Routine Prostate-specific Antigen Screening Research Articles

Clinical consequences of a genetic predisposition toward higher benign prostate-specific antigen levels

Prostate-specific antigen (PSA) levels are influenced by genetic variation unrelated to prostate cancer risk. Whether a genetic predisposition to a higher PSA level predisposes to a diagnostic work-up for prostate cancer is not known. Participants were 3110 men of African and European ancestries ages 45-70, without prostate cancer and with a baseline PSA < 4ng/mL, undergoing routine clinical PSA screening. The exposure was a polygenic score (PGS) comprising 111 single nucleotide polymorphisms associated with PSA level, but not prostate cancer. We tested whether the PGS was associated with a: 1) PSA value>4ng/mL, 2) International Classification of Diseases (ICD) code for an elevated PSA, 3) encounter with a urologist, or 4) prostate biopsy. Multivariable Cox proportional hazards models were adjusted for age and genetic principal components. Analyses were stratified by age (45-59 years, and 60-70 years old). Association estimates are per standard deviation change in the PGS. The median age was 56.6 years, and 2118 (68%) participants were 45-59 years. The median (IQR) baseline PSA level was 1.0 (0.6-1.7) ng/mL. Among men ages 45-59, the PGS was associated with a PSA > 4 (hazard ratio [HR]=1.35 [95% CI, 1.17-1.57], p=4.5×10-5), an ICD code for elevated PSA (HR=1.30 [1.12-1.52], p=8.0×10-4), a urological evaluation (HR=1.34 [1.14-1.57], p=4.8×10-4), and undergoing a prostate biopsy (HR=1.35 [1.11-1.64], p=0.002). Among men ages 60-70, association effect sizes were smaller and not significant. A predisposition toward higher PSA levels was associated with clinical evaluations of an elevated PSA among men ages 45-59 years. National Institutes of Health (NIH).

Temporal association of prostate cancer incidence with World Trade Center rescue/recovery work

BackgroundThe World Trade Center (WTC) attacks on 11 September 2001 created a hazardous environment with known and suspected carcinogens. Previous studies have identified an increased risk of prostate cancer in...

PD65-02 IMPACT OF PROSTATE-SPECIFIC ANTIGEN (PSA) SCREENING INTENSITY ON PROSTATE CANCER DIAGNOSIS IN A RACIALLY DIVERSE HEALTHCARE SYSTEM OVER A 25-YEAR PERIOD

