Repeat Prostate-specific Antigen Test Research Articles

Abstract 38: External Quality Assessment for Prostate Specific Antigen Test Accuracy: A Needs Assessment of Nigerian Tertiary Hospitals

Abstract Purpose: Prostate cancer is a major cause of death in African men, and the accuracy of prostate specific antigen (PSA) test results is important to ensure patients have access to accurate early diagnosis and treatment. External Quality Assessment (EQA) is an established framework to improve the quality of PSA results. We aimed to determine the need for implementing an EQA program for PSA in Nigeria. Methods: We used mixed-method design to collect data from 6 tertiary hospitals across the six regions in Nigeria. We conducted an online survey using a structured questionnaire developed from the International Standard Organization (ISO) 15189 checklist for accreditation of diagnostic laboratories. Responses were analyzed to obtain descriptive categorical data that was analyzed on Microsoft Excel. Using an in-depth interview guide, 12 respondents (6 Urologists and 6 Chemical Pathologists) from sampled hospitals were interviewed virtually. Responses were recorded and transcribed and relevant themes were identified and generated from the transcribed data. Results: Five of six laboratories sampled (83%) reported conducting repeat PSA testing. No sampled lab (0%) was enrolled in an EQA program for PSA. Eleven of the twelve respondents confirmed occasional disparities between PSA results and patient’s clinical status. They gave the impact of an erroneous PSA result on patient care as: extra unnecessary cost to the patient due to repeat testing; delay in decision making and initiating appropriate treatment; unnecessary invasive procedures. Training of lab staff, adoption of standard operating procedures and quality measures for EQA were considered opportunities to encourage PSA EQA practice while lack of funds for EQA programs, weak logistics for distribution of EQA samples and results, poor staff motivation and commitment were mentioned as barriers to effective practice uptake. Conclusion: There is a clear need for the implementation of an EQA program for PSA in Nigeria. This will reduce the incidence of incongruous PSA results, thus promoting better clinician approach to disease treatment and better patient outcomes especially in resource-constrained environments. Citation Format: Ifeyinwa Nnakenyi, Tonia Onyeka, Ngozi Idemili-Aronu1, Justus Onu, Echezona Ezeanolue. External Quality Assessment for Prostate Specific Antigen Test Accuracy: A Needs Assessment of Nigerian Tertiary Hospitals [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 38.

Relationship Between Baseline Prostate-specific Antigen on Cancer Detection and Prostate Cancer Death: Long-term Follow-up from the European Randomized Study of Screening for Prostate Cancer

BackgroundThe European Association of Urology guidelines recommend a risk-based strategy for prostate cancer screening based on the first prostate-specific antigen (PSA) level and age. ObjectiveTo analyze the impact of the first PSA level on prostate cancer (PCa) detection and PCa-specific mortality (PCSM) in a population-based screening trial (repeat screening every 2–4 yr). Design, setting, and participantsWe evaluated 25589 men aged 55–59 yr, 16898 men aged 60–64 yr, and 12936 men aged 65–69 yr who attended at least one screening visit in the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial (screening arm: repeat PSA testing every 2–4 yr and biopsy in cases with elevated PSA; control arm: no active screening offered) during 16-yr follow-up (FU). Outcome measurements and statistical analysisWe assessed the actuarial probability for any PCa and for clinically significant (cs)PCa (Gleason ≥7). Cox proportional-hazards regression was performed to assess whether the association between baseline PSA and PCSM was comparable for all age groups. A Lorenz curve was computed to assess the association between baseline PSA and PCSM for men aged 60–61 yr. Results and limitationsThe overall actuarial probability at 16 yr ranged from 12% to 16% for any PCa and from 3.7% to 5.7% for csPCa across the age groups. The actuarial probability of csPCa at 16 yr ranged from 1.2–1.5% for men with PSA <1.0 ng/ml to 13.3–13.8% for men with PSA ≥3.0 ng/ml. The association between baseline PSA and PCSM differed marginally among the three age groups. A Lorenz curve for men aged 60–61 yr showed that 92% of lethal PCa cases occurred among those with PSA above the median (1.21 ng/ml). In addition, for men initially screened at age 60–61 yr with baseline PSA <2 ng/ml, further continuation of screening is unlikely to be beneficial after the age of 68–70 yr if PSA is still <2 ng/ml. No case of PCSM emerged in the subsequent 8 yr (up to age 76–78 yr). A limitation is that these results may not be generalizable to an opportunistic screening setting or to contemporary clinical practice. ConclusionsIn all age groups, baseline PSA can guide decisions on the repeat screening interval. Baseline PSA of <1.0 ng/ml for men aged 55–69 yr is a strong indicator to delay or stop further screening. Patient summaryIn prostate cancer screening, the patient’s baseline PSA (prostate-specific antigen) level can be used to guide decisions on when to repeat screening. The PSA test when used according to current knowledge is valuable in helping to reduce the burden of prostate cancer.

