PSA Screening For Prostate Cancer Research Articles

Outcomes of 10 years of PSA screening for prostate cancer in Norwegian men with Lynch syndrome.

Pathogenic germline variants in the mismatch repair (MMR) genes are associated with an increased risk of prostate cancer (PCa). Since 2010 we have recommended MMR carriers annual PSA testing from the age of 40. Prospective studies of the outcome of long-term PSA screening are lacking. This study aimed to investigate the incidence and characteristics of PCa in Norwegian MMR carriers attending annual PSA screening (PSA threshold >3.0 ng/mL) to evaluate whether our recommendations should be continued. This is a prospective observational study of 225 male MMR carriers who were recommended annual PSA screening by the Section of Inherited Cancer, Oslo University Hospital from 2010 and onwards. Incidence and tumor characteristics (age, PSA at diagnosis, Gleason score, TNM score) were described. IHC and MSI-analyses were done on available tumors. Standardized incidence ratio (SIR) was calculated based on data from the Cancer Registry of Norway. Twenty-two of 225 (9.8%) had been diagnosed with PCa, including 10/69 (14.5%) MSH2 carriers and 8/61 (13.1%) MSH6 carriers. Ten of 20 (50%) tumors had Gleason score ≥4 + 3 on biopsy and 6/11 (54.5%) had a pathological T3a/b stage. Eight of 17 (47.1%) tumors showed abnormal staining on IHC and 3/13 (23.1%) were MSI-high. SIR was 9.54 (95% CI 5.98-14.45) for all MMR genes, 13.0 (95% CI 6.23-23.9) for MSH2 and 13.74 for MSH6 (95% CI 5.93-27.08). Our results indicate that the MMR genes, and especially MSH2 and MSH6, are associated with a significant risk of PCa, and a high number of tumors show aggressive characteristics. While the impact of screening on patient outcomes remains to be more firmly established, the high SIR values we observe provide support for continued PSA screening of MSH2 and MSH6 carriers. Studies are needed to provide optimal recommendations for PSA-threshold and to evaluate whether MLH1 and PMS2 carriers should not be recommended screening.

Après-Ski: A Shout Out to Winter Sports-Themed Urologic Education

Après-Ski: A Shout Out to Winter Sports-Themed Urologic Education

Viscoelastic or Viscoplastic Glucose Theory (VGT #64): Estimated Risk Probability Percentages of Prostate Cancer and its Moving Trend over 12+ Years from 1/1/2010 to 4/18/2022 using Metabolism Index, Obesity, Diet, and Exercise as the 4 Influential Factors for Prostate Cancer Risk % Based on GH-Method: MathPhysical Medicine (No. 653)

Recently, a friend of the author died from prostate cancer and leukemia. This news caused the author to read a few published medical articles regarding prostate cancer. He then outlines some key information in the Introduction section. The selected information sources have been referenced within this section and will not be listed in the Reference section. “Prostate Cancer: (1) NIH: National Cancer Institute What is the PSA test? Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The PSA test measures the level of PSA in the blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood. The blood level of PSA is often elevated in people with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, FDA approved the PSA test to be used in conjunction with a digital rectal exam (DRE) to aid in the detection of prostate cancer in men 50 years and older. Until about 2008, many doctors and professional organizations had encouraged yearly PSA screening for prostate cancer beginning at age 50. What is a normal PSA test result? There is no specific normal or abnormal level of PSA in the blood. In the past, PSA levels of 4.0 ng/mL and lower were considered normal. However, some individuals with PSA levels below 4.0 ng/mL have prostate cancer and many with higher PSA levels between 4 and 10 ng/mL do not have prostate cancer (1). In addition, various factors can cause someone’s PSA level to fluctuate. For example, the PSA level tends to increase with age, prostate gland size, and inflammation or infection. A recent prostate biopsy will also increase the PSA level, as can ejaculation or vigorous exercise (such as cycling) in the 2 days before testing. Conversely, some drugs—including finasteride and dutasteride, which are used to treat BPH—lower the PSA level. In general, however, the higher a man’s PSA level, the more likely it is that he has prostate cancer. (The author’s note: due to insufficient PSA data collection, it is not included in this VGT analysis.)

