Use Of Prostate-specific Antigen Testing Research Articles

Abstract B083: Community-based knowledge-to-action translation to improve early detection of prostate cancer among Black individuals

Abstract Introduction: Black individuals have 70-80% higher incidence and 120% higher mortality from prostate cancer when compared to all other groups in the US. This is the largest racial disparity in cancer-related mortality in the US and has persisted over the last five decades despite improvements in the diagnosis and treatment of prostate cancer. Our previous work demonstrated that intensified screening practices could reduce prostate cancer mortality among Black individuals. Challenges impede the translation of these findings into real-world interventions and practices. The objective of this study was to design a patient-centered and culturally tailored knowledge toolkit to improve the knowledge and awareness of prostate-specific antigen (PSA) testing in Black individuals to facilitate informed shared-decision making between Black patients and primary care providers. Methods: Using a community-partnered participatory research approach, we convened a working group of Black prostate cancer survivors and community advocates, and clinicians, researchers, and health communications specialists. During monthly meetings, the working group followed Graham’s Knowledge-to-Action framework to synthesize information from: 1) peer-reviewed literature on the use of shared decision-making aids; 2) interviews conducted by our research team with Black individuals regarding barriers and facilitators to access PSA testing; and 3) community input on PSA testing and prostate cancer early detection. We then facilitated four iterative design sessions with the working group to develop recommendations for toolkit content, framing, and format. Results: With the working group, we designed a comprehensive set of resources to increase knowledge and awareness of PSA testing for early detection of prostate cancer among Black individuals. The design framework includes detailed recommendations on the content, framing, and format for resources contained in the toolkit. Recommendations encompass: 1) interactive web-based documents that cover comprehensive information about prostate cancer risk and screening; 2) printable shared decision-making documents that present evidence-based information about the use of PSA testing to guide conversations between Black individuals and their primary care providers; and 3) educational videos focused on prostate cancer fundamentals and dispelling common misconceptions about prostate cancer risk and screening, with content delivered by Black prostate cancer survivors and interviews with Black providers and prostate cancer researchers. Conclusion: This study addressed the need for a community-developed approach to increasing knowledge and awareness about prostate cancer screening and early detection in an accessible, culturally tailored, and accurate manner. We used a collaborative process that centered the experiences of Black prostate cancer survivors and advocates in the design of a toolkit that can facilitate decision-making discussions between Black individuals and their care providers for use of PSA testing for prostate cancer screening. Citation Format: Jenney R. Lee, Sung Min Kim, Yohali Burrola- Mendez, Dante' Morehead, Marty Chakoian, Michael Ware, Kojo Ward, Floyd Gossett, Vida Henderson, Patricia Egwuatu, Burcu Darst, John Masembe, Erika M. Wolff, Yaw A Nyame. Community-based knowledge-to-action translation to improve early detection of prostate cancer among Black individuals [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B083.

Comparative Trends in the Distribution of Prostate Cancer Stage at Diagnosis in the Department of Defense Cancer Registry and the Surveillance, Epidemiology, and End Results Data, 2004-2014.

It has been demonstrated that there was an increase in later-stage prostate cancer (PCa) at diagnosis after the U.S. Preventive Services Task Force recommended against prostate-specific antigen screening for prostate cancer. However, the cancer characteristics at diagnosis within the equal-access Military Health System (MHS) during the period have not been described. In this study, we compared PCa stage at diagnosis and its trends between the military health care system and the general public and further compared the trends in tumor stage by race. This study was based on nonidentifiable data from the U.S. Department of Defense's Central Cancer Registry (CCR) and the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. Patients diagnosed between 2004 and 2014 were included. The distributions of PCa stage at diagnosis over time were compared between the 2 populations. Comparisons were further conducted for White and Black patients, respectively. Among the 11,895 patients in the CCR and 544,142 patients in SEER, the majority of patients were diagnosed with stage I or II prostate cancer. However, the CCR had a larger proportion of early-stage tumors (stages I and II combined) with 84.3% vs. 80.0% of SEER patients. The proportion of late-stage tumors (stages III and IV combined) increased over time from 2008 for both populations and the proportion of early-stage tumors decreased for the general population. In terms of temporal distributions by race, the trends were the same between White and Black groups in the general population. In the MHS, the trends in the White patients were similar to those in the general population, but in the Black patients, the percentages of stages I and II at diagnosis continued to increase and those of stages III and IV decreased, differing from those in the general population. The MHS consistently diagnosed PCa at an earlier stage than the U.S. general population across all time periods evaluated in this study. Although similar trends were observed for White patients between both populations, the proportion of stages I and II at diagnosis increased from 2012 among Black patients in the MHS, which stands in sharp contrast to trends in the U.S. general population. Although the differences between the two populations may be associated with various factors, differences in accessibility to care and thus the use of prostate-specific antigen testing might play an important role.

