PSA-based Prostate Cancer Screening Research Articles

PSAscreening and molecular markers

Prostate cancer (PCA) is the most common type of cancer in men. The significant increase in incidence is most likely caused by the overdiagnosis of prostate cancer by widespread prostate-specific antigen (PSA) screening. This article reviews the three largest randomized trials of PSA-based prostate cancer screening and the benefits and disadvantages of general PSA screening. It gives an overview about the strategies to avoid the harms from overdetection and overtreatment without missing clinically relevant tumors. This review article is based on aliterature search in the PubMed database on PSA-based screening, molecular serum markers and risk-adapted PSA screening. In contrast to the CAP and PLCO trial, the ERSPC study reports areduced relative and absolute mortality risk. Furthermore, the use of the PSA was associated with significantly lower risk of metastatic disease. In order to avoid unnecessary biopsy and overtreatment including treatment of insignificant prostate cancer, anumber of tests have been proposed to improve the specificity of the PSA screening including the PHI, the 4Kscore and the risk-adapted PSA screening. The assessment of a baseline PSA level in the fifth decade allows subsequent risk-adapted PSA screening intervals. This concept is currently evaluated by the largest prospective multicenter trial, the PROBASE-trial. Neither acomplete rejection of aPSA-based screening nor ageneral PSA testing is afinal solution to this dilemma. Arisk-adapted PSA screening according to abaseline PSA as well as serum markers may reduce unnecessary diagnostic and therapeutic interventions and its attendant morbidities without adecrease in sensitivity.

Changing physician PSA screening behavior in men 70 years of age and older by use of the electronic medical record.

85 Background: Since 2013, both the United States Preventive Services Task Force and the Kaiser Permanente National Prostate Cancer Guidelines have recommended against PSA-based screening for prostate cancer in men ≥70 years of age. Adherence to these guidelines has been variable. A “Best Practice Alert” (BPA) was activated in the electronic medical record (EMR) system in October 2015 at Kaiser Permanente Northern California (KPNC). This alerted physicians, in real time, if they attempted to order a PSA test in a man ≥70 years of age with no history of prostate cancer. No additional physician training or education was used. The objective of the present study was to determine the impact of this BPA on the frequency of inappropriate PSA testing. Methods: This was a retrospective study spanning the years 2013 to 2017, in men ≥70 years of age in KPNC with no prior history of prostate cancer. We compared the annual rates of PSA testing between the pre-BPA period, 2013 and 2014; and the post-BPA period , 2016 and 2017 (the post-BPA period began 3 months after the BPA was instituted). The primary outcome was the annual rate of PSA testing. The percent change between the two time periods, the rate ratio and 95% confidence interval (CI) were calculated. Results: The annual number of eligible men (men ≥70 years of age and no history of prostate cancer) and annual number of these men undergoing PSA testing are shown in the Table. Annual screening rates declined from 34.3% in the pre-BPA era to 13.5% in the post BPA era. The rate ratio was 0.394 (95% CI, 0.390-0.398). Conclusions: Following the activation of a simple and inexpensive BPA within the EMR, the rate of inappropriate PSA testing decreased 61% in men ≥70 years of age. This change was durable over the study period, demonstrating that well-conceived, straightforward interventions can have a marked effect on physician behavior. [Table: see text]

Reducing overuse of PSA screening in primary care practices.

