Prostate-specific Antigen Testing In Men Research Articles

Determinants of receipt of prostate cancer screening among men living with HIV enrolled in an urban HIV Clinic in the United States over the period of 2000–2020

BackgroundProstate cancer is projected to account for the greatest proportion of cancer-related burden among men with HIV. However, incidence is reportedly lower than in men without HIV, potentially due to differences in screening. Factors influencing receipt of screening in men with HIV are unknown. We described receipt of prostate-specific antigen (PSA) testing and assessed factors for association with receipt of PSA test. MethodsDemographics, measures of HIV and related care, and non-HIV care were assessed for association with receipt of first PSA test in men ≥40 years old each calendar year in 2000–2020 using univariable and multivariable Poisson regression. Models were additionally stratified by calendar period to identify changes in determinants of PSA test as prostate cancer screening guidelines changed. ResultsMen (n = 2,063) 72% Non-Hispanic Black, median age of 47 (IQR: 41, 53), contributed median of 4.7 years (IQR: 2.3, 10.0) of follow-up. Receipt of antiretroviral therapy (aIRR = 1.33; 95% CI: 1.14, 1.55), engagement in HIV care (aIRR = 2.09; 95% CI: 1.66, 2.62), history of testosterone-replacement therapy (aIRR = 1.34; 95% CI: 1.19, 1.50), urologist evaluation (aIRR = 1.66; 95% CI: 1.35, 2.05), and receipt of PSA test in preceding two years (no elevated PSA aIRR = 2.37; 95% CI: 2.16, 2.61; elevated PSA aIRR = 4.35; 95% CI: 3.24, 5.84) were associated with PSA testing in men aged 50 or older. Associations varied across calendar time. ConclusionFindings suggest men with greater interaction with healthcare are more likely to receive PSA test. Measures of control of HIV did not appear to influence the decision to screen.

Low-Value Prostate Cancer Screening Among Young Men With Private Insurance.

No professional society guidelines recommend PSA screening in men younger than age 40; however, data suggest testing occurs at meaningful rates in this age group. The purpose of this study was to identify the rate of PSA testing in men under 40. This is a population-based, retrospective cohort study from 2008 to 2017. Using the MarketScan database, rates of testing for the sum of the annual population of men at risk were evaluated. Descriptive statistics and statistical analyses were performed in men continuously enrolled in the database for at least 5 year. Results were stratified by receipt of PSA testing and by age group. The association of diagnoses and Charlson Comorbidity Index with receipt of PSA test was evaluated using multivariable logistic regression models. We identified 3,230,748 men ages 18 to 39 who were enrolled for at least 5 years. The rate of ever receiving PSA testing was 0.6%, 1.7%, 8.5%, and 9.1% in men less than 25, 25 to 29, 30 to 34, and 35 to 39 years, respectively. Multivariable logistic regression showed that relative to all men 18 to 39, patients who received PSA testing had higher odds of a diagnosis of hypogonadism (OR 11.77) or lower urinary tract symptoms (OR 4.19). This study found a remarkable number of young men receive PSA testing, with a strong association with diagnoses of lower urinary tract symptoms and hypogonadism. Clinicians need to be educated that assessment and management guidelines for other urologic diagnoses now defer PSA testing to prostate cancer screening guidelines.