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII (PD65)1 Sep 2021PD65-02 IMPACT OF PROSTATE-SPECIFIC ANTIGEN (PSA) SCREENING INTENSITY ON PROSTATE CANCER DIAGNOSIS IN A RACIALLY DIVERSE HEALTHCARE SYSTEM OVER A 25-YEAR PERIOD Deepansh Dalela, Marcus Jamil, Akshay Sood, Nikola Rakic, Jacob Keeley, Patrick Etta, Brett Friedman, Craig Rogers, Mani Menon, and Firas Abdollah Deepansh DalelaDeepansh Dalela More articles by this author , Marcus JamilMarcus Jamil More articles by this author , Akshay SoodAkshay Sood More articles by this author , Nikola RakicNikola Rakic More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Patrick EttaPatrick Etta More articles by this author , Brett FriedmanBrett Friedman More articles by this author , Craig RogersCraig Rogers More articles by this author , Mani MenonMani Menon More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002109.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal frequency of PSA screening remains undefined, with the US-based Prostate, Lung, Colorectal and Ovarian (PLCO) trial defining PSA testing every 1-2 years as ‘routine’ screening. In the context of evolving (and often conflicting) guidelines for PSA screening, it remains unknown if ‘routine’ screening affects prostate cancer (PCa) diagnosis differently compared to less frequent PSA testing METHODS: Henry Ford Health System is a large, racially diverse integrated healthcare system in Southeast Michigan, USA. Over the study period (1995-2019), Men aged 45+ without a prior PCa diagnosis who had at-least one PSA test and remained in the system for at-least 6 years or were diagnosed with PCa within 2 years were included in our analyses. Screening intensity was assessed based on a 5-year window: routine screening (at least one PSA test q1-2 years), occasional (at-least one test q3 yearly) and sporadic (no test for three consecutive years), averaged over the duration of the follow up in the study. Outcomes variables were time to diagnosis of PCa, PSA, incidence of clinical nodal and metastatic disease at diagnosis. RESULTS: Overall, 52,343 (34.6%), 50042 (33.1%) and 48.966 (32.4%) men were included in the sporadic, occasional and routine PSA screening groups, respectively, of which 34,623 (22.9%) were Black. Median (IQR) age for first PSA testing was 56.8 (50.3-66.5) years, and cumulative incidence of PCa was 2.3%, 3.8% and 6.2% for sporadic, occasional and routine groups respectively. Compared to men undergoing routine screening, men in occasional and sporadic groups had significantly higher median PSA (5.4 vs. 6.1 vs 7.2 ng/mL), clinical N+ (1.2% vs. 1.8% vs. 3.8%) and metastatic disease (6.5% vs. 9.5% vs. 15.4%) at diagnosis (Table 1, all p<0.001). CONCLUSIONS: Results from a large, racially diverse US-based healthcare system showed that only about one-third of the population underwent routine PSA screening (every 1-2 years), as defined by the PLCO study. Further, men undergoing routine screening had more favorable tumor characteristics at diagnosis and lower incidence of metastatic disease, highlighting its oncological benefit compared to opportunistic screening. Source of Funding: n/a © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1151-e1152 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepansh Dalela More articles by this author Marcus Jamil More articles by this author Akshay Sood More articles by this author Nikola Rakic More articles by this author Jacob Keeley More articles by this author Patrick Etta More articles by this author Brett Friedman More articles by this author Craig Rogers More articles by this author Mani Menon More articles by this author Firas Abdollah More articles by this author Expand All Advertisement Loading ...

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

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

Associations of Prostate-Specific Antigen (PSA) Testing in the US Population: Results from a National Cross-Sectional Survey.

Prostate-specific antigen (PSA) testing is one of the standard screening methods for prostate cancer (PC); however, a high proportion of men with abnormal PSA findings lack evidence for PC and may undergo unnecessary treatment. Furthermore, little is known about the prevalence of PSA testing for US men, after the US Preventive Services Task Force (USPSTF) recommended against routine PSA screening in 2012. Our objectives were to: (1) examine the self-reported patterns of PSA testing following a change in the USPSTF prostate cancer screening recommendations and (2) to determine the associated socio-demographic factors. Data were from the 2010 and 2015 National Health Interview Surveys. Men were ages ≥ 40years and responded to the question "Ever had a PSA test?". Multivariable logistic regression was used to examine PSA testing prevalence in 2010 and 2015, and their associated socio-demographic factors. The analytic sample contained 15,372 men. A majority (75.2%) identified as non-Hispanic (NHW) and 14.2% were foreign-born. Those surveyed in 2015 were less likely to report ever having had a PSA test when compared to those in 2010. Compared to US-born and older NHW men, PSA testing was statistically significantly lower among foreign-born men and men belonging to all other racial categories. Fewer men reported PSA testing following the USPSTF 2012 recommendations. Associated socio-demographic factors included nativity, age, race/ethnicity, educational attainment and type of health insurance. Further studies are required to elucidate our findings and their health implications for the US native and foreign-born population.

