antigen (PSA) testing and assess the overall risks and benefits of PSA testing for Adenocarcinoma of the Prostate, specifically in men under age 65, and those living with risk factors for the disease. Materials and Methods: An extensive literature review of PSA testing in various age groups was conducted with the goal being to review PSA screening trends and assess current recommendations regarding PSA Screening for Adenocarcinoma of the Prostate in various age groups, focusing on studies directed towards patients under the age of 65 and the long-term risks and benefits of PSA screening in the diagnostic algorithm. In order to reduce bias, we assessed our sources for variables such as reporting, measurement and/or selection bias. Our conclusions were then compared with current recommendations. Relevant studies with data compiled after 2004, centered around PSA screening in men under the age of 65 in general and specifically in men with risk factors for developing Adenocarcinoma of the Prostate were included. Editorials, newspaper articles and other non-scholarly and non-peer reviewed sources were automatically excluded.

MP79-03 WAG THE DOG?: PSA SCREENING IN KIDNEY TRANSPLANT CANDIDATES

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2015MP79-03 WAG THE DOG?: PSA SCREENING IN KIDNEY TRANSPLANT CANDIDATES Daniel Canter, Gerardo Vitiello, Blayne Sayed, Ken Ogan, and Nicole Turgeon Daniel CanterDaniel Canter More articles by this author , Gerardo VitielloGerardo Vitiello More articles by this author , Blayne SayedBlayne Sayed More articles by this author , Ken OganKen Ogan More articles by this author , and Nicole TurgeonNicole Turgeon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2860AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Screening recommendations for prostate cancer (PC) in the general population are controversial due to the low sensitivity of prostate-specific antigen (PSA) as a marker for PC as well as the indolent nature of PC. The current study aims to determine whether the use of PSA screening in men being evaluated for renal transplantation either delays the time to listing or time to kidney transplantation as well as whether the diagnosis of PC effects the rate of transplantation and graft/patient survival. METHODS A single center retrospective analysis of 3737 patients undergoing kidney transplant evaluation from January 1, 2001 to January 1, 2011 was performed. Men were categorized according to the following American Urological Association (AUA) PSA screening guideline recommendations: Group 1: <55 y.o., Group 2: 55-69 y.o. and Group 3: >69 y.o. Univariate analysis and Cox Proportional Hazards (CPH) identified the independent effect of PSA screening on transplant times. Kaplan Meier survival curves examined the effects of PSA screening and PC on overall patient and graft survivals. RESULTS In total, 1135 patients received kidney transplants (30.4%). PSA screening was performed in 53.9% of Group 1, 81.1% of Group 2, and 83.8% of Group 3. In group 2, the time to transplant was significantly longer in patients having a PSA >4 versus those having a PSA <4 (1355 vs. 853 days; p<0.001). Men with a screening PSA > 4 who never developed prostate cancer were less likely to receive transplants than those patients with a positive screen who develop prostate cancer (18.5 versus 40%, p=0.0025). PC was confirmed in 27% of patients with a PSA >4, and only 24.3% of patients with a PSA >4 received transplants. PSA screening did not impact overall patient survival or graft survivals, though a diagnosis of prostate cancer significantly reduced overall patient survival (HR 2.19 [1.04-4.59]; p=0.0038). CONCLUSIONS A PSA screening level >4 may lower the likelihood of receiving a kidney transplant, however, our data indicate that PSA screening has no effect on overall patient survival. Proper patient selection for PSA screening is essential as delayed transplant times in patients with end-stage renal disease (ESRD) leads to reduced quality of life as well as increase patients' risk of medical and cardiovascular complications while awaiting transplantation. The routine use of PSA screening in renal transplant candidates should reflect a consideration of these risks compared to the biologic phenotype of PC. At the very least, PC screening in the renal transplant population should be more in line with recent recommendations for the general population. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1011 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Canter More articles by this author Gerardo Vitiello More articles by this author Blayne Sayed More articles by this author Ken Ogan More articles by this author Nicole Turgeon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract B80: Racial differences in prostate cancer screening practices in U.S. ambulatory care settings prior to and following U.S. Preventive Services Task Force recommendations in 2008