37 Background: The United States Preventive Services Task Force and the American Urological Association both recommend against routine PSA-based screening for prostate cancer in men 70 years and older and, for men younger than 70, recommend shared-decision making to discuss the potential benefits and harms of screening before a PSA is ordered. The HIT-OVERUSE study was a 2 year group randomized study from August 2016 thru July 2018 to test a practice-based intervention to reduce overuse in primary care practices, including avoidance of routine PSA screening without shared decision-making. The purpose of this report is present the impact of this intervention on PSA screening. Methods: Twenty one primary care practices in 19 states volunteered to participate in the study. Prior to randomization, all providers received academic detailing on prostate cancer screening recommendations. Eleven practices randomized to the intervention group then received quarterly performance reports, hosted site visits for participatory planning and sent two practice representatives to a one day meeting to share ‘best practices’. The ten control practices only received performance reports. Changes in PSA testing in the past year (excluding patients with prostate cancer) were compared in control and intervention practices. Results: At the patient level, there was a significantly larger unadjusted reduction in PSA screening in men ages 40 to 69 in the past year between intervention practices (28.6 % to 19.0%) and control practices (16.5% to 12.7%) (p<0.0001). There was also a significantly larger unadjusted reduction in PSA screening in men ages 70 and older in the past year between intervention practices (25.7% to 14.7%) and control practices (21.9% to 15.6%) (p<0.0001). Adjusted changes will also be presented. Conclusions: A practice-based intervention to reduce routine PSA-screening performed without shared decision-making resulted in a greater reduction in PSA screening compared to provision of academic detailing alone. Further research could elucidate whether this type of intervention results in increased shared decision-making conversations with patients.

Creating a potential diagnostic for prostate cancer risk stratification (InformMDx™) by translating novel scientific discoveries concerning cAMP degrading phosphodiesterase-4D7 (PDE4D7).

Increased PSA-based screening for prostate cancer has resulted in a growing number of diagnosed cases. However, around half of these are 'indolent', neither metastasizing nor leading to disease specific death. Treating non-progressing tumours with invasive therapies is currently regarded as unnecessary over-treatment with patients being considered for conservative regimens, such as active surveillance (AS). However, this raises both compliance and protocol issues. Great clinical benefit could accrue from a biomarker able to predict long-term patient outcome accurately at the time of biopsy and initial diagnosis. Here we delineate the translation of a laboratory discovery through to the precision development of a clinically validated, novel prognostic biomarker assay (InformMDx™). This centres on determining transcript levels for phosphodiesterase-4D7 (PDE4D7), an enzyme that breaks down cyclic AMP, a signalling molecule intimately connected with proliferation and androgen receptor function. Quantifiable detection of PDE4D7 mRNA transcripts informs on the longitudinal outcome of post-surgical disease progression. The risk of post-surgical progression increases steeply for patients with very low 'PDE4D7 scores', while risk decreases markedly for those patients with very high 'PDE4D7 scores'. Combining clinical risk variables, such as the Gleason or CAPRA (Cancer of the Prostate Risk Assessment) score, with the 'PDE4D7 score' further enhances the prognostic power of this personalized, precision assessment. Thus the 'PDE4D7 score' has the potential to define, more effectively, appropriate medical intervention/AS strategies for individual prostate cancer patients.

The ERSPC Study: Quality Takes Time and Perseverance.

Featured Article: Schroder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009:360:1320–8.4 Although it might sound unrealistic today, historically, a diagnosis of prostate cancer (PCa)5 often meant suffering from metastatic disease and death (1). In 1991, W. J. Catalona et al. published a study on the usefulness of the prostate-specific antigen (PSA) test in the detection and staging of PCa (2), opening the doorway to early detection. In 1990, Professor Catalona came to visit Professor F. H. Schroder at the Department of Urology of the Erasmus Medical Center in Rotterdam, the Netherlands. Inspired by the scientific discussions from this visit, Schroder reached out to his colleague from the European Organization for Research and Treatment of Cancer, Professor L. J. Denis in Antwerp, Belgium. They decided to work out a plan for a European randomized PSA-based PCa screening trial to answer the following question: Does regular PSA screening, compared to no screening, reduce PCa mortality? M. J. Roobol started working in Rotterdam in 1991 to set up a pilot study to assess the logistics needed for such a trial. …

Clinical Issues for Prostate-Specific Antigen Screening: A Narrative Review

Prostate cancer, with its remarkably high prevalence, frequently creates clinical problems in terms of screening and diagnosis, as well as identifying the optimal window for treatment. Moreover, the prostate-specific antigen (PSA) blood test, despite being easy to perform, is routinely carried out without the patient’s informed consent. Although PSA-based screening for prostate cancer can reduce cancer-specific mortality, informed decision-making is mandatory; however, the clinician’s daily routine often neglects this critical discussion before performing a PSA blood test. This narrative review discusses the main questions regarding PSA screening and provides information on the epidemiological, clinical, and pathological aspects of prostate cancer.