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

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

Abstract C114: Prostate-specific antigen (PSA) screening practices before and after the U.S. Preventive Services Task Force (USPSTF) 2012 Recommendations: A focus on foreign-born men

Abstract Background: Prostate cancer (PC) is the most frequently diagnosed cancer and a leading cause of mortality among men worldwide. There is evidence of a relationship between nativity and prostate cancer incidence; and, by 2050, one in five Americans living in the U.S. will be an immigrant. Little is known about the uptake of PSA screening for U.S.-based foreign-born men. Moreover, it is unclear if the prevalence of PSA screening changed within this population after the U.S. Preventive Services Task Force (USPSTF) 2012 recommendations against routine PSA screening. Objectives: Our objectives were to: 1) describe the factors associated with PSA screening prevalence for U.S.-based foreign-born men and 2) compare PSA screening prevalence before and after the USPSTF 2012 PSA screening recommendation for these men. Methods: Data were from the 2010 and 2015 National Health Interview Surveys and limited to men ages 40 years and older who responded to the question “Ever had a PSA test?”. Data were further limited to men who indicated that they were not born in the U.S. 50 states or the District of Columbia and were living in the U.S for five years or more. Multivariable logistic regression was used to examine determinants of PSA screening and to compare screening prevalence in 2010 and 2015. Results: The sample included 2,735 foreign-born men with the largest ethnic group being those who identify as Hispanic (46%). The final multivariable model included race/ethnicity, age, education, marital status, insurance status, survey year, and length of time living in the U.S. Asian men were less likely than non-Hispanic white men to report ever having had a PSA test (Odds Ratio (OR)=0.47, 95% Confidence Interval (CI) [0.36 – 0.61]). In addition, men who were widowed had lower odds than men who were married or living with a partner of ever having had a PSA test (OR=0.65, 95% CI [0.47 – 89]). Moreover, when compared to men who reported having a first degree relative with prostate cancer, men with unknown family history of prostate cancer had lower odds of ever having had a PSA test (OR=0.54, 95% CI [0.32 – 91]). Overall, men surveyed in 2015 were less likely to report ever having had a PSA test than those in 2010 (OR=0.76, 95% CI [0.63 – 0.92]). Conclusion: Among foreign-born men, lower odds of PSA screening prevalence was reported by men who were Asian, widowed and those with unknown family history of prostate cancer. Moreover, the USPSTF 2012 PSA recommendations against routine PSA screening appeared to lower PSA screening behaviors for these men several years later. These results can inform the development of prostate cancer interventions for this underserved group. Citation Format: Jarrett A. Johnson, Richard Moser, Gary Ellison, Damali Martin. Prostate-specific antigen (PSA) screening practices before and after the U.S. Preventive Services Task Force (USPSTF) 2012 Recommendations: A focus on foreign-born men [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C114.

Robot-Assisted Radical Prostatectomy in a Post−Kidney Transplant Patient: An Initial Case Report in China

ObjectiveOur aim was to evaluate the general applicability, feasibility, and safety of robot-assisted radical prostatectomy (RARP) in Chinese renal allograft patients for prostate cancer removal. Patients and MethodsA 62-year-old patient diagnosed as having biopsy-proven localized prostate cancer in March 2016 who had undergone renal transplant 12 years ago was studied. The preoperative prostate-specific antigen value was determined to be 11.82 ng/mL and the Gleason score was determined to be 3 + 3. The RARP was carried out using a transperitoneal and posterior approach with 5 ports in May 2016. The most important technique was ensuring that the transplanted kidney and ureter remained untouched during the surgery. Only the right obturator lymph nodes were dissected because the renal allograft was overlying the iliac vessels. ResultsThe RARP was successfully concluded following 230 minutes with an estimated blood loss of 200 mL. There were no postoperative complications. Final pathology was T2cN0M0, Gleason 3 + 3. Following catheter removal, the patient was completely continent and was discharged with no change in serum creatinine or glomerular filtration rate levels. During a 21-month follow-up, unobstructed urination, no incontinence, no biochemical recurrence, and normal kidney function were observed. ConclusionRARP in Chinese renal allograft patients is a feasible method that can be accomplished with no injuries to the transplanted kidney or ureter and is achieved with favorable oncological and functional outcomes. In addition, post−kidney transplant male patients are recommended to have routine prostate-specific antigen screening for the early detection of prostate cancer.