Predictors of Low-Value PSA Screening in Elderly Men

<h3>Purpose/Objective(s)</h3> The US Preventive Services Task Force (USPSTF) advises against prostate-specific antigen (PSA) testing for prostate cancer in men over 70 and identifies men aged 55 - 69 as the target screening group. The PSA test for prostate cancer is limited by its high false-positive rate and often leads to overdiagnosis of prostate cancer. Together, these can expose patients to anxiety, invasive biopsies, and possible over-treatment. We evaluate the predictors of recent PSA testing in men over 70 using Behavioral Risk Factor Surveillance System (BRFSS) survey data. <h3>Materials/Methods</h3> BRFSS 2020 data from PSA-related questions were analyzed, including time since last PSA test, PSA test reason, and whether a provider discussed the advantages and disadvantages of PSA screening with respondents. Men over 70 who answered PSA-related questions met our study criteria. We defined "recent testing" as having had a PSA test within the past two years. We used weighted multivariable logistic regressions with two-sided significance tests to measure effects of age, insurance status, having a primary care physician (PCP), and having discussion of PSA test risks and benefits with a provider on recent testing. Recent testing rates and percentages of men tested via routine screening vs. prostate-specific evaluations were calculated. <h3>Results</h3> Our cohort included 33,556 men. Recent PSA testing was high in men over 70. Men aged 70-75, 75-80, 80+ had testing rates of 56.3%, 53.4%, and 40.8% respectively. In a multivariable regression model, positive predictors of recent testing in men over 70 included being insured (OR = 1.202, 95% CI 1.195 - 1.21, p < 0.001), having a PCP (OR = 1.459, 95% CI 1.454 - 1.465, p < 0.001), and discussing the advantages of PSA testing with a PCP (OR = 3.507, 95% CI 3.5 - 3.515, p < 0.001). Discussing the disadvantages of PSA testing with a PCP had only a small, negative effect on recent testing in men over 70 (OR = 0.996, 95% CI 0.995 - 0.998, p < 0.001). Among men over 70 who had recent PSA tests, 73.3% reported routine testing as the main reason for their tests. We repeated our analysis with the unweighted survey data and found no significant changes in results. <h3>Conclusion</h3> Despite USPSTF guidelines, men over 70 continue to be screened with PSA at a high rate. Routine testing accounted for the majority of recent PSA tests in men over 70. Having a discussion of the benefits of PSA tests with a provider had the largest effect on recent testing in men over 70, which underscores the role of the provider in positively influencing PSA testing rates. Other related predictors of PSA testing in men over 70 included being insured and having a PCP. These findings suggest changes can be made at the provider-level to increase adherence to guidelines on age-based PSA testing.

Interruptive Electronic Alerts for Choosing Wisely Recommendations: A Cluster Randomized Controlled Trial.

To assess the efficacy of interruptive electronic alerts in improving adherence to the American Board of Internal Medicine's Choosing Wisely recommendations to reduce unnecessary laboratory testing. We administered 5 cluster randomized controlled trials simultaneously, using electronic medical record alerts regarding prostate-specific antigen (PSA) testing, acute sinusitis treatment, vitamin D testing, carotid artery ultrasound screening, and human papillomavirus testing. For each alert, we assigned 5 outpatient clinics to an interruptive alert and 5 were observed as a control. Primary and secondary outcomes were the number of postalert orders per 100 patients at each clinic and number of triggered alerts divided by orders, respectively. Post hoc analysis evaluated whether physicians experiencing interruptive alerts reduced their alert-triggering behaviors. Median postalert orders per 100 patients did not differ significantly between treatment and control groups; absolute median differences ranging from 0.04 to 0.40 for PSA testing. Median alerts per 100 orders did not differ significantly between treatment and control groups; absolute median differences ranged from 0.004 to 0.03. In post hoc analysis, providers receiving alerts regarding PSA testing in men were significantly less likely to trigger additional PSA alerts than those in the control sites (Incidence Rate Ratio 0.12, 95% CI [0.03-0.52]). Interruptive point-of-care alerts did not yield detectable changes in the overall rate of undesired orders or the order-to-alert ratio between active and silent sites. Complementary behavioral or educational interventions are likely needed to improve efforts to curb medical overuse. Implementation of interruptive alerts at the time of ordering was not associated with improved adherence to 5 Choosing Wisely guidelines. NCT02709772.

What is the impact of ischemic heart disease on PSA testing?