Abstract Introduction: In May 2012, the United States Preventive Services Task Force (USPSTF) finalized its recommendation (rec.) against prostate-specific antigen (PSA) screening in all men in the general US population. The implications of the recommendations for PSA screening in African American (AA), Hispanic (H) and White (W) men will not be known for some time. However, the USPSTF's August 2008 rec. against PSA-based screening for men older than 75 years may inform expectations. The objective of this study was to investigate the impact of the 2008 USPSTF rec. on PSA screening practices during routine preventive health exams (PHE) among AA, H, and W men in ambulatory care settings. Methods: We analyzed a nationally representative sample of visits to office-based physicians' practices from 2005 to 2010 using the National Ambulatory Medical Care Survey (NAMCS). The sample consisted of outpatient visits for PHEs of men over 40 years, without prostate cancer. PHEs were identified using, 1) patient's stated reason and physician-reported major reason for visit indicating a general medical exam or prevention, or 2) physician's recorded diagnosis for general medical exam. The study period was divided into pre-rec. (2005-07) and post-rec. (2008-10) periods. Information including PSA screening during the PHE, patient demographics, physician specialty and type of office setting was collected. Descriptive and bivariate analyses accounting for the NAMCS survey design provided the unadjusted relationships between PSA screening, race/ethnicity, period and age. Generalized estimating equations (GEE) were used to investigate the demographic patterns in the receipt of PSA screening during PHEs occurring around the time of the USPSTF rec. Results: Application of the inclusion criteria resulted in 6,099 office visits for PHEs from 2005-10. Twenty percent (N=1,241) of the sample was aged ≤75 years, 76% (N=4,630) was W, 10% (N=591) AA and 9% (N=564) H. Overall, 16% received PSAs during a PHE in the pre-rec. period and 18% in the post-rec. period (p=0.14). The percentage of PSA screens received during a PHE in pre-rec. vs. post-rec. period was 13% vs. 16% (p=0.44) among AAs, 9% vs. 14% (p=0.13) among Hs, and 16% vs. 19% (p=0.12) among Ws. The percentage of W men, aged 40 to 75, receiving a PSA test during a PHE (20%) was statistically significantly higher than AAs (16%) and Hs (13%) (p= 0.03). Among those ≥75 years, there was no statistically significant difference in the receipt of PSA screening between AAs (11%), Hs (4%), and Ws (11%) (p=0.07). GEE analysis did not show a statistically significant difference in the covariate-adjusted odds of receiving a PSA screen during a PHE in the post-period compared to the pre-period (p=0.40) or among AAs compared to Ws (p=0.22). Odds of receiving a PSA screen were lower among patients aged ≥75 years compared to patients less than 75 years old (odds ratio=0.51, 95% CI=0.36-0.73; p&amp;lt;0.01). Odds of receiving a PSA screen also were lower among Hs compared to Ws (OR=0.64, 95% CI=0.43-0.96; p=0.03). Odds of receiving a PSA screen were higher for visits to a urologist compared to visits to a general practitioner (OR=4.30, 95% CI=2.92-6.34; p&amp;lt;0.01). Conclusion: The probability of receiving a PSA screening during a PHE was unchanged during the period immediately prior to and following the 2008 USPSTF rec. against PSA screening for men 75 years and older. At the same time, men 75 years and older (compared to &amp;lt;75 years) and H men (compared to W) were less likely to receive a PSA screening during a PHE. Analyses exploring the impact of the 2012 USPSTF recommendations against PSA screening for all men should consider the impact among race and age subgroups with lower baseline chances of receiving a PSA screen in ambulatory care settings. Citation Format: Jinani Jayasekera, Eberechukwu Onukwugha. Racial differences in prostate cancer screening practices in U.S. ambulatory care settings prior to and following U.S. Preventive Services Task Force recommendations in 2008. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B80. doi:10.1158/1538-7755.DISP13-B80