Approaches to shared decision-making for PSA screening in primary care practice.

33 Background: In April 2017, the United States Preventive Services Task Force published a draft statement recommending that clinicians inform men ages 55 to 65 about the potential benefits and harms of prostate-specific antigen (PSA)-based screening for prostate cancer. The HIT-OVERUSE study is an ongoing 2 year group randomized study in 20 primary care practices to test a practice-based intervention to reduce overuse, including avoidance of routine PSA screening without shared decision making. The purpose of this report is to present qualitative findings about approaches participating practices have adopted to facilitate shared decision-making for PSA screening. Methods: Eleven practices in ten states randomized to the HIT-OVERUSE intervention group have hosted on-site visits for academic detailing and participatory planning and sent two practice representatives to a one day meeting to share ‘best practices.’ Detailed notes from site visits, follow-up emails, and the ‘best practice’ meeting were reviewed to identify strategies adopted by practices to facilitate shared decision-making for PSA screening for prostate cancer screening. Results: All practices adopted at least one strategy to promote shared-decision making for PSA screening. Four practices removed standing orders for routine PSA screening. Four practices educated their clinical staff about the test; three developed scripts for staff to use when asked by patients about the test. Six practices began using patient education handouts about PSA screening. One provider started showing a brief YouTube video with patients, while another practice developed a slide show to show in the waiting room. Most providers in nearly all practices reported modifying their conversation about PSA screening with patients to include some discussion about the benefits and the harms of screening. Conclusions: Primary care practices participating an intervention to reduce overuse have adopted varied approaches to facilitate shared-decision making for prostate cancer screening. While having face-to-face conversations is one approach, other strategies may employ staff or utilize patient education or videos to convey the benefits and harms of screening.

Trends in Prostate Cancer Incidence Rates and Prevalence of Prostate Specific Antigen Screening by Socioeconomic Status and Regions in the United States, 2004 to 2013

To our knowledge it is unknown whether decreases in the prevalence of prostate specific antigen screening and prostate cancer incidence rates following the USPSTF (United States Preventive Services Task Force) recommendations against routine prostate specific antigen screening are similar across socioeconomic groups and United States census regions. We analyzed incidence rates and prostate specific antigen screening prevalence by age, race/ethnicity, disease stage, United States region and area level socioeconomic status. Annual percent changes were examined for changes in rates with time. The predicted marginal probability and 95% CIs were calculated to estimate changes in prostate specific antigen screening. Incidence rates in men 50 years old or older decreased in all race/ethnic, regional and socioeconomic status groups. From 2007 to 2013 the overall incidence rates for localized cancer significantly decreased 7.5% per year (95% CI -10.5--4.4) at ages 50 to 74 years and 11.1% per year (95% CI -14.1--8.1) at ages 75 years or greater. In contrast, the incidence of distant stage cancer significantly increased 1.4% per year (95% CI 0.3-2.5) from 2008 to 2013 at ages 50 to 74 years but stabilized from 2011 to 2013 at ages 75 years or greater at 5.1% per year (95% CI -3.4-14.4). Distant stage disease rates increased with increasing poverty level at ages 50 to 74 years but not at 75 years or greater. The prostate cancer incidence of early stage disease decreased in men 50 years old or older while the rate of distant stage disease slightly increased in men 50 to 74 years old following USPSTF recommendations against routine prostate specific antigen screening. Further studies with additional years of data are needed to substantiate our findings and monitor the effects of the late stage disease increase on prostate cancer mortality rates.