e17014 Background: Prostate Specific Antigen (PSA) testing can improve early prostate cancer detection. However, numerous factors can influence patients’ willingness and ability to undergo PSA testing. Methods: We performed a cross-sectional study investigating the impact of various degrees of ischemic heart disease (IHD) on PSA testing. We assessed 3,822 male respondents aged 55-75 from the 2018 year of the National Health Interview Survey (NHIS). Men were stratified according to the degree of IHD (none, history of angina pectoris (AP), history of myocardial infarction (MI), or history of neither, but with a diagnosis of IHD). Multivariable logistic regression analysis was used to assess the relationship between IHD and being tested for PSA, adjusting for known cofounders. Results: Multivariable logistic regression demonstrated that males with a history of IHD (no MI or AP) were more likely to have ever been PSA tested than males without IHD (p = 0.012, OR = 1.630, 95% CI 1.115-2.383), as seen in Table. Additionally, older age (p &lt; 0.001), having a partner (vs. no partner p &lt; 0.001), homosexual sexual orientation (vs. heterosexual orientation p = 0.007), and a history of cancer (vs. no history p &lt; 0.001) all increased likelihood of being PSA tested. In contrast, Asian race (vs. White, p = 0.001), and being a current smoker (vs. no smoking history, p &lt; 0.001) decreased the likelihood. Interestingly, males with a history of a symptomatic IHD (MI or AP) were not shown to be more likely to undergo PSA testing. Conclusions: Our results suggest that males with non-symptomatic IHD are more likely to be PSA tested. Males with symptomatic IHD do not seem to undergo more PSA screening, perhaps due to lower suggested life expectancy. Awareness of discrepancies in PSA testing in men with IHD should be raised. Table - Multivariable logistic regression analyses demonstrating relationships with likelihood of being PSA tested.[Table: see text]

PSA Testing in Men Receiving Testosterone Therapy With History of Prostate Cancer: A Matched Analysis of a Large Multi-Institutional Research Network

ObjectiveTo investigate the frequency of prostate-specific antigen (PSA) testing in men receiving testosterone replacement therapy (TT) and with a history of prostate cancer (PCa). MethodsWe queried the TriNetX network database, a global health research network consisting of 65 million men in 44 large healthcare organizations, to investigate rates of PSA testing in 4 cohorts of men aged 55-69 with a history of PCa diagnosis and/or a prescription for any route or formulation of testosterone. We further stratified each cohort to evaluate PSA testing in men with previously treated (CPT 55,840, 55,866, 77,778, 77,385) or untreated PCa. All cohorts’ PSA testing rates were compared against the “no PCa or TT” cohort by Chi-square test. ResultsA total of 4,525,259 men, aged 55-69, were included in our study. Following stratification into cohorts based on PCa or TT history, we found that 14.2% (P < .0001) of men without PCa or TT underwent PSA testing following an initial ambulatory visit. Among men without PCa who received TT, 33.6% (P < .0001) underwent testing. Unfortunately, only 53.2% (P < .0001) and 61.0% (P < .0001) of men receiving TT with previously untreated and treated PCa, respectively, had PSA testing. ConclusionIn contrast to current guidelines, a large proportion of men receiving TT and with a history of PCa did not undergo PSA testing. Further studies are necessary to better characterize reasons why PSA testing rates are low even in this high-risk cohort.

Prostate-specific Antigen Testing in Men with Disabilities: A Cross-sectional Analysis of the Health Information National Trends Survey

BackgroundPatients with disabilities represent a unique minority population. The incidence of prostate-specific antigen (PSA) testing among this population is unknown. ObjectiveTo compare PSA testing rates and associated predictors among men with and without reported disabilities in the USA. Design, setting, and participantsA cross-sectional study of the Health Information National Trends Survey (HINTS) for the years 2012, 2013, 2017 and 2019 was conducted in men with reported disabilities. Outcome measurements and statistical analysisBaseline demographics of the entire cohort were stratified based on their reported disabilities (none, disabled, deaf, and blind). Each disability was compared separately and in combination with the cohort without disabilities. Multivariable logistic regression models determined clinically significant predictors of PSA testing in men with disabilities compared with those without. Results and limitationsOverall, 782 (15%) men with disabilities were compared with 4569 (85%) men without disabilities. The former cohort was older with a median (interquartile range) age of 65 (56–75) versus 57 (43–67) yr (p < 0.001). On multivariable analysis, men with any disability were less likely to undergo PSA testing (odds ratio 0.77, 95% confidence interval 0.62–0.96, p = 0.018). Variables associated with increased PSA testing included age, having a health care provider, health insurance, and living with a partner. ConclusionsInequalities in PSA testing exist among men with disabilities in the USA, especially among the deaf and blind, being less likely to undergo PSA testing. Further research is required to identify and deal with any obstacles in the implementation of equal PSA testing in this unique population. Patient summaryIn the USA, men with reported disabilities are less likely to undergo PSA testing than patients without reported disabilities.