MP44-19 EFFECTS OF PROSTATE-SPECIFIC ANTIGEN SCREENING ON PROSTATE CANCER INCIDENCE AND MORTALITY: A POPULATION-BASED COHORT STUDY IN CHINA

You have accessJournal of UrologyCME1 Apr 2023MP44-19 EFFECTS OF PROSTATE-SPECIFIC ANTIGEN SCREENING ON PROSTATE CANCER INCIDENCE AND MORTALITY: A POPULATION-BASED COHORT STUDY IN CHINA Yongle Zhan, Xiaohao Ruan, Da Huang, Jingyi Huang, Jinlun Huang, Tsun Tsun Chun, Brian Ho, Ada Ng, James Tsu, and Rong Na Yongle ZhanYongle Zhan More articles by this author , Xiaohao RuanXiaohao Ruan More articles by this author , Da HuangDa Huang More articles by this author , Jingyi HuangJingyi Huang More articles by this author , Jinlun HuangJinlun Huang More articles by this author , Tsun Tsun ChunTsun Tsun Chun More articles by this author , Brian HoBrian Ho More articles by this author , Ada NgAda Ng More articles by this author , James TsuJames Tsu More articles by this author , and Rong NaRong Na More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Evidence regarding the benefit of prostate-specific antigen (PSA) testing for prostate cancer (PCa) is limited in China. Scarce research so far explores the optimal frequency and interval of repeated PSA testing. This study aims to evaluate the effects of serial screening in different frequencies and intervals against PCa incidence and mortality among Chinese population. METHODS: Data of this study came from the Chinese Electronic Health Records Research in Yinzhou (CHERRY) Study. Briefly, the CHERRY study is a population-based cohort study comprising more than one million adults enrolled from 1 January 2009 in Yinzhou, China. The population census, primary care, electronic medical records, health checks, surveillance, and death registry databases have been integrated into the CHERRY study. A total of 420,941 male participants aged over 45 at recruitment were included in the present study. Among them, a subgroup of 75,362 men who have undergone any PSA testing was selected for analysis. The number of receiving PSA screening, screening frequency and interval, PCa diagnosis and death were extracted from the electronic health records system. RESULTS: People receiving more than three times of PSA testing had 67% (95% confidence interval [CI]: 48-88%) higher risks of PCa detection, but 64% (95%CI: 30-82%) lower risks of PCa-specific mortality and 28% (95%CI: 23-33%) lower risks of overall mortality. Receiving at least one screening per four years could increase 25% (95%CI: 13-36%) risks of PCa detection, but decrease 70% (95%CI: 43-84%) and 23% (95%CI: 18-27%) risks of PCa-specific and overall mortality. For those repeated attenders, 2-yr to 3-yr intervals could decrease 50-85% risks of PCa-specific mortality and 9-57% risks of overall mortality (Figure 1). CONCLUSIONS: This study provides the first evidence for the benefits of PSA screening in Chinese general population, and supports that receiving serial screening at least once per four-year is beneficial for overall and prostate cancer-specific survival. Source of Funding: This work was in supported by grants from National Natural Science Foundation of China (Grant No. 81972645), Shanghai Youth Talent Support Program, intramural funding of The University of Hong Kong to Dr. Rong Na, and Shanghai Sailing Program (22YF1440500) to Dr. Da Huang © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e619 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yongle Zhan More articles by this author Xiaohao Ruan More articles by this author Da Huang More articles by this author Jingyi Huang More articles by this author Jinlun Huang More articles by this author Tsun Tsun Chun More articles by this author Brian Ho More articles by this author Ada Ng More articles by this author James Tsu More articles by this author Rong Na More articles by this author Expand All Advertisement PDF downloadLoading ...

The Use of 5-Alpha Reductase Inhibitors Improves the Detection of Prostate Cancer by Increasing Opportunities for Repeated Prostate-Specific Antigen Testing: A Decade-Long (2007–2016) Nationwide Observational Study in Korea

Purpose: The aim of this study was to investigate the influence of taking 5-alpha reductase inhibitors (5ARIs) on the detection of prostate cancer (PCa), considering the reported low uptake of prostate-specific antigen (PSA) testing among Korean men.Materials and Methods: From Korean National Health Insurance Sharing Service data, the number of men older than 40 years who were prescribed 5ARIs from 2007 through 2016 was identified. The association of 5ARI prescriptions with newly registered PCa was analyzed.Results: In total, 1,528,128 men who took 5ARIs for a mean of 1.523±2.221 years were identified. Among 138,614 patients with PCa, 68,529 (49.4%) took 5ARIs and 70,085 did not. The incidence of PCa was significantly higher in the 5ARI group than in the non-5ARI group during all study years (p&lt;0.001) except for 2007. Adjusted for age, the non-5ARI group had a significantly lower likelihood of PCa detection (hazard ratio [HR], 0.854; p&lt;0.001) and radical prostatectomy, including robot-assisted procedures (HR, 0.834, p&lt;0.001). The mean number of PSA tests was about 2 times higher in the 5ARI group than in the non-5ARI group (3.98 vs. 2.18, p&lt;0.001). Among the subjects who took 5ARIs, the incidence of PCa increased up to 3 years of administration, followed by a decreasing trend thereafter (p&lt;0.001).Conclusions: From this observational study in a country with limited PSA testing uptake, the prescription of 5ARIs, for which repeated PSA testing is encouraged to select suitable patients, enhances the detection of PCa, but does not prevent its development.