Prostate cancer screening: controversies and suggested solutions

Prostate cancer is the most common cancer among men in industrialized countries. The annual incidence rate in Germany is about 60,000. Every year, 13,000 men die of this disease. Nevertheless, the 10-year survival rate is relatively favorable compared to other carcinomas.Prostate cancer screening is discussed controversially both nationally and internationally. This is due to the fact that the determination of the prostate-specific antigen (PSA) for tumor detection beginning in the 1980s led to over-diagnosis of clinically insignificant prostate cancer and consequently to over-therapy-usually by radical prostatectomy or radiotherapy.This review article will discuss the largest randomized controlled trials of PSA-based prostate cancer screening to date. It will highlight the advantages and disadvantages of this screening and give an outlook on the development of future strategies for prostate cancer screening.For PSA screening, the European Randomized Study for Screening of Prostate Cancer (ERSPC) study showed arelative reduction in prostate cancer-specific mortality of approximately 21% after amedian follow-up period of 13years. However, in absolute figures, relatively few men will benefit from population-based screening and the rate of over-diagnosed men remains high.The procedure in aSwedish long-term study, in which risk-adapted screening intervals were applied on the basis of the assessment of abaseline PSA level at ayoung age (40-50) showed promising results and may provide asolution to this dilemma. This strategy is the basis for the currently largest study on risk-adapted prostate cancer screening ( www.PROBASE.de ), which evaluates this concept for the first time with arandomized design.

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.

Changes in the outcome of prostate biopsies after preventive task force recommendation against prostate-specific antigen screening

BackgroundThe benefits of PSA-based screening for prostate cancer (PCa) are controversial. The Canadian and American Task Forces on Preventive Health Care (CTFPHC & USPSTF) have released recommendations against the use of routine PSA-based screening for any men. We thought to assess the impact of these recommendations on the outcomes and trends of prostate needle biopsies.MethodsA complete chart review was conducted for all men who received prostate needle biopsies at McGill University Health Center between 2010 and 2016. Of those, we included 1425 patients diagnosed with PCa for analysis. We Compared 2 groups of patients (pre and post recommendations’ release date) using Welch’s t-tests and Chi-square test. A multivariate logistic regression model was used to analyze variables predicting worse pathological outcomes.ResultsWhen the release date of the USPSTF draft (October 2011) was used as a cut-off, we found an average annual decrease of 10.6% in the total number of biopsies. The median (IQR) baseline PSA levels were higher in post-recommendations group (n = 977) when compared to pre-recommendations group (n = 448) [8 ng/ml (5.7–12.9) versus 6.4 ng/ml (4.9–10.1), respectively. P = 0.0007]. Also, post-recommendations group’s patients had higher Gleason score (G7: 35.4% versus 28.4% and G8-G10: 31.2% versus 18.1%, respectively. P < 0.0001). Moreover, they had higher intermediate and high-risk PCa classification (36.4% versus 32.8% and 35.5% versus 22.1%, respectively. P < 0.0001). The recommendations release date was an independent variable associated with higher Gleason score in prostate biopsies (OR: 2.006, 95%CI: 1.477–2.725). Using the CTFPHC recommendations release date (October 2014) as a cut-off in further analysis, revealed similar results.ConclusionsOur results revealed a reduction in the number of prostate needle biopsies performed over time after the recommendations of the preventive task forces. Furthermore, it showed a significant relative increase in the higher risk PCa diagnosis. The oncological outcomes associated with this trend need to be examined in further studies.

Unintended consequences of decreased PSA-based prostate cancer screening.