Prostate-specific antigen testing in the disabled population: A cross-sectional analysis of the Health Information National Trends Survey (HINTS).

e17000 Background: Disabled patients are a unique minority population that may have lower literacy levels and difficulty communicating with physicians. Furthermore, their knowledge for cancer prevention recommendations is unknown. Herein, we aim to compare prostate-specific antigen (PSA) testing rates and associated predictors among disabled men and non-disabled men in the USA. Methods: We performed a cross-sectional study utilizing the Health Information National Trends Survey (HINTS) to analyze factors predicting PSA testing rates in men with disabilities (disabled, deaf, blind). Multivariable logistic regression models were used to determine clinically significant predictors of PSA testing in men with disabilities compared to that of the healthy cohort. Results: A total of 782 (14.6%) disabled men were compared to 4,569 (85.4%) non-disabled men. Disabled men were older with a mean age of 65.0 ± 14.2 vs. 55.0 ± 15.9 years (p &lt; 0.001). On multivariable analysis, after adjusting for all available confounders including race, age, geographical region, survey year, marital status, health insurance, healthcare provider, amongst others, men with any disability were less likely to undergo PSA screening (OR 0.772, 95% CI 0.623-0.956, p = 0.018). Variables associated with increased PSA screening rates included age, having a healthcare provider or health insurance, and living with a partner. Although prostate cancer detection rates were shown to be higher among disabled men, this did not reach statistical significance. Conclusions: Our data suggests that significant inequalities in PSA screening exist among men with disabilities in the USA, with disabled men, especially the deaf and the blind, being less likely to be offered PSA screening. There is a clear need to implement strategies to reduce existing gaps in the care of disabled men and strive to reach equality in PSA screening in this unique population.

Predictors of prostate-specific antigen testing in men aged ≥55years: A cross-sectional study based on patient-reported outcomes.

To examine the predictors of prostate-specific antigen discussion with a physician and prostate-specific antigen testing in men aged ≥55years. Utilizing the USA Health Information National Trends Survey, 4th Ed., a cross-sectional study from 2011 to 2014 was carried out to analyze the factors predicting prostate-specific antigen testing and discussion in men ≥55years. Associations between each covariate and prostate-specific antigen discussion/testing were determined. Multivariable logistic regression models were used to determine clinically relevant predictors of prostate-specific antigen discussion/testing. Due to multiple comparisons, the Bonferroni correction was used. A total of 2731 men included in the Health Information National Trends Survey were analyzed. Several socioeconomic parameters were found to increase the likelihood of men aged ≥55years to undergo prostate-specific antigen testing: living with a spouse, a higher level of education (college graduate or above), a higher income (>$50000 annually) and previous history of any cancer. In contrast, current smokers were less likely to undergo prostate-specific antigen testing. Having a prostate-specific antigen discussion with a physician was more likely for men surveyed in 2014, for men who were living with a spouse, who had a higher annual income (>$50000 annually) and those with a history of any cancer. Significant inequalities in prostate-specific antigen testing and discussion exist among men in the USA, mainly driven by socioeconomic factors. Ideally, prostate-specific antigen testing and discussion should be based on relevant clinical factors with a shared decision-making approach for every man. Therefore, a better understanding of the socioeconomic factors influencing prostate-specific antigen testing/discussions can inform strategies to reduce existing gaps in care.

Factors Related to Prostate-Specific Antigen-Based Prostate Cancer Screening in Primary Care: Retrospective Cohort Study of 120,587 French Men Over the Age of 50 Years.