Low-Value Prostate-Specific Antigen Test for Prostate Cancer Screening and Subsequent Health Care Utilization and Spending

Delivering low-value care can lead to unnecessary follow-up services and associated costs, and such care cascades have not been well examined in common clinical scenarios. To evaluate the utilization and costs of care cascades of prostate-specific antigen (PSA) tests for prostate cancer screening, as the routine use of which among asymptomatic men aged 70 years and older is discouraged by multiple guidelines. This cross-sectional study included men aged 70 years and older without preexisting prostate conditions enrolled in a Medicare Advantage plan during January 2016 to December 2018 with at least 1 outpatient visit. Medical billing claims data from the deidentified OptumLabs Data Warehouse were used. Data analysis was conducted from September 2020 to August 2021. At least 1 claim for low-value PSA tests for prostate cancer screening during the observation period. Utilization of and spending on low-value PSA cancer screening and associated care cascades and the difference in overall health care utilization and spending among individuals receiving low-value PSA cancer screening vs those who did not, adjusting for observed characteristics using inverse probability of treatment weighting. Of 995 442 men (mean [SD] age, 78.0 [5.6] years) aged 70 years or older in a Medicare Advantage plan included in this study, 384 058 (38.6%) received a low-value PSA cancer screening. Utilization increased for each subsequent cohort from 2016 to 2018 (49 802 of 168 951 [29.4%] to 134 404 of 349 228 [38.5%] to 199 852 of 477 203 [41.9%]). Among those receiving initial low-value PSA cancer screening, 241 188 of 384 058 (62.8%) received at least 1 follow-up service. Repeated PSA testing was the most common, and 27 268 (7.1%) incurred high-cost follow-up services, such as imaging, radiation therapy, and prostatectomy. Utilization and spending associated with care cascades also increased from 2016 to 2018. For every $1 spent on a low-value PSA cancer screening, an additional $6 was spent on care cascades. Despite avoidable care cascades, individuals who received low-value PSA cancer screening were not associated with increased overall health care utilization and spending during the 1-year follow-up period compared with an unscreened population. In this cross-sectional study, low-value PSA tests for prostate cancer screening remained prevalent among Medicare Advantage plan enrollees and were associated with unnecessary expenditures due to avoidable care cascades. Innovative efforts from clinicians and policy makers, such as payment reforms, to reduce initial low-value care and avoidable care cascades are warranted to decrease harm, enhance equity, and improve health care efficiency.

MP53-11 FOUR KALLIKREIN PANEL TESTING AMONG MEDICARE BENEFICIARIES UNDERGOING PROSTATE CANCER SCREENING

You have accessJournal of UrologyCME1 May 2022MP53-11 FOUR KALLIKREIN PANEL TESTING AMONG MEDICARE BENEFICIARIES UNDERGOING PROSTATE CANCER SCREENING Michael Leapman, Jessica Long, Rong Wang, Preston Sprenkle, Xiaomei Ma, and Cary Gross Michael LeapmanMichael Leapman More articles by this author , Jessica LongJessica Long More articles by this author , Rong WangRong Wang More articles by this author , Preston SprenklePreston Sprenkle More articles by this author , Xiaomei MaXiaomei Ma More articles by this author , and Cary GrossCary Gross More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002628.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate-specific antigen (PSA) isoforms, including a panel of four kallikrein markers, improve the prediction of high-grade prostate cancer in clinical studies and may potentially mitigate biopsy after prostate cancer screening. We evaluated determinants of real-world use of a commercially available four kallikrein marker panel (4Kscore®), and subsequent use of prostate biopsy among tested patients. METHODS: We queried the linked Surveillance, Epidemiology and End-Results Medicare database to identify a cohort of patients without a diagnosis of prostate cancer at the time of PSA testing in 1/2016-6/2019. Among patients receiving PSA screening, we evaluated clinical and sociodemographic factors associated with subsequent 4Kscore testing using descriptive statistics and multivariable generalized estimating equation models accounting for both sample weighting and repeated PSA testing events within patients. We compared the use of prostate biopsy and prostate cancer detection among 4Kscore tested versus untested patients. RESULTS: We identified a weighted sample of 3,892,492 PSA testing events, of which 10,195 were followed by 4Kscore testing (0.26%) within six months. The majority (97%) of 4Kscore tests were associated with an elevated PSA diagnosis. Beneficiaries who received 4Kscore testing were younger compared with those who did not undergo 4Kscore testing (mean 72.4 versus 74.2 years, p<0.001). In multivariable analysis, older age (odds ration [OR] = 0.13, 95% confidence interval [CI]: 0.08-0.21 for age 80+ versus 66-69 years), dual Medicaid eligibility (OR=0.61, 95% CI: 0.41-0.92), residence in higher poverty level zip codes (OR=0.55, 95% CI: 0.40-0.76 for ≥20% poverty vs <5%), and more comorbidities (OR=0.74, 95% CI: 0.62-0.90 for 1-2 versus 0 comorbidities) were associated with lower odds of 4Kscore testing. Within 6-months of PSA screening, 31% of patients who received 4Kscore testing (31%) underwent a prostate biopsy. This study is limited by absence of PSA values and clinical findings, which may influence the decision for both 4Kscore testing and biopsy. CONCLUSIONS: 4Kscore testing was used in a small proportion of older Americans screened for prostate cancer. In this setting, most patients undergoing 4Kscore testing for an elevated PSA did not undergo a subsequent prostate biopsy. Source of Funding: William O. Seery Foundation, Patterson Trust Research Award © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e899 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Leapman More articles by this author Jessica Long More articles by this author Rong Wang More articles by this author Preston Sprenkle More articles by this author Xiaomei Ma More articles by this author Cary Gross More articles by this author Expand All Advertisement PDF DownloadLoading ...