In May 2012, the US Preventive Services Task Force issued a grade D recommendation against PSA-based prostate cancer screening. Epidemiologists have concerns that an unintended consequence is a problematic increase in high-risk disease and subsequent prostate cancer-specific mortality. To assess the effect of decreased PSA screening on the presentation of high-risk prostate cancer post-radical prostatectomy (RP). Nine high-volume referral centers throughout the United States (n = 19,602) from October 2008 through September 2016 were assessed and absolute number of men presenting with GS ≥ 8, seminal vesicle and lymph node invasion were compared with propensity score matching. Compared to the 4-year average pre-(Oct. 2008-Sept. 2012) versus post-(Oct. 2012-Sept. 2016) recommendation, a 22.6% reduction in surgical volume and increases in median PSA (5.1-5.8ng/mL) and mean age (60.8-62.0years) were observed. The proportion of low-grade GS 3 + 3 cancers decreased significantly (30.2-17.1%) while high-grade GS 8 + cancers increased (8.4-13.5%). There was a 24% increase in absolute numbers of GS 8+ cancers. One-year biochemical recurrence rose from 6.2 to 17.5%. To discern whether increases in high-risk disease were due to referral patterns, propensity score matching was performed. Forest plots of odds ratios adjusted for age and PSA showed significant increases in pathologic stage, grade, and lymph node involvement. All centers experienced consistent decreases of low-grade disease and absolute increases in intermediate and high-risk cancer. For any given age and PSA, propensity matching demonstrates more aggressive disease in the post-recommendation era.

Cost implications of PSA screening differ by age

BackgroundMultiple guidelines seek to alter rates of prostate-specific antigen (PSA)-based prostate cancer screening. The costs borne by payers associated with PSA-based screening for men of different age groups—including the costs of screening and subsequent diagnosis, treatment, and adverse events—remain uncertain. We sought to develop a model of PSA costs that could be used by payers and health care systems to inform cost considerations under a range of different scenarios.MethodsWe determined the prevalence of PSA screening among men aged 50 and higher using 2013-2014 data from a large, multispecialty group, obtained reimbursed costs associated with screening, diagnosis, and treatment from a commercial health plan, and identified transition probabilities for biopsy, diagnosis, treatment, and complications from the literature to generate a cost model. We estimated annual total costs for groups of men ages 50-54, 55-69, and 70+ years, and varied annual prostate cancer screening prevalence in each group from 5 to 50% and tested hypothetical examples of different test characteristics (e.g., true/false positive rate).ResultsUnder the baseline screening patterns, costs of the PSA screening represented 10.1% of the total costs; costs of biopsies and associated complications were 23.3% of total costs; and, although only 0.3% of all screen eligible patients were treated, they accounted for 66.7% of total costs. For each 5-percentage point decrease in PSA screening among men aged 70 and older for a single calendar year, total costs associated with prostate cancer screening decreased by 13.8%. For each 5-percentage point decrease in PSA screening among men 50-54 and 55-69 years old, costs were 2.3% and 7.3% lower respectively.ConclusionsWith constrained financial resources and with national pressure to decrease use of clinically unnecessary PSA-based prostate cancer screening, there is an opportunity for cost savings, especially by focusing on the downstream costs disproportionately associated with screening men 70 and older.

Unintended consequences of decreased PSA-based prostate cancer screening

Unintended consequences of decreased PSA-based prostate cancer screening

Impact of 2012 USPSTF prostate cancer screening recommendations on prostate cancer detection and presentation at Kaiser Permanente Northern California (KPNC).

37 Background: In 2012, the USPSTF gave a “D” grade to PSA-based prostate cancer screening stating “the benefits of PSA-based screening for prostate cancer do not outweigh the harms”. The impact on prostate cancer screening, detection and presentation are unknown. Methods: A retrospective cohort design encompassing the years 2010 to 2015. In screen-eligible, KPNC members (African American men ages 45-69 and all other men ages 50-69), the annual rates of PSA testing, prostate biopsy and the grade and stage of all prostate cancers at presentation were compared between the pre-guideline period, 2010/2011; and the post-guideline period , 2014/2015. Results: The rate of screening declined substantially from the pre-guideline period to the post-guideline period, from a rate of 42.7% of eligible men screened per year during 2010/2011 to a rate of 32.5% of eligible men screened per year during 2014/2015; the relative rate and 95% confidence interval (CI) was 0.762 (0.759-0.765). Comparing the same time periods, the rates of prostate biopsy and overall prostate cancer detection declined even more sharply, with relative rates of 0.391 (95%CI 0.375-0.407) and 0.455 (95%CI 0.436-0.475) respectively. There was a modest increase in the rate of metastatic disease between these two time periods, with a relative rate of 1.29 (95%CI 1.11-1.48). Conclusions: Following the 2012 USPSTF statement, significant declines in PSA testing, prostate biopsy and overall cancer detection rates were seen along with a significant increase in the rate of patients presenting with metastatic disease. [Table: see text]