Alarmingly High Rate of Prostate Cancer Detected by Routine Prostate-Specific Antigen Screening in a County HIV Clinic

Background Routine prostate-specific antigen (PSA) screening in the general population and in HIV-infected men is controversial. The aim of this study is to determine the prevalence of prostate cancer (PC) among patients living with HIV (PLWH).MethodsAfter an index case of PC was detected by sporadic PSA screening, we performed a prospective (2/2010–10/2016) cohort study following PSA levels and biopsies of African-American (AA) men ≥45 years and non-AA men ≥50 years. Screening was done at the discretion of the provider.ResultsOf the 124 men (82 AA, 17 Hispanic, 16 Caucasian, 7 Asian, 2 other) who received PSA screening, 7 (5.6%) had a PSA > 5 and underwent prostatic biopsy. Five patients (4%) were found to have PC, all of whom had a history of good long-term HIV virologic control. Mean age of PC patients was 60 years vs. non-PC patients (55 years) (P = 0.031). Mean years of HIV in PC patients was 18 years vs. non-PC patients (14 years) (P = 0.068).CaseAgeRacePSA Value (ng/mL)Stage/ Glisson ScoreRisk FactorsTreatment1 index case68AA133 + 3 = 6aTransplant recipientradiation258AA6.23 + 3 = 6aNoneProstatectomy pending364AA143 + 5 = 8a mets to nodesPaternal history PCRadical prostatectomy; hormone treatment458Caucasian7.64 + 3 = 7aNoneRadical prostatectomy560Caucasian9.93 + 3 = 6aNoneTransferred care aAll specimens positive for PC.ConclusionPSA screening is controversial and not universally recommended. Other retrospective studies of PLWH have shown equally high rates of PC. Compared with the general population (1/1,000 non-AA and 1.7/1,000 AA), men in our cohort had a 25 times higher rate (4%)of PC. All patients had aggressive tumors and required surgery, including one patient with metastasis to regional nodes. As expected, age was a significant risk factor for PC. We recommend implementing routine cohort PSA screening in PLWH.Disclosures All authors: No reported disclosures.

Rural and Urban Differences in Stage at Diagnosis of Prostate Cancer in Hunan Province, China

This study set out to investigate whether patients in rural areas tend to have more advanced prostate cancer (PCa) than urban areas in Hunan province, define possible factors related to the stage at diagnosis of PCa between rural and urban areas, and to determine the potential correlations between these factors and PCa stage at time of diagnosis. Data were used from a retrospective database of 490 PCa patients from the Third XiangYa hospital. Rural and urban differences in PCa stage, age, delay in diagnosis, prostate specific antigen (PSA) values, PSA screening, and metabolic syndrome were described and analyzed. Pearson correlation, Spearman correlation, and multiple linear regression were performed to examine the correlations between factors which may attribute to regional differences and stage. The percentage of advanced stage in rural cases was higher than in urban cases. Moreover, younger age, longer delay in diagnosis, less metabolic syndrome, and fewer PSA screening prior to diagnosis were observed in rural patients compared with the urban patients. Current study revealed that rural patients were more likely to have advanced PCa stage and PSA values at time of diagnosis. Perhaps, most importantly, these data demonstrated that both rural and urban patients in Hunan province suffered from an unacceptable frequency of advanced PCa, presumably from lack of routine PSA screening.

Is prostate cancer screening responsible for the negative results of prostate cancer treatment trials?

Clinical guidelines continue to move away from routine prostate specific antigen screening (PSA), once a widespread medical practice. A curious difference exists between early prostate cancer and early breast cancer. While randomized trials of therapy in early breast cancer continue to show overall survival benefit, this is not the case in prostate cancer, where prostatectomy was no better than observation in a recent trial, and where early androgen deprivation is no better than late androgen deprivation. Here, I make the case that prostate cancer screening contributes so greatly to over diagnosis that even treatment trials yield null results due to contamination with non-life threatening disease.