Reimagining prostate cancer screening: the IMPACT of germline mutations.

Structured prostate-specific antigen (PSA) screening allows for the early detection of prostate cancer in men aged 55–69 years with a reduction in the incidence of metastatic disease at presentation and cancer-specific mortality at 16 year's follow-up. 1 Hugosson J Roobol MJ Månsson M et al. A 16-yr follow-up of the European randomized study of screening for prostate cancer. Eur Urol. 2019; 76: 43-51 Summary Full Text Full Text PDF PubMed Scopus (182) Google Scholar Population-based screening has been associated with a non-negligible risk of overdiagnosis (ie, the detection of cancers that would not have caused symptoms), which can be as high as 40%, and has limited its adoption at a large scale 2 Martin RM Donovan JL Turner EL et al. Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality: the CAP randomized clinical trial. JAMA. 2018; 319: 883-895 Crossref PubMed Scopus (210) Google Scholar such that no national prostate cancer screening programmes exist in the USA and Europe. 3 Van Poppel H Hogenhout R Albers P van den Bergh RCN Barentsz JO Roobol MJ A European model for an organised risk-stratified early detection programme for prostate cancer. Eur Urol Oncol. 2021; (published online Aug 4)https://doi.org/10.1016/j.euo.2021.06.006 Summary Full Text Full Text PDF Scopus (11) Google Scholar Restricting the use of repeated PSA testing to men at risk of early-onset disease because of a family history of prostate cancer or germline mutations has been proposed as a means of improving the effectiveness of screening. 2 Martin RM Donovan JL Turner EL et al. Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality: the CAP randomized clinical trial. JAMA. 2018; 319: 883-895 Crossref PubMed Scopus (210) Google Scholar , 4 Gandaglia G Albers P Abrahamsson PA et al. Structured population-based prostate-specific antigen screening for prostate cancer: the European Association of Urology Position in 2019. Eur Urol. 2019; 76: 142-150 Summary Full Text Full Text PDF PubMed Scopus (49) Google Scholar , 5 Page EC Bancroft EK Brook MN et al. Interim results from the IMPACT study: evidence for prostate-specific antigen screening in BRCA2 mutation carriers. Eur Urol. 2019; 76: 831-842 Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar A prospective prostate cancer screening programme for men with pathogenic variants in mismatch repair genes (IMPACT): initial results from an international prospective studyAfter the first screening round, carriers of MSH2 and MSH6 pathogenic variants had a higher incidence of prostate cancer compared with age-matched non-carrier controls. These findings support the use of targeted PSA screening in these men to identify those with clinically significant prostate cancer. Further annual screening rounds will need to confirm these findings. Full-Text PDF Open Access