Changes observed in prostate biopsy practices in an inner city hospital with a high risk patient population following the 2012 uspstf psa screening recommendations.

ABSTRACTIntroduction:We compared characteristics of patients undergoing prostate biopsy in a high-risk inner city population before and after the 2012 USPSTF recommendation against PSA based prostate cancer screening to determine its effect on prostate biopsy practices.Materials and Methods:This was a retrospective study including patients who received biopsies after an abnormal PSA measurement from October 2008-December 2015. Patients with previously diagnosed prostate cancer were excluded. Chi-square tests of independence, two sample t-tests, Mann-Whitney U tests, and Fisher's exact tests were performed.Results:There were 202 and 208 patients in the pre-USPSTF and post-USPSTF recommendation cohorts, respectively. The post-USPSTF cohort had higher median PSA (7.8 versus 7.1ng/mL, p=0.05), greater proportion of patients who were black (96.6% versus 90.5%, p=0.01), and greater percentage of biopsy cores positive for disease (58% versus 29.5%, p<0.001). Multivariable analysis supported that the increase in PSA was independent of the increase in the proportion of patients who were black. The proportion of patients who were classified as D’Amico intermediate and high-risk disease increased in the post-USPSTF cohort and approached statistical significance (70.1% versus 58.8%, p=0.12).Conclusions:Our study suggests that the USPSTF recommendations may have led to an increase in pre-biopsy PSA as well as greater volume of disease. Also, a greater proportion of patients were being classified with intermediate or high risk disease. While the clinical significance of these findings is unknown, what the data suggests is somewhat troubling. Future research should further examine these changes in a larger cohort as well as resultant long-term outcomes.

Determination of an optimum cut-off point for %fPSA/tPSA to improve detection of prostate cancer

Background: Total serum prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) are known to be useful in the detection of prostate carcinoma (PCa). It has been reported that %fPSA/tPSA is more accurate when it comes to distinguishing PCa from non-malignant conditions such as BPH. The recommended cut-off value of %fPSA/tPSA in western countries is 20-25%. Through this study, we aim to determine an optimum cut-off value for %fPSA/tPSA in an Indian population. Methods: This study was performed at our institution between September 2015 and August 2016. The study population included 181 patients who had prostate enlargement and who then underwent PSA based prostate cancer screening with tPSA and %fPSA/tPSA and whose diagnosis was later confirmed by histopathology. An ROC curve analysis was performed to determine sensitivity, specificity and other performance characteristics. The optimum cut-off value of %fPSA/tPSA was determined from ROC curve using Youden’s index. Result: Malignant histology was seen in 17 (9.4%) cases. ROC curve analysis of %fPSA/tPSA revealed an AUC value of 0.777. The cut-off value of %fPSA/tPSA having the optimum balance between sensitivity and specificity was found to be 12.07% (Sensitivity: 70.6%, Specificity: 84.8%, Positive predictive value: 0.324, Negative predictive value: 0.965, Positive likelihood ratio: 4.631 and Negative likelihood ratio: 0.347). Conclusion: The cut-off value of %fPSA/tPSA obtained from our study (12.07%), which was conducted on a South Indian population, is different from the cut-off values seen in western countries and in many studies conducted in western populations. DOI: 10.21276/APALM.1254

Revisiting Prostate Cancer Screening Practices Among Vermont Primary Care Physicians.