Perception, Practice, and Attitude Toward Prostate-specific Antigen Test Among Sudanese Urologists

Background: The introduction of prostate-specific antigen (PSA) has revolutionized the diagnosis of prostate cancer (PC). However, there is a wide variation in the daily practice of PSA testing with ongoing efforts to increase its sensitivity. This study aims to evaluate the attitude of Sudanese urologists toward the PSA test in their daily practice.
 Methods: An online questionnaire was formed and sent to the academic group of Sudanese urologists; it was left for two months with weekly reminders. The group contains 135 members. Data were then collected and analyzed.
 Results: Of the 135 members, 83 (61.5%) responded to the questionnaire, all were males, with 43% of them being consultants, and 37% having an experience between 5 and 10 years. Most participants (85%) use the test according to international guidelines, the majority (60%) counsel patients before the test, with 72% finding the test more than 50% reliable. In addition, >33% face problems when requesting PSA with >29% of them finding it unreliable. Moreover, in >13%, the test is unavailable. Nearly all participants (95%) think that there is a need for national guidelines to regulate the use of PSA tests.
 Conclusion: For the diversity of practice toward the PSA test and the unavailability of adjunct methods that increase its sensitivity, there is a need for national guidelines to regulate the use of the test in the context of other clinical factors.

PSA TESTING: UTILIZATION, OUTCOMES AND VARIATIONS ACROSS AGE, GENDER AND GEOGRAPHIC REGIONS

OBJECTIVE: This study aims to evaluate the utilization and outcomes of PSA (Prostate-Specific Antigen) testing in the context of prostate cancer screening and diagnosis. The patterns of the PSA testing, the rates of exceeding the reference range, and its relationship with cancer diagnoses were examined in the study. MATERIAL AND METHODS: Data for a five-year period (2017 - 2021) were analyzed, including a total of 148,526,228 PSA tests requested from 27,146,267 individuals. The test counts, test rates per population, and rates of exceeding the reference range were assessed based on gender, age groups, geographic regions, and healthcare institution types. The rates of cancer diagnosis among individuals who underwent PSA testing were also examined. RESULTS: The study reveals that PSA testing was not only performed on men, but also on a significant number of women. The test counts and rates per population varied across different age groups, with higher rates observed in older individuals. The rates of exceeding the reference range were highest among older age groups. The cancer diagnosis rates among individuals who underwent PSA testing were found to be moderate but varied across different years. The study also highlights the differences in test utilization and outcomes based on geographic regions and healthcare institution types. CONCLUSIONS: PSA testing is widely utilized for prostate cancer screening and diagnosis. The findings of this study emphasize the need for a comprehensive evaluation of PSA testing patterns, outcomes, and limitations. The results contribute to a better understanding of the appropriateness and effectiveness of PSA testing in different populations. Further research is required to optimize the use of PSA testing and improve the accuracy of cancer diagnoses.

The Effect of Prostate-Specific Antigen (PSA) Test on Radiation Risk Estimate for Prostate Cancer Incidence among Atomic-Bomb Survivors.