Prostate-Specific Antigen Screening According to Health Professional Counseling and Age in the United States

Background In 2018, the US Preventive Services Task Force recommended that PSA screening for prostate cancer involve men aged 55–69, based on a personal decision following consultation with a health professional. PSA screening in men aged 70 or older should only occur if symptoms exist. This study identifies the association between having a PSA test in the past two years and whether or not there was consultation with a health professional about the benefits and/or harms of PSA screening. Methods Analyses were based on data involving men aged 40 years or older, who responded to PSA related questions in the 2018 BRFSS survey. Results Approximately 32.0% (14.6% for ages 40–54, 41.7% for ages 55–69, and 49.8% for ages 70 years and older) of respondents had a PSA test in the past two years. Approximately 81.7% of these men had talked with a health professional about the benefits and/or harms of PSA screening, with 42.4% having discussed the benefits and harms, 54.6% having discussed the benefits only, and 3.0% having discussed the harms only. The odds of a PSA test in the past two years in men having talked with a health professional about the benefits and harms of the test versus no talk are 10.1 (95% CI 9.3–10.8), in men who talked with a health professional about the benefits only versus no talk are 10.8 (95% CI 10.0–11.6), and in men who talked with a health professional about the harms only versus no talk are 3.9 (95% CI 2.9–5.1). Conclusion PSA screening is most common in men aged 70 or older, which is counter to the US Preventive Task Force recommendation. Most men having a PSA test have talked with a health professional about the test, but the talks tended to focus on just the benefits of screening and not both potential benefits and harms.

Abstract 774: Highly effective isolation of circulating tumor cells using lateral magnetophoretic technology for precise genetic analysis of prostate cancer

Abstract Introduction Prostate cancer is the second leading cancer among men in the world and known as the most frequently diagnosed cancer in more than half of countries with estimated 1.3 million new emerging cases. Because of low specificity of serum PSA screening for prostate cancer, it raised concerns in keep management of clinical prognosis and therapeutic decision and thereby, there are still needed precise real-time biomarkers. Many recent studies have reported that circulating tumor cells (CTCs) can be used as important biomarkers for prostate cancer at cellular and molecular levels. However, due to their extreme rarity in the circulatory system and the lack of technology to isolate them precisely, it is still difficult to isolate them with high purity and efficiency that can be applied for clinical purposes. In this study, we introduce a microfluidic technology using lateral magnetophoresis for isolating CTCs from blood of prostate cancer patients (n=62) with high purity and efficiency and demonstrate clinical usefulness of isolated CTCs at cellular and molecular levels. Materials and methods By the lateral magnetophoretic technology using immunomagnetic nanobeads, highly pure CTCs were isolated from 5 ml blood, drawn from patients with localized (n=25) and metastatic (n=37) prostate cancer. Then, prostate cancer related genes (AR, AR-V7, EpCAM, KRT-19, PSA and PSMA) were quantified by droplet digital PCR (ddPCR) method using mRNA in CTCs. Results and discussion CTCs were detected from all blood samples (n=62). In localized cases, the average number of isolated CTCs and purity were 6.58 per ml and 2.09%. In metastatic cases, the average number of isolated CTCs and purity were 27.55 per ml and 6.00%, higher than those of localized cases. Then, mRNA was extracted from isolated CTCs and used for detecting prostate cancer specific genes. Their detection rate and expression level were increased from localized to metastatic stages. AR was detected at a similar rate of 76.00% in both localized and mHSPC stages and increased to 100% in mCRPC stage. AR-V7 was detected only in metastatic stages, mainly in mCRPC stages. EpCAM showed the highest detection rate in all stages, such as 96.00% in localized, 88.89% in mHSPC and 100% in mCRPC. This result indicates that CTCs are isolated from all blood of patients. KRT-19 showed slightly lower detection rate than EpCAM, but tend to be similar to EpCAM expression for cancer stages. PSA and PSMA were expressed very high in metastatic stage. PSA expression level in metastatic stage was 198.28 times higher than that in localized stage. Interestingly, the expression of PSA mRNA measured from CTCs was linearly proportional to serum PSA protein level, which is a commonly used diagnostic biomarker for prostate cancer. Conclusions In all stages of prostate cancer patients, the proposed microfluidic technology using the lateral magnetophoresis is a high-performance method for isolating CTCs with high detection rate and purity that can be used for precision genetic analysis. Citation Format: Hyungseok Cho, Ki-Ho Han, Jae-Seung Chung. Highly effective isolation of circulating tumor cells using lateral magnetophoretic technology for precise genetic analysis of prostate cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 774.