The objective of this study was to assess the prostate cancer screening practices of Vermont primary care physicians and compare them with a prior study in 2001. An electronic survey was created and emailed to all currently practicing primary care physicians in Vermont. Data was stratified by practice length, practice location, university affiliation, and internal medicine versus family practice. Surveys were received from 123 (27.2%) primary care physicians. 27.7% of physicians in practice <10years recommended prostate specific antigen (PSA) testing, compared with 55.9% of those practicing ≥10years (p = 0.006). Of those who modified their recommendations in the past 5years, 96.1% reported that the United States Preventive Services Task Force (USPSTF) 2012 statement influenced them. Respondents who continued to use PSA testing were less likely to stop screening after age 80 compared with those surveyed in 2001 (51% in 2014 vs. 74% in 2001; p <0.001). Primary care physicians in practice for 10 or more years were more likely to recommend PSA-based screening than those in practice for less time. The USPSTF statement discouraging PSA-based screening for prostate cancer has had significant penetrance among Vermont primary care physicians.

A randomized trial of early detection of clinically significant prostate cancer (ProScreen): study design and rationale.

The current evidence of PSA-based prostate cancer screening shows a reduction in cause-specific mortality, but with substantial overdiagnosis. Recently, new developments in detection of clinically relevant prostate cancer include multiplekallikreins as biomarkers besides PSA, and multiparametric magnetic resonance imaging (mpMRI) for biopsy decision. They offer opportunities for improving the outcomes in screening, particularly reduction in overdiagnosis and higher specificity for potentially lethal cancer. A population-based randomized screening trial will be started, with 67,000 men aged 55-67years at entry. A quarter of the men will be allocated to the intervention arm, and invited to screening. The control arm will receive no intervention. All men in the screening arm will be offered a serum PSA determination. Those with PSA of 3ng/ml or higher will have an additional multi-kallikrein panel and those with indications of increased risk of clinically relevant prostate cancer will undergo mpMRI. Men with a malignancy-suspect finding in MRI are referred to targeted biopsies. Screening interval is 6years for men with baseline PSA<1.5ng/ml, 4years with PSA 1.5-3.0 and 2years if initial PSA>3. The main outcome of the trial is prostate cancer mortality, with analysis at 10 and 15years. The statistical power is sufficient for detecting a 28% reduction at 10years and 22% at 15years. The proposed study has the potential to provide the evidence to justify screening as a public health policy if mortality benefit can be sustained with substantially reduced overdiagnosis.

PD03-09 RISING INCIDENCE OF METASTATIC PROSTATE CANCER IN CALIFORNIA, 1988-2014

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2017PD03-09 RISING INCIDENCE OF METASTATIC PROSTATE CANCER IN CALIFORNIA, 1988-2014 Marc Dall'Era, Ralph Devere White, Danielle Rodriguez, and Rosemary Cress Marc Dall'EraMarc Dall'Era More articles by this author , Ralph Devere WhiteRalph Devere White More articles by this author , Danielle RodriguezDanielle Rodriguez More articles by this author , and Rosemary CressRosemary Cress More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.215AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Early detection of prostate cancer with PSA based screening can reduce the risk of prostate cancer mortality by 21%. Screening for prostate cancer has dramatically declined in the United States since the United States Preventive Services Task Force (USPSTF) recommended against routine PSA based prostate cancer screening for all men in 2012. This led to dramatic reductions in the diagnosis of localized disease across all clinical risk groups. We sought to study trends in newly diagnosed metastatic prostate cancer incidence, specifically the impact of patient age and race. METHODS We analyzed new prostate cancer incidence by stage at diagnosis between 1988-2014 using data from the California Cancer Registry. We further stratified cases by age and four major race/ethnicity groups (non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic and non-Hispanic Asian/PI (API)). Incidence rates per 100,000 were age-adjusted to the 2000 US Standard Population. Joinpoint regression was used to detect changes in incidence and to calculate the average percent change (APC) over time. Joinpoint finds the best fit model with the smallest number of joinpoints and will not add an additional joinpoint if it does not make significant improvement on the model. RESULTS Adjusted rates of remote prostate cancer incidence for men of all races aged 65-74 and NHW men of all ages significantly increased over the most recent time period by 2.4% and 1%, respectively, p<0.05 (Figure 1 and 2). In contrast, incidence of remote prostate cancer continued to decline for NHB (-2.42%), Hispanic (-1.94%), and API (-1.66%) men. Localized disease incidence continues to decline significantly for all age and racial groups. CONCLUSIONS Incidence rates of newly metastatic prostate cancer have significantly increased for the first time in California for men aged 65-74 and white men. Although not possible to determine the etiology of these findings, decreased PSA screening and early detection of aggressive as well as indolent tumors is likely to contribute. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e60 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Marc Dall'Era More articles by this author Ralph Devere White More articles by this author Danielle Rodriguez More articles by this author Rosemary Cress More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD58-12 PSA SCREENING AT THE INTERSECTION OF POLITICS AND POLICY