Abstract B68: Men at high risk for prostate cancer and the prostate-specific antigen (PSA) test: Uptake levels and physician recommendations

Abstract Introduction: The Prostate-Specific Antigen (PSA) is a protein secreted by the cells of the prostate gland. Abnormalities in the prostate, such as cancer, can lead to an increase in PSA blood levels. The PSA test was developed for early detection of prostate cancer. Recently, the U.S. Preventive Services Task Force (USPSTF) updated their original 2008 recommendation against the use of PSA screening for men 75 years and older to include men in the general U.S. population of all ages [5]. The arguments made by the USPSTF apply to the general population with average risk, as opposed to men who have increased risk, such as men with the BRCA 1 or 2 mutations. The PSA test may have benefits of early detection of prostate cancer among this population. This study defines ‘high risk’ men as those who had their blood drawn by a nurse or healthcare professional to see if they carried a gene mutation that may confer increased risk for hereditary cancer and aims to investigate the utilization levels of the PSA test among these high risk men and if the test was recommended to them by their physicians. Methods: Data were gathered from a subset of a survey intended to explore the perceptions and attitudes toward Preimplantation Genetic Diagnosis (PGD) among males who either carry a BRCA mutation or had partners or immediate relatives who had a BRCA mutation [14]. This study focused on analyzing demographics, clinical characteristics, PSA test uptake and physician recommendations. The data were separated into categories of men who indicated that they had a genetic test for hereditary cancer in the past (n=64), and those who had not (n=164). The men who answered ‘yes’ to having had a genetic test in the past were considered high-risk for the purpose of this study. Results: 58.7% of high-risk men were recommended for the PSA test by their doctor or healthcare provider, while 31.7% had not received a recommendation. Of those men not recommended for a PSA test, 20.0% tested positive for a gene that may put them at increased risk for hereditary cancer. The investigation also revealed that 50.79% of high-risk men utilized the PSA test while 46.03% did not. Among men who did not take the PSA test, 17.2% tested positive for a gene that may put them at increased risk for hereditary cancer. Conclusion: The results of this study add to the argument that although the PSA test is an effective long-term diagnostic tool, it is only being utilized by about 50% of men who meet the criteria for being at high-risk for developing prostate cancer and physicians are only recommending about 59% of these high-risk men. Physicians should be encouraged to pay close attention to men who show signs of increased hereditary risk and recommend them for long-term PSA monitoring and better efforts should be made to educate the high risk community of men about the benefits of non-invasive PSA monitoring. Citation Format: Meshka Anderson, Gwendolyn Quinn, Susan Vadaparampil. Men at high risk for prostate cancer and the prostate-specific antigen (PSA) test: Uptake levels and physician recommendations. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B68. doi:10.1158/1538-7755.DISP13-B68