BackgroundInternational guidelines recommend avoiding prostate-specific antigen (PSA)-based prostate cancer screening in the elderly when life expectancy is less than 10 years. For younger men, most recommendations encourage a shared decision-making process taking into account patient comorbidities.ObjectiveThe objective was to assess the performance of PSA-based prostate cancer screening in men older than 74 years and assess whether the presence (vs absence) of comorbidities was related to the performance of PSA testing in younger men aged 50 to 74 years who were eligible for screening.MethodsWe analyzed data from the French national health care database (Loire-Atlantique geographic area). We reported the follow-up of two cohorts of men from April 1, 2014, to March 31, 2016: 22,480 men aged over 74 years and 98,107 men aged 50 to 74 years. We analyzed whether these patients underwent PSA testing after 2 years of follow-up and whether PSA testing performance was related to the following patient-related variables: age, low income, proxy measures indicative of major comorbidities (repeated ambulance transportation, having one of 30 chronic diseases, taking 5 or more drugs per day), or proxy measures indicative of specific comorbidities (cancer diseases, cardiovascular diseases, or psychiatric disorders). Statistical analysis was based on a multivariate mixed-effects logistic regression.ResultsThe proportion of patients who underwent a PSA-based screening test was 41.35% (9296/22,480) among men older than 74 years versus 41.05% (40,275/98,107) among men aged 50 to 74 years. The following factors were associated with less frequent PSA testing in men older than 74 years—age (odds ratio [OR] 0.89, 95% CI 0.88-0.89), low income (OR 0.18, 95% CI 0.05-0.69), suffering from a chronic disease (OR 0.82, 95% CI 0.76-0.88), repeated ambulance transportation (OR 0.37, 95% CI 0.31-0.44), diabetes requiring insulin (OR 0.51, 95% CI 0.43-0.60), dementia (OR 0.68, 95% CI 0.55-0.84), and antipsychotic treatment (OR 0.62, 95% CI 0.51-0.75)—whereas cardiovascular drug treatment was associated with more frequent PSA testing (OR 1.6, 95% CI 1.53-1.84). The following factors were associated with less frequent PSA testing in men aged 50 to 74 years—low income (OR 0.61, 95% CI 0.55-0.68); nonspecific conditions related to frailty: suffering from a chronic disease (OR 0.80, 95% CI 0.76-0.83), repeated ambulance transportation (OR 0.29, 95% CI 0.23-0.38), or chronic treatment with 5 or more drugs (OR 0.89, 95% CI 0.83-0.96); and various specific comorbidities: anticancer drug treatment (OR 0.67, 95% CI 0.55-0.83), diabetes requiring insulin (OR 0.55, 95% CI 0.49-0.61), and antiaggregant treatment (OR 0.91, 95% CI 0.86-0.96)—whereas older age (OR 1.07, 95% CI 1.07-1.08) and treatment with other cardiovascular drugs (OR 2.23, 95% CI 2.15-2.32) were associated with more frequent PSA testing.ConclusionsIn this study, 41.35% (9296/22,480) of French men older than 74 years had a PSA-based screening test. Although it depends on patient comorbidities, PSA testing remains inappropriate in certain populations.

Effects of an Educational Program for Prostate Cancer Prevention on knowledge and PSA Testing in Men Over 50 Years old in Community Areas of Shiraz in 2016

Background and Objectives:Prostate cancer was reported to be the second cause of cancer death in men in 2013. Studies have shown that those with higher knowledge levels are much more likely to undergo prostate cancer screening. The present study was aimed to determinate the effect of an educational program for prostate cancer prevention on knowledge and prostate-specific antigen (PSA) testing in men over 50 years old in community areas of Shiraz.Methods:This clinical trial was conducted among 93 men over 50 years old who were randomly divided into an intervention (n=48) and a control (n=45) group. The intervention group took part in an educational program focusing on the importance of prostate cancer prevention with emphasis on cultural and economic issues. Data were collected using a demographic information form, the Weinrich questionnaire for measuring the knowledge level about prostate cancer and screening, and also a researcher-made questionnaire covering reasons for not doing the test, before and 3 months after the intervention. Additionally, participation in PSA testing was evaluated 3 months after the intervention. All data were entered into the SPSS statistical software (version 14) and p<0.05 was considered to be statistically significant.Findings:The results showed that the intervention group’s participation in PSA testing increased from 6.12% to 36.4% three months after the intervention. However, no significant change was observed in the control group. In addition, the intervention group’s mean score of knowledge increased by about 2.69 points after the intervention, and a significant difference was observed between the two groups in this regard (p<0.05).Conclusion:The results of the current study revealed effectiveness of the educational program in increasing the knowledge about prostate cancer and participation in PSA testing in men over 50 years of age. Hence, managers and authorities should execute plans to educate men regarding prostate cancer screening and promote their health status.