Following our previous report on the radiation dose-response for prostate cancer incidence rates in the Life Span Study (LSS) cohort of atomic bomb survivors, we reevaluated the radiation-related risk adjusting for differences in baseline cancer incidence rates among three subsets of the LSS cohort defined by the timing of their first participation in biennial health examinations offered to the Adult Health Study (AHS) sub-cohort members and prostate-specific-antigen (PSA) testing status for AHS participants: 1. non-AHS participants, 2. AHS participants before receiving PSA test, and 3. AHS participants after receiving PSA test. We found a 2.9-fold increase in the baseline incidence rates among AHS participants after receiving PSA test. After adjusting for the PSA-testing-status effects on the baseline rates the estimated excess relative risk (ERR) per Gy was 0.54 (95% CI: 0.15, 1.05), which was almost identical to the previously reported unadjusted ERR estimate (0.57, 95% CI: 0.21, 1.00). The current results confirmed that, while the PSA testing among AHS participants increased the baseline incidence rates, it did not impact the radiation risk estimate, strengthening the previously reported dose-response relationship for prostate cancer incidence in the LSS. As the use of PSA tests continue in screening and medical settings, analyses of possible effects of PSA testing should be an important aspect of future epidemiological studies of the association between radiation exposure and prostate cancer.

The use of PSA testing over more than 20-years: A population-based study in North-Eastern Italy.

To describe the practice of prostate-specific antigen (PSA) testing over more than 20 years in Friuli Venezia Giulia (FVG), North-Eastern Italy. A population-based, ecological study was conducted using information derived from regional administrative health-related databases. Data on PSA and prostate biopsies performed on resident men aged ⩾45 years from 1998 to 2019 were retrieved. PSA and biopsy rates were calculated as the number of men who had at least one such procedure in each calendar year over the mean resident male population of the same year. Temporal trends were analyzed using joinpoint regression (annual percentage change -APC). A total of 2,502,670 PSA were made between 1998 to 2019 in men aged ⩾45 years. The number of PSA steadily increased from 51,055 in 1998-1999 to 134,504 in 2010-2011, then dropped to 122,080 in 2018-2019. Significant changes in the slopes of PSA rates emerged in 2002 and 2009: the largest increase occurred during 1998-2002 (APC 18.4), followed by a smaller increase in 2002-2009 (APC 3.4) and a subsequent reduction (APC -2.5). Similar patterns emerged for all ages, but the decrease since 2009 was smaller for men aged ⩾65 years. An upward trend emerged in biopsy rate from 1998 to 2001 (APC 13.0), followed by a smaller increase until 2007 (APC 5.7) and a subsequent decrease. Biopsies as percentage of PSA decreased from 3.2% to 2.2%, particularly in those aged ⩾75 years. Although overall declining PSA rates have been observed in FVG since 2009, rates remained higher in the ⩾65-year-old group than in the 45-64-year-old group.

Commentary: Kappen S, Jürgens V, Freitag MH, Winter A. Attitudes Toward and Use of Prostate-Specific Antigen Testing Among Urologists and General Practitioners in Germany: A Survey.

Commentary: Kappen S, Jürgens V, Freitag MH, Winter A. Attitudes Toward and Use of Prostate-Specific Antigen Testing Among Urologists and General Practitioners in Germany: A Survey.

Attitudes Toward and Use of Prostate-Specific Antigen Testing Among Urologists and General Practitioners in Germany: A Survey.

BackgroundIn 2020, around 1.4 million new prostate cancer (PCa) cases were recorded worldwide. Early detection of PCa by prostate-specific antigen (PSA) screening remains debated, leading to different specialist-specific recommendations in PCa guidelines. This study aimed to assess attitudes toward and use of PSA testing among urologists in Germany and general practitioners (GPs) in Lower Saxony (Germany).MethodsA nationwide questionnaire was sent to urologists via the mailing lists of the Professional Association of German Urologists and the German Urological Society. A version of the questionnaire for GPs was sent to email addresses via the Association of Statutory Health Insurance Physicians Lower Saxony. The online questionnaires covered use of PSA testing, information communication, handling of test results, and handling of/knowledge about national and international guidelines and recommendations on early detection of PCa. Statistical analysis was performed at a descriptive level.ResultsIn total, 432 of 6,568 urologists (6.6%) and 96 of 1,579 GPs (6.1%) participated in this survey. Urologists and GPs differed in their attitudes and approaches toward PSA testing. Most urologists (86.8%, n=375) judged the test as “very meaningful” or “meaningful”, compared with 52.1% (n=50) of GPs. Almost two-thirds of the urologists (64.4%, n=278) viewed the PCa mortality reduction by PSA testing as proven, compared with one-fifth of GPs (20.8%, n=20). Almost 80% of male urologists (79.9%, n=291) indicated that they would undergo a PSA test in the future (again), compared with 55.1% of male GPs (n=38). In addition, 56.3% (n=243) of urologists stated that “considerably more than half” or “almost all” men aged 45 years or older received a PSA test, compared with 19.8% (n=19) of GPs.ConclusionsUrologists are more convinced about the PSA test than GPs. PSA testing is therefore used more often in urological settings, although the preselected patient population must be considered. In accordance with specialist-specific recommendations, GPs show a more reserved approach toward PSA testing. Instead of focusing on different attitudes and recommendations on PSA testing, the exchange between specialist groups should be improved to achieve a consistent approach to PSA testing.