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety I1 Apr 2017PD58-12 PSA SCREENING AT THE INTERSECTION OF POLITICS AND POLICY Jesse Sammon, Emily Serrel, Malte Vetterlein, Patrick Karabon, Gregory Mills, Moritz Hansen, Mani Menon, Quoc-Dien Trinh, and Firas Abdollah Jesse SammonJesse Sammon More articles by this author , Emily SerrelEmily Serrel More articles by this author , Malte VetterleinMalte Vetterlein More articles by this author , Patrick KarabonPatrick Karabon More articles by this author , Gregory MillsGregory Mills More articles by this author , Moritz HansenMoritz Hansen More articles by this author , Mani MenonMani Menon More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2627AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The implementation of health care policy in the U.S. may be impacted by conflicting political philosophies. A ″conservative″ view of health care emphasizes an individual′s right to self-determination, while a ″liberal″ view holds that government can effectively utilize strategies to balance the needs of the community with those of an individual. Federal screening guidelines promoting population health may be perceived to conflict with conservative values. The aim of this study was to assess the inter-relationship of a states percentage of ″conservative″ men and the impact that the 2012 USPSTF recommendation against PSA-based prostate cancer (PCa) screening on screening probability. METHODS Data from the 2012 and 2014 Behavioral Risk Factor Surveillance System was used to identify asymptomatic men (age ≥ 50) without PCa who reported PSA screening in the past 12 months. Odds ratios were determined by multivariate logistic regression analysis, adjusting for age, race, education, income, insurance, healthcare access, and marital status. The change in PSA screening rates were assessed as a function of the percentage of adults in a state describing themselves as ″conservative″ or ″very conservative″ in Gallup U.S. Daily (accessed 4/4/16). RESULTS Among 222,475 survey respondents, the prevalence of PSA screening decreased between 2012 and 2014 (OR=0.87, p<0.001; Fig 1a). In the most conservative states (upper tertile of self-described conservatives) screening prevalence was unchanged (OR=0.92, CI 0.84-1.00), and in the least conservative states (lowest tertile) there was a significant decline (OR=0.72, CI 0.64-0.81; Fig 1b).Up to 22% of the variation in PSA screening rates may be ascribed to a state′s dominant political leaning (coefficient of determination=0.22), a moderate and significant correlation (ρ= 0.47, P<0.001). CONCLUSIONS The changes in PSA screening rates appear to reflect the political divide in the U.S. Despite the 2012 USPSTF guideline and subsequent overall decrease in PSA screening, there was no decline in PSA screening in the most conservative states. This is a hypothesis-generating finding, as it is predicated on observational data that may be affected by other factors. Nonetheless, this finding suggests that a state′s dominant political ideology influences the implementation of federal health care screening policy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1132 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jesse Sammon More articles by this author Emily Serrel More articles by this author Malte Vetterlein More articles by this author Patrick Karabon More articles by this author Gregory Mills More articles by this author Moritz Hansen More articles by this author Mani Menon More articles by this author Quoc-Dien Trinh More articles by this author Firas Abdollah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

243 - Outcomes of PSA-based prostate cancer screening among men using non-steroidal anti-inflammatory drugs

243 - Outcomes of PSA-based prostate cancer screening among men using non-steroidal anti-inflammatory drugs