Decline in Prostate Cancer Screening by Primary Care Physicians: An Analysis of Trends in the Use of Digital Rectal Examination and Prostate Specific Antigen Testing

Prostate cancer screening by digital rectal examination and prostate specific antigen testing has been routine clinical practice in the United States for the last 25 years. Recent studies have shown a national decline in prostate specific antigen testing following the USPSTF (United States Preventive Services Task Force) recommendation against routine prostate specific antigen screening. However, to our knowledge the effect of this recommendation on digital rectal examination utilization remains unknown. We used NAMCS (National Ambulatory Medical Care Survey) to characterize trends in the rate of digital rectal examination and prostate specific antigen testing by primary care physicians in men older than 40years presenting for preventive care. From 2005 to 2012 NAMCS contained 3,368 such visits (unweighted) for the study of digital rectal examination trends and 4,035 unweighted visits from 2002 to 2012 for the study of prostate specific antigen trends. Following the USPSTF recommendation the proportion of visits where digital rectal examination was performed decreased from 16.0% (95% CI 13.1-19.5) to 5.8% (95% CI 4.0-8.3, p <0.001). Similarly, the proportion of visits where prostate specific antigen testing was performed decreased from 27.3% (95% CI 24.5-30.3) to 16.7% (95% CI 12.9-21.2, p <0.001). This represents a relative 64% decrease in digital rectal examination and a 39% decrease in prostate specific antigen testing. Among men 55 to 69 years old the number of visits where digital rectal examination and prostate specific antigen testing were performed decreased 65% and 39%, respectively (p <0.001). Utilization of digital rectal examination and prostate specific antigen has declined significantly following the release of the USPSTF recommendation against prostate specific antigen screening. This suggests that prostate cancer screening is rapidly disappearing from primary care practice.

Impact of Prostate-specific Antigen (PSA) Screening Trials and Revised PSA Screening Guidelines on Rates of Prostate Biopsy and Postbiopsy Complications

BackgroundProstate biopsy and postbiopsy complications represent important risks of prostate-specific antigen (PSA) screening. Although landmark randomized trials and updated guidelines have challenged routine PSA screening, it is unclear whether these publications have affected rates of biopsy or postbiopsy complications. ObjectiveTo evaluate whether publication of the 2008 and 2012 US Preventive Services Task Force (USPSTF) recommendations, the 2009 European Randomized Study of Screening for Prostate Cancer and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or the 2013 American Urological Association (AUA) guidelines was associated with changes in rates of biopsy or postbiopsy complications, and to identify predictors of postbiopsy complications. Design, setting, and participantsThis quasiexperimental study used administrative claims of 5279315 commercially insured US men aged ≥40 yr from 2005 to 2014, of whom 104584 underwent biopsy. InterventionsPublications on PSA screening. Outcome measurements and statistical analysisInterrupted time-series analysis was used to evaluate the association of publications with rates of biopsy and 30-d complications. Logistic regression was performed to identify predictors of complications. Results and limitationsFrom 2005 to 2014, biopsy rates fell 33% from 64.1 to 42.8 per 100000 person-months, with immediate reductions following the 2008 USPSTF recommendations (−10.1; 95% confidence interval [CI], −17.1 to −3.0; p<0.001), 2012 USPSTF recommendations (−13.8; 95% CI, −21.0 to −6.7; p<0 .001), and 2013 AUA guidelines (−8.8; 95% CI, −16.7 to −0.92; p=0.03). Concurrently, complication rates decreased 10% from 8.7 to 7.8 per 100000 person-months, with a reduction following the 2012 USPSTF recommendations (−2.5; 95% CI, −4.5 to −0.45; p=0.02). However, the proportion of men undergoing biopsy who experienced complications increased from 14% to 18%, driven by nonsepsis infectious complications (p<0.001). Predictors of complications included prior fluoroquinolone use (odds ratio [OR]: 1.27; 95% CI, 1.22–1.32; p<0.001), anticoagulant use (OR: 1.14; 95% CI, 1.04–1.25; p=0.004), and age ≥70 yr (OR: 1.25; 95% CI, 1.15–1.36; p<0.001). Limitations included the retrospective design. ConclusionsAlthough there has been an absolute reduction in rates of biopsy and 30-d complications, the relative morbidity of biopsy continues to increase. These observations suggest a need to reduce the morbidity of biopsy. Patient summaryAbsolute rates of biopsy and postbiopsy complications have decreased following landmark publications about prostate-specific antigen screening; however, the relative morbidity of biopsy continues to increase.