The impact of a family history of prostate cancer on the prognosis and features of the disease in Korea: results from a cross-sectional longitudinal pilot study.

Reports on the impact of a family history of prostate cancer among Asians are scarce. We evaluated whether a positive prostate cancer family history is associated with the prognosis and features of the disease. From January 2006 to December 2015, patients who received treatment for pathologically diagnosed prostate cancer were enrolled. Information on family history was obtained via self-administered questionnaires between January 2015 and December 2016. The overall survival rate for all patients and the rate of biochemical failure after radical prostatectomy were assessed according to the presence of family history. Of 1266 patients (median age, 68.1years; median prostate-specific antigen, 8.73ng/mL; median follow-up, 40.0months), 47 (3.8%) were identified as having a family history. Men with a family history had a younger age, higher proportion of cases diagnosed before 55years of age, and lower stage than those without a family history. Family history was not a potential risk factor for overall survival. In an analysis of patients who underwent radical prostatectomy (median prostate-specific antigen, 7.40ng/mL; median follow-up, 40.5months), no differences in pathologic characteristics were found between patients with (n=39, 93.5%) and without (n=567, 6.4%) a family history. Family history was not predictive of biochemical failure. A family history of prostate cancer seemed to have no effect on prognosis and disease aggressiveness. However, this study proposed a rationale for performing earlier prostate-specific antigen testing in men with a family history of prostate cancer.

PSA testing for men at average risk of prostate cancer.

Prostate-specific antigen (PSA) testing of men at normal risk of prostate cancer is one of the most contested issues in cancer screening. There is no formal screening program, but testing is common - arguably a practice that ran ahead of the evidence. Public and professional communication about PSA screening has been highly varied and potentially confusing for practitioners and patients alike. There has been much research and policy activity relating to PSA testing in recent years. Landmark randomised controlled trials have been reported; authorities - including the 2013 Prostate Cancer World Congress, the Prostate Cancer Foundation of Australia, Cancer Council Australia, and the National Health and Medical Research Council - have made or endorsed public statements and/or issued clinical practice guidelines; and the US Preventive Services Task Force is revising its recommendations. But disagreement continues. The contention is partly over what the new evidence means. It is also a result of different valuing and prioritisation of outcomes that are hard to compare: prostate cancer deaths prevented (a small and disputed number); prevention of metastatic disease (somewhat more common); and side-effects of treatment such as incontinence, impotence and bowel trouble (more common again). A sizeable proportion of men diagnosed through PSA testing (somewhere between 20% and 50%) would never have had prostate cancer symptoms sufficient to prompt investigation; many of these men are older, with competing comorbidities. It is a complex picture. Below are four viewpoints from expert participants in the evolving debate, commissioned for this cancer screening themed issue of Public Health Research & Practice. We asked the authors to respond to the challenge of PSA testing of asymptomatic, normal-risk men. They raise important considerations: uncertainty, harms, the trustworthiness and interpretation of the evidence, cost (e.g. of using multiparametric magnetic resonance imaging to triage patients with elevated PSA), a likely bias towards intervention (particularly for cancer), and the potential to limit harm by treating more conservatively (although this may not occur consistently). They provide important insights, and disagree on some issues, but generally concur that men should decide for themselves whether to be tested. It seems reasonable to support men's autonomy to make their own decisions based on their own values. However, the support men might require to decide is likely to be considerable, and this needs to be taken seriously in policy making.

Known susceptibility SNPs for sporadic prostate cancer show a similar association with "hereditary" prostate cancer.