Differences in Prostate Cancer Incidence and Mortality in Lower Saxony (Germany) and Groningen Province (Netherlands): Potential Impact of Prostate-Specific Antigen Testing.

BackgroundProstate cancer (PCa) is the most frequent cancer among men in Europe. Differences in PCa incidence around the world can be partly explained by variations in recommendations for prostate-specific antigen (PSA), particularly for early detection. For example, the PSA testing policy is more conservative in the Netherlands than in Germany. To better understand the relationship between PSA testing recommendations and PCa incidence, stage distribution, and mortality, we compared these variables over time between Lower Saxony in northwestern Germany and the neighboring province of Groningen in the Netherlands.MethodsPopulation data, tumor stage- and age group-specific PCa incidence (ICD-10 C61) and mortality rates for Lower Saxony and Groningen were obtained from the Lower Saxony Epidemiological Cancer Registry, the Netherlands Comprehensive Cancer Organization, and Statistics Netherlands for 2003–2012. Incidence and mortality rates per 100,000 person-years were age-standardized (ASR, old European standard). Trends in age-standardized incidence rates (ASIR) and mortality rates (ASMR) for specific age groups were assessed using joinpoint regression.ResultsThe mean annual PCa ASIR between 2003 and 2012 was on average 19.9% higher in Lower Saxony than in Groningen (120.5 vs. 100.5 per 100,000), while the mean annual ASMR was on average 24.3% lower in Lower Saxony than in Groningen (21.5 vs. 28.4 per 100,000). Between 2003 and 2012, the average annual percentage change (AAPC) in PCa incidence rates did not change significantly in either Lower Saxony (−1.8%, 95% CI −3.5, 0.0) or Groningen (0.2%, 95% CI −5.0, 5.7). In contrast, the AAPC in mortality rate decreased significantly during the same time period in Lower Saxony (−2.5%, 95% CI −3.0, −2.0) but not in Groningen (0.1%, 95% CI −2.4, 2.6).ConclusionsHigher PCa incidence and lower PCa-related mortality was detected in Lower Saxony than in Groningen. Although recommendations on PSA testing may play a role, the assessed data could not offer obvious explanations to the observed differences. Therefore, further investigations including data on the actual use of PSA testing, other influences (e.g., dietary and ethnic factors), and better data quality are needed to explain differences between the regions.

Rising Prostate Cancer Incidence in Sub-Saharan Africa: A Trend Analysis of Data from the African Cancer Registry Network.

Prostate cancer is the leading cancer in men in sub-Saharan Africa (SSA) regarding incidence and mortality. Published data from a few registries in SSA suggest that the rates are still rising, but there is little comprehensive information on the time trends of prostate cancer incidence. We analyzed registry data on 13,170 incident prostate cancer cases in men aged 40 years or above, from 12 population-based cancer registries in 11 SSA countries, with at least a 10-year time span of comparable data. We observed an increase in cumulative risks (CR) and age-standardized incidence rates (ASR) over time in all registries (statistically significant in all but one). The highest values of CR were found in Seychelles and Harare (Zimbabwe). The highest annual increase in the ASRs was seen in Seychelles and Eastern Cape (South Africa), whereas the lowest was seen in Mauritius. We mainly found a steady increase in incidence with age and during successive periods. This analysis reveals that prostate cancer incidence rates are rising in many populations in SSA-often very rapidly-which is in contrast to recent observations worldwide. We acknowledge that the reasons are multifactorial and largely remain unclear, but believe that they are primarily associated with improvements in health care systems, for example, a broader use of prostate-specific antigen testing. This study is the first to compare population-level data on time trends of prostate cancer incidence between multiple countries of SSA, presenting the different rates of increase in 11 of them.