Prostate cancer screening in Primary Health Care: the current state of affairs.

This study aims to examine the current practice of General practitioners (GPs)/primary care physicians in opportunistic screening for prostate cancer (PC) by digital rectal examination(DRE) and Prostate Specific Antigen(PSA) testing and identify any difference in screening practice.Printed copies and/or electronic versions of a survey was distributed amongst 438 GPs throughout Australia in 2012. Statistical analyses (Wilcoxon rank-sum test, Fisher’s exact test or Pearson chi-square test)were performed by outcomes and GP characteristics.There were a total of 149 responses received (34%), with similar gender distribution in rural and metropolitan settings. 74% GPs believed PSA testing was at least ‘somewhat effective’ in reducing PC mortality with annual PSA screening being conducted by more GPs in the metropolitan setting compared to the rural GPs (35% vs 18.4%), while 25% of rural GPs would not advocate routine PSA screening. When examining the concordance between DRE and PSA testing by gender of GP, the male GPs reported performing PSA testing more frequently than DRE in patients between ages 40 to 69 (p = 0.011).Urology Society guidelines (77.2%) and College of GPs (73.2%) recommendations for PC screening were thought to be at least ‘somewhat useful’. Although reference ranges for PSA tests were felt to be useful, the majority (65.8%) found it easier to refer to an urologist due to the disagreements in guidelines.In conclusion, the current guidelines for PSA screening appear to cause more confusion due to their conflicting advice, leaving GPs to formulate their own practice methods, calling for an urgent need for uniform collaborative guidelines.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-0819-8) contains supplementary material, which is available to authorized users.

Editorial Comment

The risk of infectious complications after prostate biopsy has been increasing. 1 Carignan A. Roussy J.F. Lapoint V. et al. Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis?. Eur Urol. 2012; 62: 453-459 Abstract Full Text Full Text PDF PubMed Scopus (213) Google Scholar This has important implications for prostate-specific antigen screening, as the rate of false positives is as high as 75.9%. 2 Schroder F.H. Hugosson J. Roobol M.J. et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med. 2012; 366: 981 Crossref PubMed Scopus (1004) Google Scholar As the vast majority of patients biopsied will not have prostate cancer, even 1 infection is too many. Indeed, when the US Preventative Service Task Force recommended against routine prostate-specific antigen screening, they used the complications associated with prostate biopsies as part of their rationale. 3 Moyer V.A. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012; 157: 120-134 Crossref PubMed Scopus (1611) Google Scholar Reduction in Hospital Admissions With the Addition of Prophylactic Intramuscular Ceftriaxone Before Transrectal Ultrasonography–guided Prostate BiopsiesUrologyVol. 85Issue 3PreviewTo evaluate the hospitalization rates in 2 pre–prostate biopsy antibiotic protocols. Full-Text PDF

Image-guided focal therapy for prostate cancer.

The adoption of routine prostate specific antigen screening has led to the discovery of many small and low-grade prostate cancers which have a low probability of causing mortality. These cancers, however, are often treated with radical therapies resulting in long-term side effects. There has been increasing interest in minimally invasive focal therapies to treat these tumors. While imaging modalities have improved rapidly over the past decade, similar advances in image-guided therapy are now starting to emerge--potentially achieving equivalent oncologic efficacy while avoiding the side effects of conventional radical surgery. The purpose of this article is to review the existing literature regarding the basis of various focal therapy techniques such as cryotherapy, microwave, laser, and high intensity focused ultrasound, and to discuss the results of recent clinical trials that demonstrate early outcomes in patients with prostate cancer.