BackgroundMore than 70 single nucleotide polymorphisms (SNPs) have been reported to be associated with prostate cancer (PC) risk; these were mainly identified in the general population with predominantly sporadic PC (SPC). Previous studies have suggested similar associations between a selection of these SNPs and hereditary PC (HPC). Our aim was to evaluate the effect of all known PC risk SNPs and their discriminative value for SPC and HPC.MethodsSeventy‐four PC susceptibility SNPs (reported in literature up to June 2014) were genotyped in a population‐based series of 620 SPC patients, 312 HPC patients from the national Dutch registry and 1819 population‐based referents. Association analyses were performed using logistic regression, focusing on directional consistency of the odds ratios (ORs) with those in the original reports, that is, whether the OR was in the same direction as in the original report. Discriminative performance was evaluated by a genetic risk score used in logistic regression and receiver operating characteristic (ROC) curve analyses.ResultsDirectional consistency was seen for 62 SNPs in SPC and 64 SNPs in HPC, 56 of which overlapped. ORs were mostly higher for HPC with 22 ORs >1.25 versus 5 for SPC. Discriminative performance was better for HPC with an area under the ROC curve of 0.73 versus 0.64 for SPC.ConclusionsA large overlap was found for the associations between low‐penetrance susceptibility SNPs and SPC and HPC, suggesting a similarity in genetic etiology. This warrants a reconsideration of “HPC” and a restrictive policy toward prostate‐specific antigen testing in men with a positive family history. Genetic risk scores might be used for PC risk stratification on the population level. Prostate 75: 474–483, 2015 © 2014 The Authors. The Prostate published by Wiley Periodicals, Inc.

Association of sociodemographic factors and prostate-specific antigen (PSA) testing

ObjectivesThere are conflicting recommendations regarding the use of prostate specific antigen (PSA) as a screening test. Integral to this debate is an understanding of who is currently being tested. The purpose of this study was to provide a detailed account of PSA testing practices in a major Canadian city (Calgary, Alberta) and to identify variables that may affect access to the PSA test. Design and methodsPSA test counts were retrieved from Calgary Laboratory Services' Laboratory Information System from January 1, 2011 to December 31, 2011. A total of 75,914 individual PSA tests were included in our analysis. The frequency of PSA testing was plotted onto a dissemination area map of Calgary using ArcGIS software. Associations with sociodemographic variables were tested using Poisson regression. ResultsThe median PSA value was 0.93μg/L and the median age at collection was 58years. Forty-three percent of men aged 60–69 received a PSA test. Visible minority status ‘Black’ (P=0.0002) and Métis status (P=0.0075) were associated with lower PSA testing frequencies, while median household income (P=<0.0001) and university education (P=<0.0001) were associated with higher PSA testing frequencies. ConclusionThere are areas in Calgary which are significantly over or under tested relative to the mean. The amount of PSA testing in men <50years of age is increasing, which is contrary to PSA testing guidelines.

Population-based assessment of prostate-specific antigen testing for prostate cancer in the elderly

ObjectivesTo perform a population-based analysis to characterize the effect of prostate-specific antigen (PSA) testing on oncologic outcomes in men diagnosed with prostate cancer. Materials and methodsWe used the Surveillance, Epidemiology, and End Results–Medicare–linked data to identify 98,883 men diagnosed with prostate cancer from 1996 to 2007. We stratified frequency of PSA testing as none, 1 to 2, 3 to 5, and≥6 tests in the 5 years before prostate cancer diagnosis. We used propensity scoring methods to assess the effect of frequency of PSA testing on likelihood of (1) metastases at diagnosis and (2) overall mortality and prostate cancer–specific mortality. ResultsIn adjusted analyses, the likelihood of being diagnosed with metastatic prostate cancer decreased with greater frequency of PSA testing (none, 10.6; 1–2, 8.3; 3–5, 3.7; and≥6, 2.5 events per 100 person years, P<0.001). Additionally, greater frequency of PSA testing was associated with improved overall survival and prostate cancer–specific survival (P<0.001 for both). ConclusionsGreater frequency of PSA testing in men 70 years of age or older in the 5 years before prostate cancer diagnosis is associated with lower likelihood of being diagnosed with metastatic prostate cancer and improved overall and prostate cancer–specific survival.