Dilemmas Over the Decision to Perform Repeat Prostate Biopsies

Regardless of age, patients with persistently elevated prostate-specific antigen (PSA) levels and/or a suspicious result on a digital rectal exam but with a previous history of a negative prostate biopsy result usually present a dilemma to urologists. Published reports have shown that the positive rate of repeat prostate biopsy in men suspected of having prostate cancer and at least 1 previous negative biopsy is around 10% to 35% [1,2]. Potential reasons for previous negative findings in men who have cancer detected in repeat biopsies include inadequacy of the initial biopsies (fewer cores taken) or the presence of precancerous lesions, such as atypical small acinar proliferation. As a result of concerns over missed cancer, urologists frequently resort to repeat biopsy. However, in reality, the aforementioned positive rates in repeat biopsies demonstrate that the results of most repeat biopsies will prove to be negative. In addition to causing significant anxiety, prostate biopsies can result in complications that can sometimes be severe. Some investigators have even reported that the rate of hospitalization for infection following prostate biopsies is on the rise [3]. Furthermore, in a Western series, it was shown that about 1 in 10 men refuse a repeat biopsy or require analgesia or sedation for the procedure [4]. Overall, it would be safe to say that the decision to recommend a repeat prostate biopsy is never an easy one for urologists to make. So how can urologists overcome such a dilemma? It may just be that we are digging a hole for us to be buried in by recommending PSA testing to the wrong group of men, specifically, younger men, in the first place. A recently published American Urological Association (AUA) guideline on prostate cancer detection recommends against PSA screening in men aged <40 years [5]. Also, despite causing some controversy, the same AUA guideline states that routine screening is not recommended in men aged 40 to 54 years and at average risk. Such statements may well have been made for the following reasons: a low prevalence of prostate cancer in younger men, absence of evidence for PSA screening in younger men, and risk of harm from biopsies and treatments. Accordingly, to avoid the dilemma of agonizing over the decision to perform repeat biopsy in younger men, we should be more judicious in recommending PSA testing initially. Although we should not actively discourage PSA testing in younger men on the whole (especially among those with a family history or other risk factors), a more careful approach in PSA screening would eventually prove beneficial in lessening the dilemma over repeat biopsies. Also, newly developed markers, such as PCA3, phi, and 4Kscore (although not yet available worldwide), will likely be helpful in decision-making for prostate biopsies. In addition, multiparametric magnetic resonance imaging has been frequently mentioned to increase the probability of a positive repeat biopsy. Applications of these tools would certainly be helpful in lessening urologists' burden over repeat biopsy decisions in the future. However, unless a breakthrough occurs in the detection of prostate cancer, which allows us to do away with PSA testing completely, we will never be 100% freed from the dilemma over repeat biopsies. Despite the current overall sentiment towards PSA testing, the fear of missed tumors will always linger.

Prostate-specific antigen velocity based risk-adapted discontinuation of prostate cancer screening in elderly men

• To evaluate weather prostate-specific antigen (PSA) velocity could be used to stratify patients at risk of death from prostate cancer (PCa) and be useful in aiding decision making regarding PSA screening in elderly men, as previous studies have shown that PSA velocity can predict PCa risk. • The cohort included 3,525 patients aged ≥ 75 years with two or more PSA tests before a diagnosis of PCa. Cox proportional hazard model was used to evaluate which variables at time of last PSA measurement were associated with death from PCa. • The rates of death from PCa after diagnosis in different PSA velocity groups were calculated. Kaplan-Meier and log rank test were used to assess the significant difference in death from PCa after diagnosis, stratified by PSA velocity cutoff. • On multivariate analysis, men with a PSA velocity of PSA velocity ≥ 0.45 ng/mL/year had a 4.8-fold higher risk of death from PCa as compared to men with a PSA velocity of < 0.45 ng/mL/year (p value = 0.013). After a median 6.5 (up to 16.9) years of follow-up from diagnosis, 1.4% of the men with a PSA velocity < 0.45 ng/mL/year had died of PCa as compared to 8.7% of those with a PSA velocity ≥ 0.45 ng/mL/year. • The cumulative rate of death from PCa after diagnosis, stratified by a PSA velocity of 0.45 ng/mL/year, was statistically different (log rank test, P < 0.001). • Men age ≥ 75 years old with a PSA velocity of <0.45 ng/mL/year are unlikely to die of PCa. It may be safe to discontinue PSA screening in these men.

Will Emerging Prostate Cancer Markers Redeem Themselves?