Relevance of prostate-specific antigen screening in elderly individuals: A cross-sectional analysis from a tertiary care referral teaching hospital in India

Background: Prostate-specific antigen (PSA) screening is a routine clinical practice in the geriatric clinical practice– often intended to pick up early cases of prostate cancer. Multiple studies done across the world have demonstrated population-specific normative values of PSA with varying thresholds for prostate cancer. Universal application of the normative values results in false-positive screening results thus leading to unnecessary apprehension and invasive follow-up for the same– often unnecessary. Objectives: a. To study the PSA values of geriatric patients and postulate the possible normal values of PSA in different age groups of elderly. b. To correlate the PSA values with biopsy reports, wherever available, thus hypothesising the acceptable limits of PSA, beyond which prostatic biopsy may be indicated. Methods: This was a retrospective, cross-sectional study done at Amrita Institute of Medical Sciences, Kochi, India, where PSA of patients registered for the Comprehensive Geriatric Health Checkup Package between January 2012 and June 2013 were studied (n = 1038). Results: a. 105 patients were found to have an elevated PSA, of which 24 underwent biopsy after serial estimations as per protocol. Only 7 were proven to be malignant. b. Mean PSA values were found to be 1.55, 1.4 and 1.20 in the 60–69 years, 70–79 years and 80+ categories, respectively. Conclusion: a. Age-specific ranges of PSA are essential in interpreting PSA of the elderly and our study showed values that are similar to the expected. b. The study also demonstrates that roughly 10% of the elderly population in all age subsets has PSA values over the normal. Routine PSA testing puts roughly 1 in 10 patients at risk for biopsy and also places them at risk of probably unnecessary worry about a possible prostatic malignancy. c. Only 7 malignancies were picked up by the routine use of PSA testing in the study population of 1038, i.e., 6.7/1000. This brings us to the question of the cost effectiveness and utility of routine PSA screening, particularly when it places roughly 10% at risk for biopsy. d. Malignancies were detected in patients with falling PSA values and also who had unsuspicious findings on PR, hence questioning its relevance.

Abstract PO-250: Factors associated with different levels of shared decision-making for prostate specific-antigen tests: Results from the National Health Interview Survey

Abstract Background: Shared decision-making (SDM) discussions are recommended by professional organizations prior to all prostate specific-antigen (PSA) tests. During these discussions, clinicians are encouraged to disclose the advantages, disadvantages, and fidelity of the PSA test, thus arming the patient with the pertinent information to make an informed decision. However, research suggests that discussions about the use of PSA testing are rare. With a growing foreign-born population in the U.S. and the paucity of studies examining SDM, little is known about the demographic associations of SDM for U.S.-born and foreign-born men. Objectives: Our objectives were to examine the levels of SDM for PSA testing and associated factors among a population of U.S. and foreign-born men using data from a nationally representative, cross-sectional survey. Methods: Data were combined from the 2010 and 2015 National Health Interview Survey (NHIS). Eligibility included men ≥ 40 years old. Men were excluded if they indicated that they did not know if they ever had a PSA test, the test was not for a routine exam, or had missing information on socio-demographic variables of interest. SDM was operationalized into three mutually exclusive categories: full (all elements), partial (mixture of advantages and disadvantages with experts disagree), and none. Bivariate and multinomial logistic regression were used to examine levels of SDM and the associated socio-demographic factors. All analyses were completed using SAS version 9.4, were weighted and deemed statistically significant at α ≤ 0.05. Results: The analytic sample contained 6509 men, of which most were non- Hispanic whites (81.2%), 60-69 years (34.0)%, U.S.-born (90.5%); the receipt of full SDM was low (14.5%). The final multinomial logistic regression model included survey year, race/ethnicity, region, education, marital status, and type of insurance. Compared to men who received no SDM, full SDM was more likely for men surveyed in 2015 (Odds Ratio [OR]=1.59, 95% Confidence Interval [CI] [1.31 – 1.92]), non- Hispanic blacks compared to non-Hispanic whites (OR=1.69, 95% CI [1.29 – 2.22), college/technical school graduates compared to less than high school education (OR=1.95; 95% CI [1.40 – 2.71]), and those with dual eligible compare to men with private insurance (OR=2.91; 95% CI [1.40 – 2.71]). Similar results were observed for the receipt of partial SDM for non-Hispanic blacks compared to non-Hispanic whites (OR=1.43; 95% CI [1.18 – 1.73]), college/technical school graduates compared to less than high school education (OR=1.38; 95% CI [1.13 – 1.70]), and those with dual eligible compared to men with private insurance (OR=1.36; 95% CI [1.04 – 1.78]). Conclusion: Among U.S. and foreign-born men, the receipt of full SDM for PSA testing was low in the population and varied by year and socio-demographic factors, but not by nativity. Further studies are required to examine the reasons for the observed low rate of full SDM in this population. Citation Format: Jarrett A. Johnson, Richard P. Moser, Gary L. Ellison, Damali M. Martin. Factors associated with different levels of shared decision-making for prostate specific-antigen tests: Results from the National Health Interview Survey [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-250.