PD65-07 LIFESTYLE MODIFICATIONS AND THEIR EFFECT ON SERUM PROSTATE SPECIFIC ANTIGEN LEVELS

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII (PD65)1 Sep 2021PD65-07 LIFESTYLE MODIFICATIONS AND THEIR EFFECT ON SERUM PROSTATE SPECIFIC ANTIGEN LEVELS Alexandre R. Zlotta, Jimmy Misurka, Katherine Lajkosz, Andrea Mari, Serena Marzario, Cynthia Kuk, Sophie O’Halloran, Alex Zisman, Annette Erlich, Michael Nesbitt, Dhiral Kot, Rob Hamilton, Girish Kulkarni, Nathan Perlis, Anto Finelli, Sigrid Carlsson, and Neil Fleshner Alexandre R. ZlottaAlexandre R. Zlotta More articles by this author , Jimmy MisurkaJimmy Misurka More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , Andrea MariAndrea Mari More articles by this author , Serena MarzarioSerena Marzario More articles by this author , Cynthia KukCynthia Kuk More articles by this author , Sophie O’HalloranSophie O’Halloran More articles by this author , Alex ZismanAlex Zisman More articles by this author , Annette ErlichAnnette Erlich More articles by this author , Michael NesbittMichael Nesbitt More articles by this author , Dhiral KotDhiral Kot More articles by this author , Rob HamiltonRob Hamilton More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , Nathan PerlisNathan Perlis More articles by this author , Anto FinelliAnto Finelli More articles by this author , Sigrid CarlssonSigrid Carlsson More articles by this author , and Neil FleshnerNeil Fleshner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002109.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guidelines recommend to repeat serum Prostate Specific Antigen (PSA) measurement to confirm an elevated value before proceeding with further testing. The effect of diet and lifestyle on repeat PSA levels to minimize false positives has rarely been examined. We aimed here to explore the effects of dietary and lifestyle changes on serum PSA values in men with intermediate PSA levels and normal digital rectal examination (DRE). METHODS: We used a case-control design including 204 men with PSA levels between 2-10ng/ml. 82 men who followed lifestyle changes (intervention group) were matched with 122 men (control group), who did not undergo any lifestyle modifications (avoiding spicy foods, alcohol, caffeine consumption and biking) before repeat PSA. PSA changes between baseline and repeat measurement were compared between the intervention group and controls using the Mann-Whitney U test. Multivariable logistic regression models were used to assess differences in PSA changes below different pre-determined thresholds. Linear mixed models implemented for changes in PSA as a continuous covariate helped visualize the predicted change in PSA from baseline. RESULTS: Age (61.0 vs 60.3 years), prostate volume (52.3 vs 49.0 cc) and PSA levels at baseline (5.83 vs 5.75 ng/ml) in the control and intervention arm, respectively, were not different. Compared to controls, at a median 2.81 months interval (IQR: 1.69-4.61), men in the intervention arm had a significantly lower total PSA on repeat PSA testing (4.14 vs 5.32ng/ml, p<0.001). Lifestyle changes resulted in PSA levels dropping below 4ng/ml in 40% of men with initial PSA 4-10 ng/ml in the intervention group vs 22% in controls (p=0.02). In the 2-4ng/ml range, 45% of men in the intervention group vs 14% in controls had their repeat PSA <2ng/ml (p=0.02). Intervention was an independent predictor of repeat PSA dropping <3ng/ml for men with baseline PSA of 3-10ng/ml (OR 5.39, 95% CI 1.96, 14.8, p=0.001). Limitations include the retrospective design of the study, absence of use of metrics to measure adherence to recommendations and lack of cycling information. CONCLUSIONS: In men with intermediate PSA levels and negative DRE, dietary and lifestyle modifications decrease serum PSA values more, and in a larger proportion than simply repeating the test. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1154-e1154 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre R. Zlotta More articles by this author Jimmy Misurka More articles by this author Katherine Lajkosz More articles by this author Andrea Mari More articles by this author Serena Marzario More articles by this author Cynthia Kuk More articles by this author Sophie O’Halloran More articles by this author Alex Zisman More articles by this author Annette Erlich More articles by this author Michael Nesbitt More articles by this author Dhiral Kot More articles by this author Rob Hamilton More articles by this author Girish Kulkarni More articles by this author Nathan Perlis More articles by this author Anto Finelli More articles by this author Sigrid Carlsson More articles by this author Neil Fleshner More articles by this author Expand All Advertisement Loading ...

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

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

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

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

Abstract C88: Novel use of electronic health records (EHRs) to facilitate free community prostate screening events

Abstract Introduction Free screening events, while a valuable means to educate and provide cancer screening for individuals in socioeconomically disadvantaged communities, suffer from a number of limitations including: limited scope, poor patient follow up, and lack of long term tracking of individuals with high risk screening outcomes. The Center for Medicare and Medicaid Services advocates for electronic health records (EHRs) to flag opportunities for “reduction of disparities, research, or outreach.” EHRs represent a potentially powerful tool to assimilate and track individual screening outcomes. However, implementation of electronic health records a to facilitate free screening events such as for prostate cancer has not been reported. Among the barriers to EHR use for free screenings is the requirement to create billable encounters for each patient for whom personal health information is to be entered. Therefore, we reconfigured our EHR to create HIPAA compliant, non-billable encounters for the purposes of entering demographic information, tracking screening results, and generating follow-up letters to participants and their primary care physicians (PCPs) after a free community screening event in an at risk community. Materials &amp; Methods Between 2013 and 2015 our group hosted three annual free prostate cancer community-screening events in the city of New Haven, CT. To facilitate tabulation of demographic information and screening results we prevailed upon our EHR administrators to design workflows to allow for patient registration and patient data capture unique to our screening events that would not be associated with a billable encounter. Providers counseled patients on prostate specific antigen (PSA) testing, ordered testing if appropriate, and performed a digital rectal examination (DRE) for each encounter. Demographic information and DRE results were manually entered into the EHR by a registered nurse for all patients and PSA testing performed by our own hospital-based ancillary service with direct resulting of PSA tests into the EHR. Automatic electronic alerts were generated for all PSA results and were preconfigured to be routed to the MD directing the event and two nurse managers. Results In the most recent screening year, 93 men were screened of whom 27 (29%) were flagged for follow-up: 21 (23%) for abnormal screening results and six for benign urologic issues who requested follow-up with our physicians. Using demographic information entered at the time of registration, 26 of the 27 (96%) participants flagged for follow-up were successfully contacted and only one participant could not be reached for follow-up. Letters to PCPs were successfully transmitted for all participants who had provided PCP information during the intake process. Of 21 participants with abnormal screening, 3 were known to have a preexisting diagnosis of prostate cancer and were actively under the care of a urologist and/or oncologist, 3 had established relationships with urologists and indicated their intent to follow-up with their regular urologist, 9 underwent repeat PSA testing and were offered follow-up with one of our urologists at no cost, 3 were scheduled for MRI of the prostate for further stratification of risk, and 3 were scheduled for prostate biopsy with one of our physicians. All tracking of results, coordination of care, and external communication to participants and their PCPs was executed through the EHR Conclusion The electronic health record when reconfigured to serve as a platform for a community screening event, allows for a novel, secure and multidimensional tool to enhance screening, provide appropriate follow-up, and establish vital long-term relationships with participants. Citation Format: Charles Walker, Meghan Curran, Jay Patel, Beth A. Jones. Novel use of electronic health records (EHRs) to facilitate free community prostate screening events. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C88.