Discrepancies between guidelines and clinical practice regarding prostate-specific antigen testing

Most guidelines recommend a judicious use of prostate-specific antigen (PSA) testing, whereas in daily practice, an increase of the incidence of PSA testing has been shown. Accurate up-to-date PSA test incidence rates are, however, lacking. To investigate the PSA test incidence rates in general practices over the past 10 years and to study which factors are associated with more frequent test use. We performed a retrospective cohort study using the routine health care database of the Julius General Practitioners Network from 2002 to 2011, of which data were available from more than 65 000 male patients. We calculated the annual incidence of PSA testing rates per 1000 person-years. Co-morbidities were analysed by means of International Classification of Primary Care codes. Relative risks (RRs) of having a PSA test were estimated as the ratio of observed rates of co-morbidities in men who underwent the test compared with a control group, and 95% confidence intervals (CI) were calculated. From 2002 to 2011, the overall incidence rate of PSA testing in men ≥45 years increased almost 4-fold, from 15.5 to 54.3 per 1000 person-years. As from 2005, the incidence rates appear to increase more than those before 2005. Men with cardiovascular diseases, joint disorders, psychiatric diseases, respiratory diseases, overweight and diabetes mellitus were predisposed to undergo a PSA test, but men with urinary problems had the highest relative risk (RR 1.77, 95% CI 1.72-1.82). From 2002 to 2011, PSA incidence testing rates increased, particularly in men with urinary symptoms and cardiovascular disease, despite several international guidelines that suggest a judicious use of PSA tests.

Prostate-Specific Antigen Testing in Men Aged 40-64 Years: Impact of Publication of Clinical Trials

We assessed the impact of the publication of trials and changes in recommendations on the rates of prostate-specific antigen (PSA) screening in men aged 40 to 64 years by analyzing monthly medical claims for PSA testing in a commercial insurance database from 2001 to 2011, covering more than 1.5 million men in each year. The testing rates for men aged 40 to 49 years, 50 to 59 years, and 60 to 64 years were 12.1%, 32.7%, and 42.7%, respectively, in 2001 vs 15.7%, 34.2%, and 42.0%, respectively, in 2011. Men aged 40 to 49 years experienced a gradual increase in testing rate from 2001 through 2008 (annual change in PSA testing per 10,000 men [AC] = 4.37; P < .001), which became flat from mid-2009 through 2011(AC = -0.06; P =.98). The slope of PSA testing rates did not change in men aged 50 to 59 years or 60 to 64 years with the publication of the results of the large trials in 2009 or with the subsequent changes in recommendations on PSA testing.

Screening for prostate cancer in New Zealand general practice

To ascertain the rates and patterns of prostate-specific antigen (PSA) screening in New Zealand men. The study population included 35,958 men aged 40+ years, with no prior diagnosis of prostate cancer, enrolled in 31 general practices in the Midland Cancer Network Region of New Zealand in 2010. Computerized practice records were searched for information, including reasons for testing, for men with elevated PSA test results in 2010. PSA results for 2007-2010 were obtained from community laboratories. Screened men were identified and screening rates calculated by age. Of 9344 men who underwent one or more PSA tests in 2010, 84.9% were classified as having been screened. The overall screening rate was 22.1%, with 24.4% of men aged 70+ years screened. Elevated PSA levels were found in 2.1% of screened men. Of the men screened in 2010, 57.3% had had a screening test in the previous three years. General practitioners in New Zealand commonly screen men (including those aged 70+) for prostate cancer, despite the lack of trial evidence that these men would benefit from screening. The value of annual PSA testing in men with previous normal PSA levels is unproven. Longer intervals between tests would be appropriate.

Screening for prostate cancer with prostate-specific antigen testing: American Society of Clinical Oncology Provisional Clinical Opinion.

An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to the ASCO membership after publication or presentation of potentially practice-changing data from major studies. This PCO addresses the role of prostate-specific antigen (PSA) testing in the screening of men for prostate cancer. Prostate cancer is the second leading cause of cancer deaths among men in the United States. The rationale for screening men for prostate cancer is the potential to reduce the risk of death through early detection. Evidence from a 2011 Agency for Healthcare Research and Quality systematic review primarily informs this PCO on the benefits and harms of PSA-based screening. An update search was conducted to March 16, 2012, for additional evidence related to the topic. In one randomized trial, PSA testing in men who would not otherwise have been screened resulted in reduced death rates from prostate cancer, but it is uncertain whether the size of the effect was worth the harms associated with screening and subsequent unnecessary treatment. Although there are limitations to the existing data, there is evidence to suggest that men with longer life expectancy may benefit from PSA testing. Adverse events associated with prostate biopsy are low for the majority of men; however, several population-based studies have shown increasing rates of infectious complications after prostate biopsy, which is a concern.