Increasing incidence of prostate cancer in Taiwan: A study of related factors using a nationwide health and welfare database.

Over the past decades, the incidence of prostate cancer in Taiwan kept rising. Many possible factors including the utility of prostate specific antigen tests, lifestyle remodeling, and patient's comorbidities may contribute to the increasing of incidence or prostate cancer. We aim to use the nationwide Health and Welfare Database (HWD) to investigate possible associated factors.We used HWD, a nationwide database of medical information, to assess the incidence of prostate cancer, utilization of prostate-specific antigen (PSA) test, and underlying diseases of patients and to evaluate whether there was a common trend among these factors.In total, 32,508 patients with newly diagnosed prostate cancer from 2006 to 2013 were identified. The incidence rate of prostate cancer per 100,000 men increased from 35.47 in 2006 to 52.87 in 2012. The number of patients with prostate cancer and underlying diseases related to metabolic syndrome increased every year. The number of total PSA tests and patients undergoing PSA testing, as well as average times of PSA testing per person in the whole population, increased every year. The average PSA test times of patients with newly diagnosed prostate cancer within 3 years before the diagnosis of prostate cancer also increased every year. There was a high correlation between the average PSA test times and the number of patients with newly diagnosed prostate cancer (r2 = 0.9734).The trends of incidence of prostate cancer, utilization of PSA testing, and underlying diseases related to metabolic syndrome at the diagnoses of cancer were similar, increasing every year in the study period. The results suggested that increasing use of PSA tests may increase the diagnosis of prostate cancers. Underlying diseases related to metabolic syndrome might also affect the incidence of prostate cancer.

Prostate-specific antigen testing after the US Preventive Services Task Force recommendation: a population-based analysis of electronic health data.

This study describes longitudinal trends in the use of prostate-specific antigen (PSA)-based testing in two geographically distinct healthcare systems following the 2011 US Preventive Services Task Force (USPSTF) recommendations against routine PSA screening. We analyzed population-based health claims data from 253,139 men aged 40-80 who were enrolled at two US healthcare systems. We assessed trends in the percentage of eligible men receiving ≥ 1 PSA test per year by time period (2000-2008, 2009-2011, 2012-2014), age (40-54, 55-69, 70-80), and race (white, black, other, unknown), and conducted a joinpoint regression analysis. Men aged 55-69 and 70-80years of all races had similar use of PSA testing between 2000 and 2011, ranging between 47 and 56% of eligible men by year, while only 22-26% of men aged 40-54 had a PSA test per year during this period. Overall, the percentage of men receiving at least one PSA test per year decreased by 26% between 2009-2011 and 2012-2014, with similar trends across race and age groups. PSA testing declined significantly after 2011 (annual percent change = -11.28). Following the 2011 USPSTF recommendations against routine PSA screening, declines in PSA testing were observed among men of all races and across all age groups in two large US healthcare systems.