Variation in Guideline Concordant Active Surveillance Followup in Diverse Urology Practices

We examined the frequency of followup prostate specific antigen testing and prostate biopsy among men treated with active surveillance in theacademic and community urology practices comprising MUSIC (Michigan Urological Surgery Improvement Collaborative). MUSIC is a consortium of 42 practices that maintains a prospective clinical registry with validated clinical data on all patients diagnosed with prostate cancer at participating sites. We identified all patients in MUSIC practices who entered active surveillance and had at least 2 years of continuous followup. After determining the frequency of repeat prostate specific antigen testing and prostate biopsy, we calculated rates of concordance with NCCN Guidelines® recommendations (ie at least 3 prostate specific antigen tests and 1surveillance biopsy) collaborative-wide and across individual practices. We identified 513 patients who entered active surveillance from January 2012 through September 2013 and had at least 2 years of followup. Among the 431 men (84%) who remained on active surveillance for 2 years 132 (30.6%) underwent followup surveillance testing at a frequency that was concordant with NCCN® (National Comprehensive Cancer Network®) recommendations. At the practice level, the median rate of guideline concordant followup was 26.5% (range 10% to 67.5%, p<0.001). Among patients with discordant followup, the absence of followup biopsy was common and not significantly different across practices (median rate 82.0%, p = 0.35). Among diverse community and academic practices in Michigan, there is wide variation in the proportion of men on active surveillance who meet guideline recommendations for followup prostate specific antigen testing and repeat biopsy. These data highlight the need for standardized active surveillance pathways that emphasize the role of repeat surveillance biopsies.

Association of changing prostate-specific antigen (PSA) levels on repeat testing with lower risk for Gleason Score (GS) ≥ 7 prostate cancer.

284 Background: PSA levels are often verified before recommending a prostate biopsy because of the variability of PSA, We used data from the STHLM3 trial to assess the value of a second PSA test taken prior to biopsy. Methods: STHLM3 is a prospective and population-based prostate cancer diagnostic study performed in Stockholm, Sweden, 2013-2015. 1686 men in STHLM3 with a PSA value 3-10 ng/ml performed a second PSA test within 8 weeks of the first test and then underwent prostate biopsy. We compared proportions of cancer detected in men with stable PSA levels (2nd PSA within +/-10% of 1stPSA) to men whose PSA levels increased or decreased at least 10%, respectively. Results: Men with GS ≥ 7 cancer in the biopsy had more stable PSA than men with benign biopsies; the median change was 13.7% (inter-quartile range (IQR) 6.1-26.9) in men with benign biopsies, 13.0% (IQR 6.1-25.6) in men with GS ≤ 6 tumors and 8.2% (IQR 4.5-16.7) in men with GS ≥ 7 tumors. The average risk of having GS ≥ 7 cancer was 15.4% (95% CI 13.7 – 17.1) after the first test (i.e. the entire cohort), 21.6% (95% CI 18.6 – 24.6) in men with stable PSA levels compared with 13.5% (95% CI 10.2 – 16.7) and 9.0% (95% CI 6.6 – 11.4) if PSA levels increased or decreased at least 10%, respectively. There were no significant differences in risk of GS ≤ 6 tumor for men with stable PSA compared to men with increasing/decreasing PSA. Conclusions: As previously shown, the risk of prostate cancer decreases if a repeat PSA test shows decreasing levels. We show that this effect mainly affect GS ≥ 7 tumors, and that the risk of prostate cancer also decreases with increasing PSA values. Our findings need validation, but suggest that PSA is more stable in men with GS ≥ 7 cancer, whereas elevated but fluctuating PSA levels to a higher degree are caused by other processes (e.g. inflammation). Use of decision tools could aid incorporation of complex information such as repeat PSA values in diagnostics.

Reducing the Harm of Prostate Cancer Screening: Repeated Prostate-Specific Antigen Testing

ObjectiveTo determine if repeating a prostate-specific antigen (PSA) test in men with an elevated PSA level is associated with a decreased risk of prostate biopsy and cancer diagnosis. Patients and MethodsA cohort of patients referred to the Ottawa Regional Prostate Cancer Assessment Clinic from April 1, 2008, through May 31, 2013, who had referral PSA levels between 4 and 10 ng/mL were included in the study. Univariate and multivariate associations between a normal result on repeated PSA testing and the risk of prostate biopsy, cancer diagnosis, and Gleason score of 7 or higher were examined. ResultsThe study cohort included 1268 patients. Repeated PSA test results were normal in 315 patients (24.8%). Men with normal results on repeated PSA testing were younger (mean ± SD age, 61.5±8.2 years vs 65.2±8.2 years; P<.001) and had lower referral PSA levels (mean ± SD, 5.5±1.4 ng/mL vs 6.6±1.5 ng/mL; P<.001) than men with an abnormal repeated PSA result. In multivariate analysis, men with normal results on repeated PSA testing were less likely to undergo prostate biopsy (relative risk [RR], 0.42; 95% CI, 0.34-0.50) and were at lower risk for cancer diagnosis (RR, 0.22; 95% CI, 0.14-0.34) and Gleason score of 7 or higher (RR, 0.16; 95% CI, 0.08-0.34) compared with men who had an abnormal repeated PSA test result. ConclusionRoutinely repeating a PSA test in patients with an elevated PSA level is independently associated with decreased risk of prostate biopsy and prostate cancer diagnosis. Men with an elevated PSA level should be given a repeated PSA test before proceeding to biopsy.