Abstract 5068: 1-stearoylglycerol is associated with risk of prostate cancer: Results from serum metabolomic profiling

Abstract Background: Although prostate cancer is the most commonly diagnosed malignancy and the second leading cause of cancer death in most developed populations, there are no well-established modifiable risk factors for the disease. Further, recent recommendations against routine prostate-specific antigen screening have cast doubt on its utility for early detection. Emerging metabolomic technologies that measure an array of low molecular weight biochemicals in blood and other tissue have the potential to identify compounds relevant to cancer etiology and early detection. Methods: We compared the metabolomic profiles of prospectively collected fasting serum from 74 prostate cancer cases and 74 controls selected from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort of male smokers. Serum metabolomic profiling was conducted at Metabolon, Inc. (Durham, N.C.) using ultrahigh performance liquid chromatography/mass spectroscopy (LC-MS) and gas chromatography/mass spectroscopy (GC-MS); 420 identified compounds were available for analysis. We estimated the association between log-metabolite levels and prostate cancer by logistic regression. Multivariable models were adjusted for age, assay batch, trial supplement assignment, first-degree family history of prostate cancer, and physical activity. A threshold for statistical significance of 0.000119 was applied based on a Bonferroni correction for 420 tests. Results: Circulating 1-stearoylglycerol (1-SG, or 1-monostearin) was statistically significantly inversely associated with risk of prostate cancer after Bonferroni correction for multiple comparisons (OR=0.34, 95% CI=0.20 - 0.58, p=6.3 x 10-5). The magnitude of this association did not differ by disease aggressiveness and was observed for cases diagnosed up to 23 years after blood collection. Similar but somewhat weaker prostate cancer risk signals were also evident for glycerol and alpha-ketoglutarate. Conclusions: In this study of smokers, we found 1-SG to be inversely associated with risk of prostate cancer several years prior to diagnosis, supporting a role for dysregulation of lipid metabolism in prostate carcinogenesis. Further studies are needed to reexamine our findings, including particularly whether the 1-SG metabolite signal strength varies during a 10 or 20 year sub-clinical, prediagnostic period and may have potential utility as a prostate cancer early detection biomarker. Studies with serial blood sampling prior to diagnosis will be very informative in this regard. Whether the observed signal for 1-SG is independent of or correlated with PSA concentrations should also be examined. Citation Format: Alison M. Mondul, Steven Moore, Stephanie Weinstein, Satu Mannisto, Johsua Sampson, Demetrius Albanes. 1-stearoylglycerol is associated with risk of prostate cancer: Results from serum metabolomic profiling. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5068. doi:10.1158/1538-7445.AM2014-5068

1-stearoylglycerol is associated with risk of prostate cancer: results from serum metabolomic profiling.

Although prostate cancer is the most commonly diagnosed cancer among men in developed populations, recent recommendations against routine prostate-specific antigen screening have cast doubt on its utility for early detection. We compared the metabolomic profiles of prospectively collected fasting serum from 74 prostate cancer cases and 74 controls selected from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort of male smokers. Circulating 1-stearoylglycerol (1-SG, or 1-monostearin) was statistically significantly inversely associated with risk of prostate cancer after Bonferroni correction for multiple comparisons (i.e., 420 identified metabolites) (OR=0.34, 95% CI=0.20 - 0.58, p=6.3 × 10-5). The magnitude of this association did not differ by disease aggressiveness and was observed for cases diagnosed up to 23 years after blood collection. Similar but somewhat weaker prostate cancer risk signals were also evident for glycerol and alpha-ketoglutarate. In this population, men with higher serum 1-SG were less likely to develop prostate cancer, supporting a role for dysregulation of lipid metabolism in this malignancy. Additional studies are needed to retest the association and to examine 1-SG for its potential as a prostate cancer early detection marker.