A genetic risk assessment for prostate cancer influences patients' risk perception and use of repeat PSA testing: a cross-sectional study in Danish general practice.

BackgroundProstate cancer (PC) is the most common cancer among men in the western world. Genetic lifetime risk assessment could alleviate controversies about prostate specific antigen (PSA) testing for early diagnosis.AimTo determine how men interpret information about their lifetime risk for PC and how this can affect their choice of having a repeated PSA test.Design & settingA genetic test was offered for assessment of individual PC lifetime risk in general practices in Denmark, with the purpose of promoting appropriate use of PSA testing.MethodParticipants had a genetic lifetime risk assessment for PC diagnosis (either high or normal risk). A month after receiving the result, participants answered a questionnaire about their perceived risk of getting or dying from PC compared with other men, as well as their intentions for repeated PSA testing.ResultsNearly half (44.7%) of 555 participants who received the genetic risk assessment were not aware they had a genetic test. Nevertheless, compared with men with a normal genetic risk, those with high genetic risk reported higher perceived risk for PC (mean difference of 0.74 [95% confidence interval {CI} = 0.56 to 0.96] on a 5-point scale), higher perceived risk of dying from PC (mean difference of 0.48 [95% CI = 0.29 to 0.66] on a 5-point scale), and increased intention for repeated PSA testing (mean difference of 0.48 [95% CI = 0.30 to 0.65] on a 4-point scale).ConclusionDespite low awareness and/or understanding of the test result, a high genetic risk for PC made participants more aware of their risk, and it increased their intention and probability for repeated PSA testing.

The effect of assessing genetic risk of prostate cancer on the use of PSA tests in primary care: A cluster randomized controlled trial.

BackgroundAssessing genetic lifetime risk for prostate cancer has been proposed as a means of risk stratification to identify those for whom prostate-specific antigen (PSA) testing is likely to be most valuable. This project aimed to test the effect of introducing a genetic test for lifetime risk of prostate cancer in general practice on future PSA testing.Methods and findingsWe performed a cluster randomized controlled trial with randomization at the level of general practices (73 in each of two arms) in the Central Region (Region Midtjylland) of Denmark. In intervention practices, men were offered a genetic test (based on genotyping of 33 risk-associated single nucleotide polymorphisms) in addition to the standard PSA test that informed them about lifetime genetic risk of prostate cancer and distinguished between “normal” and “high” risk. The primary outcome was the proportion of men having a repeated PSA test within 2 years. A multilevel logistic regression model was used to test the association.After applying the exclusion criteria, 3,558 men were recruited in intervention practices, with 1,235 (34.7%) receiving the genetic test, and 4,242 men were recruited in control practices. Men with high genetic risk had a higher propensity for repeated PSA testing within 2 years than men with normal genetic risk (odds ratio [OR] = 8.94, p < 0.01). The study was conducted in routine practice and had some selection bias, which is evidenced by the relatively large proportion of younger and higher income participants taking the genetic test.ConclusionsProviding general practitioners (GPs) with access to a genetic test to assess lifetime risk of prostate cancer did not reduce the overall number of future PSA tests. However, among men who had a genetic test, knowledge of genetic risk significantly influenced future PSA testing.Trial registrationThis study is registered with ClinicalTrials.gov, number NCT01739062.

Prostate cancer incidence and mortality in the Baltic states, Belarus, the Russian Federation and Ukraine

BackgroundProstate cancer incidence varies internationally largely attributable to differences in prostate-specific antigen (PSA) use. The aim of this study was to provide the most recent detailed international epidemiological comparison of...