Impact of the 2012 United States Preventive Services Task Force statement on prostate-specific antigen screening: analysis of urologic and primary care practices.

To identify the effect of the 2012 United States Preventive Services Task Force (USPSTF) prostate-specific antigen (PSA) recommendation statement on primary care referral patterns and urologists' decision making. Men referred to our institution for newly elevated PSA level from June 2011 to June 2013 were identified. Patients with a prior history of prostate cancer or biopsy were excluded. Clinical and management parameters were compared between those presenting in the year before vs the year after the USPSTF statement. Factors predictive of receiving a prostate biopsy were identified using multivariate regression analysis. A total of 201 men were identified in the pre-USPSTF period and 212 men, thereafter. The groups were comparable in age, race, prostate cancer family history, PSA values, and digital rectal examination findings. At the initial evaluation, patients presenting after the statement were more likely to undergo PCA3 testing (27% vs 11%; P <.01) and repeat PSA testing (82% vs 72%; P = .02) and less likely to undergo immediate biopsy (16% vs 24%; P = .03). The proportion of patients ultimately receiving a biopsy was equivalent. The groups were similar in the percentage of positive biopsies, Gleason distribution, and D'Amico risk. African American race and family history were predictors for receiving a biopsy in the post-USPSTF group but not in the pre-USPSTF group. The 2012 USPSTF recommendation statement has not affected the number or clinical characteristics of patients referred to a tertiary center for elevated PSA level. After recommendation, urologists ordered significantly more PCA3 and repeat PSA tests and recommended fewer biopsies at the initial visit. The fraction of patients ultimately receiving a biopsy remained the same.

MP63-13 REPEAT PROSTATE-SPECIFIC ANTIGEN TESTING REDUCES UNNECESSARY PROSTATE BIOPSIES.

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2014MP63-13 REPEAT PROSTATE-SPECIFIC ANTIGEN TESTING REDUCES UNNECESSARY PROSTATE BIOPSIES. Andrew Binette, Kelsey Witiuk, Ranjeeta Mallick, Chris Morash, Ilias Cagiannos, Luke Lavallee, and Rodney Breau Andrew BinetteAndrew Binette More articles by this author , Kelsey WitiukKelsey Witiuk More articles by this author , Ranjeeta MallickRanjeeta Mallick More articles by this author , Chris MorashChris Morash More articles by this author , Ilias CagiannosIlias Cagiannos More articles by this author , Luke LavalleeLuke Lavallee More articles by this author , and Rodney BreauRodney Breau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1950AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of repeating a prostate-specific antigen (PSA) test in a patient with a single abnormal value has been inadequately studied. Our primary objective was to evaluate the effect of an automatic repeat PSA in patients referred to a regional cancer diagnostic centre with an abnormal PSA value. METHODS All patients seen at The Ottawa Regional Prostate Cancer Assessment Clinic from April 2008 to May 2013 were reviewed. As per protocol, all patients were requested to obtain a repeat PSA prior to their consultation. Patients referred with a PSA ≥10 ng/L, a previous prostate biopsy, normal initial PSA value, or greater than 3 months between PSA tests were excluded. Patient age, prostate exam findings, and PSA values were obtained. Any prostate biopsy within 1 year following initial consultation was included. RESULTS Of the 1758 patients seen during the study period, 1271 (72%) met inclusion criteria and had a PSA at referral between 4 and 10 ng/L. Mean age was 64.3±8.4, mean first PSA was 6.3±1.6, and mean second PSA was 9.8±150.7. The repeated PSA was normal (<4ng/L) in 315 (25%) patients. A prostate biopsy was performed in 594 (62%) patients with an abnormal repeat PSA compared to 89 (28%) patients with a normal repeat PSA (RR of biopsy associated with abnormal repeat 2.20; CI 1.8-2.6; p<0.001). When the repeat PSA was abnormal, 57% of biopsies detected cancer and 31% detected Gleason ≥7 cancer. When the repeat PSA was normal, only 29% detected cancer (RR 0.52; CI 0.4-0.7; p<0.0001) and 11% detected Gleason ≥7 cancer (RR 0.69; CI 0.4-1.1; p=0.15). Analyses using age-specific and 2.5ng/L PSA thresholds had similar associations and will be presented. CONCLUSIONS Repeat PSA testing in patients with an abnormal screening PSA is clinically useful. A normal second PSA is associated with decreased risk of prostate biopsy and prostate cancer diagnosis. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e713 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Andrew Binette More articles by this author Kelsey Witiuk More articles by this author Ranjeeta Mallick More articles by this author Chris Morash More articles by this author Ilias Cagiannos More articles by this author Luke Lavallee More articles by this author Rodney Breau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Association between race and follow‐up diagnostic care after a positive prostate cancer screening test in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial

Follow-through of a positive screening test is necessary to reap the potential benefits of cancer screening. Racial variation in follow-through diagnostic care may underlie a proportion of the known disparity in prostate cancer mortality. The authors used data from the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial to determine whether race is associated with the use of follow-up diagnostic testing after a positive initial screening evaluation. Men who had a prostate-specific antigen (PSA) level >4 ng/mL at any time during the study were included. The proportion of men who underwent follow-up evaluation with a repeat PSA, a prostate biopsy, or either test within 9 months was determined, and the authors tested for differences in follow-through according to race using mixed-effects multivariate models with a random effect for accrual site to account for clustering. Models were stratified according to age (<65 years and ≥65 years). Among 6294 men who had a PSA elevation during the study period, 70% underwent a repeat PSA or prostate biopsy within 9 months. Non-Hispanic black men aged <65 years had 45% lower odds of undergoing a repeat PSA test or prostate biopsy compared with non-Hispanic white men (odds ratio, 0.55; 95% confidence interval, 0.37-0.82), whereas there was no racial difference in follow-through among older men. The current results suggest that limitations in access to care among non-Hispanic black men under the age of Medicare eligibility may underlie the paradoxically low use of follow-through diagnostic care among non-Hispanic black men in the United States.

Variable Prostate-specific Antigen Management Patterns by Nonurologist Providers at a Tertiary Care Medical Center

To determine prostate-specific antigen (PSA) management patterns of nonurologist providers. Urologists are involved in the management of men's prostate health. In practice, nonurology providers are more likely to see patients in the screening setting. Survey questions were designed to evaluate a nonurologist's approach to PSA screening. The survey instrument was distributed to physicians and physician extenders in fields of internal medicine and family practice at a tertiary-care medical center. Of 116 nonurologist providers, 86 (74%) completed the survey. There was variability with respect to the age at which to screen the index patient (asymptomatic white man without a prostate cancer family history): 16% initiated screening at 41-50 years of age and 77% at 51-60 years. Additionally, heterogeneity was found with regard to categorizing an elevated PSA level, with 62% of providers using an absolute PSA cutoff of >4 ng/mL and only 27% citing age-specific criteria. When diagnosing an asymptomatic man with an elevated PSA level, most providers will recheck PSA in 3-6 months (38%) or initiate a trial of empiric antibiotics (30%). Only a smaller fraction will refer the patient to a urologist (21%) or repeat PSA test immediately within 2-4 weeks (11%). We noted variability in PSA management patterns by nonurologists. Only 27% of providers used age-specific criteria, and almost 70% managed an elevated value by rechecking at a delayed interval or initiating a trial of antibiotics. This suggests that education might be necessary to create uniformity in PSA screening amongst nonurologists.

Association of Black Race With Follow-up of an Abnormal Prostate-Specific Antigen Test

Delayed evaluation after a clearly abnormal prostate-specific antigen (PSA) result may contribute to more advanced prostate cancer at diagnosis in black men. In 46 primary care practices over a period of 4.5 years, we studied men aged more than 50 years without known prostate cancer who had a PSA of at least 10.0 ng/mL for the first time. PSA follow-up included: a urology appointment, a new prostate diagnosis, or repeat PSA test. Cox proportional hazards models assessed time to follow-up, adjusting for demographic, clinical, and health care factors with censoring at a time that represents excessive delay (200 days). Among all 724 study men (27% black), delay until PSA follow-up averaged 115.2 days (+/- 79.7 d) and the unadjusted hazard ratio (HR) for follow-up was shorter for black men than nonblack men (HR, 1.23; 95% CI, 1.00-1.51). However, black men were more likely to have had prior urology care and had higher index PSA levels than other men; both factors were associated with shorter follow-up. After adjustment, delay did not differ for black vs nonblack race (HR, 1.05; 95% Cl, 0.78-1.43) but men aged at least 75 years had a longer delay than men aged 74 years or less (HR, 0.72; 95% CI, 0.59-0.89). Despite black men having greater risk of advanced prostate disease at diagnosis and better linkage to urologic care, follow-up was delayed, on average, by more than 3 months and did not differ by race. These results reveal a potentially important, remediable factor to improve prostate cancer prevention and care for black men.

Treatment of localized prostate cancer: when is active surveillance appropriate?

Testing for prostate-specific antigen (PSA) has caused a dramatic increase in the incidence of prostate cancer during the past two decades. Many cancers identified by repeated PSA testing are small volume, low-grade lesions that pose little threat of progression over 15-20 years. Data from a recently reported randomized trial indicate that as many as 48 men must undergo treatment to prevent one prostate cancer-related death. Unfortunately, no test is currently available that can identify those men who have clinically significant disease. Men least likely to experience disease progression are men who harbor tumors with a Gleason score of 6 involving 2 needle cores or less; these men may want to consider active surveillance as their initial treatment option. Researchers have followed over 2,500 men on active surveillance protocols (over 200 men have been followed for >10 years). To date, prostate cancer-specific survival is over 99%. About 25% of men enrolled in active surveillance programs have abandoned this approach because of concerns about disease progression. For men harboring tumors with a Gleason score >7, data from two recently reported Swedish trials suggest lower prostate cancer-related mortality for those men receiving either surgery or radiation.