MP75-02 STATE RURALITY DOES NOT INCREASE RISK OF PROSTATE CANCER DEATH

INTRODUCTION AND OBJECTIVE: Prostate cancer is the second most common cancer among men. It is the fifth leading cause of death amongst cancer. PSA based screening for prostate cancer was introduced in the 1980s and resulted in a significant decline in prostate cancer mortality. Current AUA guidelines recommend PSA screening in average risk patients between the ages of 55 and 69. There are public health concerns in rural areas of the United States potentially due to decreased access of care. In this study, we sought to evaluate the prevalence of prostate cancer screening and death rate in rural communities within the United States. METHODS: After IRB approval from our institution, data was collected from several different sources. Annual prostate cancer death rate from 2011-2015 was obtained from the American Cancer Society. Data from the Behavioral Risk Factor Surveillance System (BRFSS) regarding prostate cancer screening during this time interval was acquired. Data regarding populations (rural and urban), population race and socioeconomic status was obtained from the United States Census. Descriptive analyses were used to describe the population and Pearson Correlation Coefficient to determine screened, death rates and rurality correlations. All analyses were completed using SPSS. RESULTS: The median percent of United States population residing in rural and urban areas was 25.8% (12.5-34.6, IQR: 22.1%) and 73.8% (65.4-87.5, IQR: 22.1%), respectively. The median percent of male patients screened using PSA 50 years and older was 56.2% (52.4-59.4, IQR: 7.0%). The median death rate (per 100,000) from prostate cancer per state was 19.5 (18.8-20.5, IQR: 1.7%). Prostate cancer death rate was found to have no correlation to percent of population screened (p=0.29) and percent rurality (p=0.98). The percent rural population versus percent of screened men over the age of 50 was also not significant (p=0.20). CONCLUSIONS: Neither death rate due to prostate cancer nor screening rate for prostate cancer using PSA demonstrated a significant association with the percent of patient’s living in rural communities. This is evidence that within the United States, rural communities are following guidelines for PSA screening for prostate cancer and therefore there is no discrepancy in prostate cancer death in these areas compared to urban. This study is evidence that the barriers that may be associated with living in rural communities, such as decreased access to healthcare do not translate into worse outcomes related to prostate cancer. Source of Funding: None

Cancer Genomics for Oncologists: Cancer Risk and Management of BRCA1 and BRCA2 Carriers

The rise of routine integration of genetic testing into oncological pathways, through initiatives such as mainstream testing, is making it increasingly important for oncologists to understand more about the wider implications of inherited mutations in cancer susceptibility genes. This is vital to facilitate accurate information-giving by oncologists, taking informed consent for testing, and to ensure they are referring patients appropriately for risk reduction strategies such as screening. In this review, the most relevant information for oncologists discussing and consenting patients will be discussed. Kuchenbaecker et al. (JAMA 317(23):2402-2416, 2017) have provided updated risk estimates for BRCA1 and BRCA2 carriers, from a large meta-analysis of international cohorts. For those considering risk-reducing interventions, we have evidence now from the POSH study to suggest that those diagnosed < 40 years have a 12% risk of carrying a mutation, with no detrimental effect from undergoing risk-reducing surgery. The role of chemotherapy for BRCA carriers with breast cancer was further assessed in cohorts from The Netherlands, MSKCC and the GeparSixto studies, assessing both overall survival and breast cancer–specific survival. For those considering surgical intervention, Metcalfe et al. (JAMA oncology 1(3):306-313, 2015) reported a survival advantage in BRCA cancers diagnosed with breast cancer undergoing risk-reducing bilateral salpingo-oophorectomy (RRBSO). The use of ovarian screening for BRCA carriers continues to be investigated by Rosenthal et al. (J Clin Oncol 35(13):1411-1420, 2017), who reported phase II of the UK FOCSS study, looking at their CA-125 algorithm and trans-vaginal ultrasound scanning. Whilst there is still no reduction in mortality for ovarian cancer, the studies of PSA screening for prostate cancer in BRCA carriers look more promising from the IMPACT study. The role of inherited gene mutations in ovarian cancer susceptibility outside of BRCA and Lynch was assessed by Song et al. (J Clin Oncol 33(26):2901-2907, 2015) in two different studies, investigating the role of BRIP1, RAD51C, RAD51D, RAD51B, BARD1, PALB2 and NBN. They concluded a causative role can only be confirmed for RAD51C, RAD51D and BRIP1. Work continues on identifying the best way to find and test patients with germline genetic mutations, and the best way to manage carriers. These studies provide updated information on risk and the screening and management of individuals carrying these mutations to ensure they receive optimal care stratified by genetic risk.