Structured Population-based Prostate-specific Antigen Screening for Prostate Cancer: The European Association of Urology Position in 2019

Prostate cancer (PCa) is one of the first three causes of cancer mortality in Europe. Screening in asymptomatic men (aged 55–69yr) using prostate-specific antigen (PSA) is associated with a migration toward lower staged disease and a reduction in cancer-specific mortality. By 20yr after testing, around 100 men need to be screened to prevent one PCa death. While this ratio is smaller than for breast and colon cancer, the long natural history of PCa means many men die from other causes. As such, the nonselective use of PSA testing and radical treatments can lead to overdiagnosis and overtreatment. The European Association of Urology (EAU) supports measures to encourage appropriate PCa detection through PSA testing, while reducing overdiagnosis and overtreatment. These goals may be achieved using personalized risk-stratified approaches. For diagnosis, the greatest benefit from early detection is likely to come in men assessed using baseline PSA levels at the age of 45yr to individualize screening intervals. Multiparametric magnetic resonance imaging as well as risk calculators based on family history, ethnicity, digital rectal examination, and prostate volume should be considered to triage the need for biopsy, thus reducing the risk of overdiagnosis. For treatment, the EAU advocates balancing patient's life expectancy and cancer's mortality risk when deciding an approach. Active surveillance is encouraged in well-informed patients with low-risk and some intermediate-risk cancers, as it decreases the risks of overtreatment without compromising oncological outcomes. Conversely, the EAU advocates radical treatment in suitable men with more aggressive PCa. Multimodal treatment should be considered in locally advanced or high-grade cancers. Patient summaryImplementation of prostate-specific antigen (PSA)-based screening should be considered at a population level. Men at risk of prostate cancer should have a baseline PSA blood test (eg, at 45yr). The level of this test, combined with family history, ethnicity, and other factors, can be used to determine subsequent follow-up. Magnetic resonance imaging scans and novel biomarkers should be used to determine which men need biopsy and how any cancers should be treated.

Perspective on Prostate Cancer Screening.

Undoubtedly, no biomarker has had more profound impact on our approach to cancer detection, staging, and monitoring after treatment than the prostate-specific antigen (PSA)7 test. PSA is a serine protease produced by the prostate epithelium, secreted into seminal fluid, and measurable in peripheral blood by immunoassay laboratory techniques detecting both free unbound forms and that bound to the protease inhibitor α1-antichymotrypsin. The introduction of the PSA test as a diagnostic means to monitor and detect prostate cancer during the 1980s was based on discoveries in the laboratories of Kuriyama, Wang, and Papsidero, together with observations in clinical cohorts never exposed to screening by Stamey, Catalona, and others, noting that men with prostate cancer (or benign prostatic hyperplasia) had higher PSA concentrations compared with healthy controls (1). The PSA test was far more sensitive than assays of prostatic acid phosphatase and digital rectal examination. These findings set off a rapid widespread introduction of the PSA test in clinical practice, mainly in the US, which contributed to a dramatic surge in prostate cancer incidence in the US during the late 1980s through the mid-1990s. There is clear evidence from large population-based randomized trials—the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Goteborg randomized screening trial—that early detection (and concomitant management) by PSA screening reduces a man's risk of dying from prostate cancer. Indeed, extensive use of PSA testing has importantly contributed to a 40% to 50% decline in prostate cancer mortality in the US between 1993 and 2015. However, the widespread use of PSA testing of asymptomatic men, combined with liberal criteria to perform a prostate biopsy, has led to important harms associated with the overdiagnosis of tumors that would never have caused symptoms or harm during a man's lifetime, as well as consequential risk of unnecessary treatment. …

Prostate Cancer Detection: Complexities and Strategies

Prostate cancer (PCa) incidence is increasing due to the ageing worldwide population. In recent years, the unsuitability of prostate specific antigen (PSA) as a diagnostic biomarker has become apparent. Unnecessary treatment of men with non-lethal disease leading to significant quality-of-life reducing side-effects resulted in 2017 in the US Preventative Services Task Force (USPSTF) recommending selective and limited use of PSA testing for PCa. An immediate need exists for a test capable of accurate and early diagnosis of PCa. Critically, this test must differentiate between indolent and aggressive PCa to inform appropriate management of the disease. The key to predictive accuracy is the utilisation of combinations of diverse biomarkers and clinical data. A number of suitable new tests have emerged since 2013 but none of these have been implemented in the clinical setting. Extensive clinical validation of these tests is critical to address the chasm that now exists in PCa diagnostics. This mini review assesses current clinical issues for PCa diagnosis, evaluates currently available commercial tests and critically assesses next-generation diagnostic tools that could revolutionise PCa diagnostics.