During the last several decades, the incidence of prostate cancer has increased dramatically, largely because of the widespread use of prostate-specific antigen (PSA)2 for diagnostic screening. Serum PSA is undoubtedly one of the most clinically useful cancer markers. Early detection of clinically relevant cancers is possible with PSA-based screening, but the overall benefit of screening is debatable. The benefits and harms of PSA-based screening have recently been assessed in 2 randomized studies. In the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial from the US, no benefit could be demonstrated for PSA screening in men between 55 and 74 years of age. In the European study, however, a 20% reduction in mortality was observed after a mean follow-up time of 8.8 years in men between 55 and 69 years of age who were screened for PSA (1). Thus, the results from screening studies are conflicting. PSA is not cancer specific. The serum PSA concentration also reflects prostate volume, and thus it increases in benign prostatic hyperplasia and in various other benign conditions. Therefore, many men will be subjected to unnecessary repeat biopsies, causing a major amount of concern and discomfort. Another problem with PSA-based screening is the high rate of overdiagnosis, i.e., finding clinically insignificant cancers that would not surface during the patient's remaining life. The rate of overdiagnosis has been estimated at up to 50%. Many men with such tumors will receive unnecessary treatment, with the associated harmful effects. To reduce treatment of patients who do not benefit from it, clinicians are increasingly using active surveillance. Patients judged to have …

Editorial Comment

Moul 1 Moul JW. Public survey and survival data do not support recommendations to discontinue PSA screening in men at age 75. Urology. Google Scholar concludes that the United States Preventive Services Task Force (USPSTF) recommendation “to discontinue screening at age 75 was supported neither by public opinion or disease risk and survival results.” However, the findings are unlikely to represent well-informed public opinion and do not accurately portray or refute USPTF prostate cancer screening recommendations. 2 Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008; 149: 185-191 Crossref PubMed Scopus (486) Google Scholar Surveyed men were a highly selected group who attended an annual free prostate cancer screening clinic and agreed to complete a survey. Authors reported patient awareness—but not their knowledge of the USPSTF recommendations or the content of the screening clinic message—although presumably the clinic strongly favors screening given that free PSA tests are offered annually. Findings from their selected case series of men treated with radical prostatectomy do not provide reliable information on benefits and harms of screening, outcomes among men aged ≥75 years of age with newly diagnosed prostate cancer vs men aged <75 years, or comparative effectiveness of early intervention vs observation. Public Survey and Survival Data Do Not Support Recommendations to Discontinue Prostate-specific Antigen Screening in Men at Age 75UrologyVol. 75Issue 5PreviewTo evaluate the US Preventative Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75. Full-Text PDF ReplyUrologyVol. 75Issue 5PreviewI am honored that our paper has received an editorial comment by Drs. Wilt and Calonge, both distinguished members of the United States Preventive Services Task Force (USPSTF). I know and respect Dr. Wilt, having served with him on various committees and panels over the prostate-specific antigen (PSA) era. However, I disagree with the USPSTF recommendation regarding PSA testing in older men. Full-Text PDF

Editorial Comment

The US Preventive Services Task Force (USPSTF), with no urology representative, reviewed what it considered the relevant published data and concluded that available evidence is insufficient to assess the balance between potential benefits and harms of using PSA to screen men aged < 75 years old for prostate cancer and has recommended against screening men aged > 75 years old (even those at high risk). 1 U.S. Preventive Services Task ForceScreening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008; 149: 185-191 Crossref PubMed Scopus (484) Google Scholar Public Survey and Survival Data Do Not Support Recommendations to Discontinue Prostate-specific Antigen Screening in Men at Age 75UrologyVol. 75Issue 5PreviewTo evaluate the US Preventative Services Task Force (USPSTF) recommendation to discontinue prostate-specific antigen (PSA) screening at age 75. Full-Text PDF ReplyUrologyVol. 75Issue 5PreviewWe sincerely appreciate Dr Catalona's Editorial Comment regarding our article and agree completely with his comments. Over the last year, prostate cancer seems to have been the “whipping boy” of the press. In August 2008, as Dr Catalona notes, the USPSTF recommended against PSA testing in men aged ≥75 years. This was front-page news in USA Today and other papers as it hinted of health care rationing and age discrimination. In the spring of 2009, the press had a field day with the ERSPC and PLCO trial results, generally headlining that screening is not beneficial and ignoring the positive findings from the ERSPC study that showed a 20% reduction in mortality and a 41% reduction in metastatic disease rates in screened men. Full-Text PDF

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

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