State rurality does not increase risk of prostate cancer death.

119 Background: Prostate cancer is the third most common cancer among men. PSA based screening for prostate cancer was introduced in the 1980s and resulted in a significant decline in prostate cancer mortality. Current AUA guidelines recommend PSA screening in average risk patients between the ages of 55 and 69. There are public health concerns in rural areas of the United States (US) potentially due to decreased access of care. In this study, we sought to evaluate the prevalence of prostate cancer screening and death rate in rural communities within the US. Methods: After IRB approval, data was collected from several different sources. Annual prostate cancer death rate (2011-2015) was obtained from the American Cancer Society. Data from the Behavioral Risk Factor Surveillance System regarding prostate cancer screening during this time interval was acquired. Data regarding populations was obtained from the US Census. Descriptive analyses were used to describe the population and Pearson Correlation Coefficient to determine screened, death rates and rurality correlations. All analyses were completed using SPSS. Results: The median percent of US population residing in rural and urban areas was 25.8% (IQR 22.1%) and 73.8% (IQR 22.1%), respectively. The median percent of male patients screened using PSA 50 years and older was 56.2% (IQR 7.0%). The median death rate (per 100,000) from prostate cancer per state was 19.5 (IQR 1.7%). Prostate cancer death rate was found to have no correlation to percent of population screened (p = 0.29) and percent rurality (p = 0.98). The percent rural population versus percent of screened men over the age of 50 was also not significant (p = 0.20). Conclusions: Neither death rate nor screening rate for prostate cancer using PSA demonstrated a significant association with the percent of patient’s living in rural communities. This is evidence that within the US, rural communities are following guidelines for PSA screening for prostate cancer and therefore there is no discrepancy in prostate cancer death in these areas compared to urban. This study is evidence that the barriers that may be associated with living in rural communities, such as decreased access to healthcare do not translate into worse outcomes related to prostate cancer.

The role of the affect heuristic and cancer anxiety in responding to negative information about medical tests

Objective: Little is known about the affective implications of communicating negative information about medical tests. This research explored how affective processes – particularly the Affect Heuristic and cancer anxiety – influence the way in which people respond to such information.Design: Participants received different types of information about PSA screening for prostate cancer and magnetic resonance imaging (MRI) scans for migraine headaches. This was a 2 (Test harm information: present vs. absent) × 2 (Test benefit information: present vs. absent) × 2 (Test recommendation: present vs. absent) between-participants design.Outcome Measures: Perceived risk, perceived benefit and general attitudes towards PSA and MRI testing, cancer anxiety, preferences to receive the tests vs. not.Results: As predicted by the Affect Heuristic, test harm information reduced perceived test benefits. However, information about uncertain test benefit did not increase perceived test risks. Information about the test reduced cancer anxiety, indicating defensive coping. These variables – affect, anxiety, perceived risks and benefits – all uniquely predicted test preferences.Conclusion: Affective processes play an important role in how people respond to and interpret negative information about medical tests. Information about harms and information about the lack of benefit can both make a test seem less beneficial, and will reduce cancer anxiety as a result.

History of PSA screening on prostate cancer aggressiveness.

5066 Background: In 2012, PSA screening for prostate cancer (CaP) detection was given a “Grade D” recommendation for all men by the USPSTF. Recent U.S. studies report declines in PSA screening with concomitant increases in advanced CaP at diagnosis. This study examined the association between PSA screening history and CaP aggressiveness in a racially diverse, military cohort with equal health care access. Methods: This retrospective cohort study evaluated CaP patients undergoing radical prostatectomy (RP) from 1994-2015 at Walter Reed National Military Medical Center. Whole-mounted prostatectomy specimens were classified using 2014 ISUP Gleason grading system. Excluding the diagnostic PSA, screening history was categorized as: ≥ 6 PSA’s prior to CaP diagnosis (uppermost quartile), 1-5 (lower 3 quartiles), vs. no screening history. Multivariable logistic regression (MLR) was used to examine NCCN risk stratum (intermediate-high vs. low) and Gleason upgrade (GU) from biopsy to RP. Multivariable Cox proportional hazards (Cox PH) analyses were used to model time to biochemical recurrence (BCR). Multivariable models controlled for age at RP, race, family history and obesity (BMI &gt; 30 vs. ≤ 30 kg/m2). The GU and BCR models also controlled for NCCN risk classification. Results: There were 1,772 eligible patients with a median follow-up and age at RP of 7.0 and 59.8 years, respectively. Prior to CaP diagnosis, 42% and 19% of men had 1-5 and ≥ 6 PSA’s screenings, respectively. MLR showed greater odds of intermediate or high vs. low risk disease for PSA screening history of none vs. 1-5 (OR = 1.33, CI = 1.03-1.70, p = 0.028) but not for none vs. ≥ 6 (p = 0.44). MLR showed increased odds of GU for none vs. ≥ 6 (OR = 1.81, CI = 1.23-2.7, p &lt; 0.001). Multivariable Cox PH models showed incrementally poorer BCR-free survival as screening history decreased (HRNone vs. ≥6 = 2.27, CI = 1.54-3.33, p &lt; 0.001; HRNone vs. 1-5= 1.49, CI = 1.15-1.92, p = 0.002). Conclusions: In this RP cohort, higher risk stratum, increased GU, and poorer BCR-free survival were associated with no PSA screening history. BCR-free survival was incrementally worsened by less PSA screening. A complete absence of PSA screening may lead to more aggressive disease at presentation and poorer clinical outcomes.

Positron-Emission Tomography-Computed Tomography for Cancer Screening: Boon or Bane.

We read the article by Caliskan et al. [1] with great interest. The authors have reported a case of incidentally detected rectal cancer in a patient undergoing positron-emission tomography–computed tomography (PET-CT) examination for assessment of a screen detected pulmonary nodule. Though PET-CT may be able to further characterize the lesion (more than 8-mm solid or partly solid pulmonary nodule) identified on screening CT, it is of low specificity if the patient has granulomatous disease. Based on the identification of a clinically asymptomatic rectal cancer in this patient, the authors have pitched for utilization of PET-CT for cancer screening. They have flagged the government policy for not reimbursing the cost of PET-CT done for cancer screening. The case report is interesting, but its scientific value is anecdotal, at best. There are some vital questions which need to be addressed before one endorses the use of PET-CT for cancer screening. Firstly, there has been a lot of scepticism about the benefits of cancer screening: whether it really leads to a reduction in solid tumours related mortality rates in the screened population. It needs to be further clarified that differences in survival rates following cancer screening do not always translate into differences in mortality rates due to ‘lead time’ and ‘over diagnosis’ bias. PSA screening for prostate cancer has been a classic example of how the screening failed to reduce the mortality rates despite having improvement in survival rates. Secondly, using PET-CT for cancer screening has its own pitfalls. The impact of PET-CTcancer screening on the cancer-related mortality has not been investigated by any prospective randomized controlled trial. The cost effectiveness and efficiency of PET-CT and other conventional screening tests (mammography, colonoscopy etc.) has also never been compared in any previous study to ascertain if it can lead to superior detection of those lesions which are missed by conventional screening tests. This is a well-known fact that small malignant or precancerous lesions are likely to be missed by a PET-CT (for example, in colon cancer) while resection of these early lesions actually may bring about reduction in cancer-related mortality [2]. Moreover, false positive findings are a major concern as they result in further work up and secondary expenditure. Another area of concern is FDG-negative malignant lesions which may not be evident of PET-CT and may lead to false negative results [3]. One of the criteria for a good screening test is that it should minimally affect the nondiseased screened individuals. In the absence of robust data to support benefit of PET-CT in cancer screening, its associated radiation hazard remains an important deterring factor against its indiscriminate use. The expansion of indications for PET-CT in oncology is inevitable in the time to come. However, various pitfalls of this extremely alluring imaging investigation need to be explained to the patients/asymptomatic persons with complete professional integrity. * Pankaj Kumar Garg dr.pankajgarg@gmail.com

‘Should I get a PSA test?’ – the question is not that simple

PSA screening for prostate cancer is a controversial issue around the world. In this article the authors describe the situation in North America where screening is not being advised. They argue that patients should be tested and that men will adapt and learn to live with the results as active surveillance becomes more acceptable.

Capsule Commentary on Shelton et al., Reducing PSA-Based Prostate Cancer Screening in Men ≥ 75Years Old with Highly Specific Computerized Clinical Decision Support.

Clinical decision support (CDS) systems can improve patient safety by providing physicians with important information and guidance at the point of care. This guidance should be evidence-based, and the alert message clear and concise, to allow physicians to directly act on the information received. Shelton et al. develop a highly specific and targeted CDS alert to remind providers of the current guidelines and policy at the point of ordering a screening PSA.1 This relatively simple intervention has been shown to significantly reduce inappropriate PSA screening for prostate cancer. Alerts which lack clinical relevance (low alert specificity) are often overridden by the physician, thus contributing to alert fatigue.2,3 The authors of this study reflected on how they used a wide range of structured clinical data (including laboratory, pharmacy, and problem list data) to help increase the specificity of their alert, and believe that this may have contributed to its success. Alert specificity and sensitivity is recognized as being important.4 Patient specific parameters, e.g., age, should be incorporated into decision-making algorithms to improve the accuracy and appropriateness of alerts. One study found that only 10 % of drug–drug interaction alerts would be applicable in all circumstances; however, by incorporating laboratory results and other clinical parameters, this percentage could rise to 25 % or possibly higher.5 The effectiveness of alerts should always be monitored; this includes how often they fire and whether clinicians choose to accept or override the alerts. Interestingly, Shelton et al. reported sharp increases in screening rates during periods when the alerts were switched off. This finding underscores the importance of CDS as a tool to guide physician decision-making and improve the quality and efficiency of health care. Furthermore, it shows how they can address inappropriate overuse of preventive care and, in turn, reduce health care costs.

18 The influence of physican recommendation on PSA screening

INTRODUCTION AND OBJECTIVES: PSA screening for prostate cancer is a controversial topic, and little is known regarding a physician’s impact on a patient’s decision to undergo screening. The study’s objective was to evaluate the impact of a patient’s understanding of the risks and benefits of PSA screening compared to the final recommendation of the health care provider on the patient’s decision to undergo PSA screening. METHODS: Using the 2012 BRFSS, males aged 55 years who did not have a prior history of prostate cancer/prostate “problem” and who reported a PSA test within the preceding 12 months were considered to have undergone PSA screening. The percentage of men informed and not informed of the risks and benefits of PSA screening and the percentage men receiving recommendations for PSA screening from their HCP was reported. Multivariable complex-samples logistic regression calculated the odds ratio of undergoing screening in men informed of PSA screening benefits, screening risks, and for those receiving a recommendation to undergo screening. RESULTS: Seventy-five percent of men were informed of screening benefits, however 32% were informed of screening risks. After being informed of both, 55.6% of men opted for PSA screening if the HCP recommended it, compared to only 20.6% when not recommended. Men receiving a recommendation to undergo PSA testing had higher odds of undergoing screening (OR 4.98, 95% CI: 4.53-5.48) compared to those who were only informed about screening benefits (OR 2.40, 95% CI: 2.18-2.65) or risks (OR 0.92, 95% CI: 0.86-0.98). Significant limitations of our study include recall and non-response bias. CONCLUSIONS: Physicians have a tendency to report the favorable aspects of screening while under informing patients of the possible risks of screening. A patient’s decision to undergo or forgo PSA screening is heavily influenced by the recommendation of their physician, and thus it is imperative that physicians are cognizant of their biases and facilitate an unbiased shared decision making process.

Combined cryotherapy and external beam radiation therapy for the treatment of intermediate-risk localized prostate cancer: A case series

Introduction: Routine PSA screening for prostate cancer (PCa) has increased the detection of intermediate-risk, localized disease. Conventional treatments for localized PCa include surgery, brachytherapy, cryotherapy or external beam radiotherapy (EBRT). However, for intermediate risk patients, rates of recurrence are moderately high and a multi-modal treatment approach for these patients may be necessary. We treated patients with a combination of cryotherapy and low dose EBRT to assess the safety and feasibility of this combinatory approach as well as to evaluate early oncological outcomes. Case Presentation: Men with intermediate risk (PSA = 10-20 ng/ml and/or Gleason = 7 and/or clinical T2b) localized PCa were prospectively enrolled in this study. Patients underwent cryotherapy and then 39 Gy EBRT 4-6 weeks after surgery. After completing EBRT, the men were followed every 3 months for 2 years. Adverse events, PSA, urinary and erectile function were assessed during each follow-up. Three patients completed the study. Preoperative PSA ranged from 3.5 to 7.9 ng/ml. There were no intraoperative complications and the treatment was well tolerated. Following cryotherapy and EBRT, all patients were pad-free within 6 months and remained continent for the duration of the study. Bother index remained stable throughout the study for all patients. No urethral strictures or rectal toxicities were observed. PSA remained undetectable for all patients. Conclusions: In this prospective study, cryotherapy combined with low dose EBRT was a safe approach for the treatment of intermediate-risk, localized PCa. Early oncological outcomes appeared to be favorable with all patients having undetectable PSA during the 2-year follow-up period. Further studies are warranted to confirm these preliminary results.

5-alpha reductase inhibitors and PSA screening for prostate cancer

5-alpha reductase inhibitors and PSA screening for prostate cancer

5-alpha reductase inhibitors and PSA screening for prostate cancer

5-alpha reductase inhibitors and PSA screening for prostate cancer

Urinary a HGF, IGFBP3 and OPN as Diagnostic and Prognostic Biomarkers for Prostate Cancer

Serum PSA screening for prostate cancer (PCa) is controversial. Here, we identify three urinary biomarkers - aHGF, IGFBP3 and OPN - for PCa screening and prognostication. Urinary aHGF, OPN and IGFBP3 from healthy men (n = 19) and men with localized (n = 65) and metastatic (n = 36) PCa were quantified via ELISA. Mann-Whitney nonparametric t-test and the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) analyses were used to analyze associations. Mean aHGF and IGFBP3 levels were significantly elevated in PCa patients versus controls (p = 0.0006 and p = 0.0012, respectively), and the area under the curve of the receiver operating characteristic curve (indicator of diagnostic accuracy) for aHGF and IGFBP3 was 0.75 and 0.74, respectively. OPN levels were significantly higher in metastatic groups (p = 0.0060) versus localized and controls (area under the curve = 0.68). Urinary aHGF and IGFBP3 exhibit the capacity for diagnostic discrimination for PCa, whereas OPN may indicate presence of metastatic disease.

PSA screening rates in older men in the United States based on nine-year estimated remaining life expectancy.

e16006 Background: PSA screening for prostate cancer (PCa) is controversial, but informed decision making is recommended for men with an estimated 10 years of remaining life expectancy (RLE). The association between screening of men 65+ and estimated 9-year life expectancy is unknown. Our purpose was to determine the association between predicted 9-year life expectancy and PCa screening in 2005 and 2010. Methods: Data were extracted from the 2005 and 2010 National Health Interview Survey. Men 65+ without prostate known PCa were divided into quartiles with a validated index estimating 9-year RLE (&lt;27%, 27-52%, 53-75%, and &gt;75%). The proportions of men screened in 2005 and 2010 were determined. Logistic regression was used to compare screening in 2005 and 2010. Results: Screening rates for men 65+ were 48.3% (95% CI, 45.6-50.9%) in 2005 and 48.5% (95% CI, 45.5-51.6%) in 2010 (p = 0.9). There were no differences in screening between cohorts by age and predicted mortality for 65-74 (all p &gt; 0.05 for &lt;27%, 27-52%, 53-75%, and &gt;76% predicted mortality) and 75+ year olds (all p&gt; 0.05). The most screened group were 65-74 year olds with a &lt;27% chance of 9-year mortality, with 58.3% (95% CI, 53.6–63.1) and 56.1% (95% CI, 50.6-61.5) screened in 2005 and 2010. Conclusions: PSA-based PCa screening did not differ between 2005 and 2010 for men 65+. Over 35% and 33% of older men with limited estimated 9-year RLE were screened in 2005 and 2010 despite minimal clinical benefit. [Table: see text]

Krebsfrüherkennung und Risikokommunikation

In most psychological and medical research, patients are assumed to have difficulties with health statistics but clinicians not. However, studies indicate that most doctors have problems in understanding health statistics, including those of their own speciality. For example, only two out of 20 urologists knew the information relevant for a patient to make an informed decision about whether to take PSA screening for prostate cancer, just 14 out of 65 physicians in internal medicine understood that 5-year survival rates do not tell anything about screening's benefit, and merely 34 out of 160 gynecologists were able to interpret the meaning of a positive test result. This statistical illiteracy has a direct effect on patients understanding and interpretation of medical issues. Not rarely their own limited health literacy and their doctors' misinformation make them suffer through a time of emotional distress and unnecessary anxiety. The main reasons for doctors' statistical illiteracy are medical schools that ignore the importance of teaching risk communication. With little effort doctors could taught the simple techniques of risk communication, which would make most of their statistical confusion disappear.