Routine Prostate Cancer Screening Research Articles

1270 Elevated PSA in Elderly Men

Abstract Introduction Elevated PSA is a common urological cancer pathway referral. Investigating older men can result in overdiagnosis and overtreatment. Routine screening for prostate cancer is not recommended. Current NICE guidelines advice referring PSAs > 3 in 50-69-years, but no guidelines exist for elderly patients (>80-years). Aim 1)To identity the number of elderly men investigated under the 2WW pathway for elevated PSA. 2) Review of outcomes of newly diagnosed prostate-cancer in the elderly with PSA <20ng/ml. Method Retrospective data between Jan 2020-July 2021 identified 108 patients ≥ 80-years referred with elevated PSA: 38% with PSA ≤10ng/ml (n = 60), 32% with PSA 10ng-19/ml (n = 51). Patients were classified according to age-group; 1) 80-85-years, 2) 86-90-years, 3) >90-years. A further sub-group within each age-group according to PSA: 1) PSA 0-10ng/ml and 2) PSA 10-19ng/ml. Results 45% (n = 18) of <85-years (n = 40) with PSA <10ng/ml progressed to investigations with MRI (n = 16), TP-biopsy(n = 12) and bone-scan (n = 9). Within this group 17.5%(n = 7) were treated with hormone and/or radiotherapy. In a similar cohort (n = 32) with PSA 10-19ng/ml 56% (n = 18) were investigated (MRI n = 11, TP-biopsy n = 6, and bone-scan n = 13), of which 15.6% (n = 5) had hormone and/or radiotherapy. Men aged 86-90-years 5.6% (n = 1) and 53.8% (n = 7) had bone-scans only for respective PSA <10ng/ml (n = 18), and 10-19ng/ml(n = 13) group. Men >90-years had no investigations. Men >85-years had no treatment. Conclusions 11% of 80-85 years-old with PSA <20ng/ml received hormone or radiotherapy. Managing elevated PSA in the elderly is a contentious issue, requiring further large-study investigations, and new guidelines to avoid over-diagnosis and investigation.

PD13-09 TRENDS IN SURVIVAL FOR MEN WITH DE NOVO METASTATIC PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD13-09 TRENDS IN SURVIVAL FOR MEN WITH DE NOVO METASTATIC PROSTATE CANCER Nina Wyatt, and Christopher Filson Nina WyattNina Wyatt More articles by this author , and Christopher FilsonChristopher Filson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002545.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The USPSTF recommended against routine prostate cancer screening in 2008 (men >75 years) and 2011 (all men). After 2010, novel therapies were approved for men with metastatic prostate cancer, such as abiraterone. We examined the characteristics and survival of the men presenting with metastatic prostate cancer before and after those time periods. We hypothesized that men diagnosed more recently would have improved survival compared to men diagnosed long ago. METHODS: Using SEER cancer registry data, we identified men newly diagnosed with metastatic prostate cancer diagnosis from 2004–2018. Our outcome of interest was prostate cancer specific survival. Primary exposure was time period of diagnosis (2004–2008; 2009–2012; 2013–2016; 2017–2018). We evaluated factors including age, race/ethnicity, registry, and PSA level. We performed survival analysis to generate Kaplan-Meier curves for men eligible for at least 3 years follow up (diagnosed 2004–2016) (Figure). Multivariable Cox proportional hazard model provided adjusted estimates for cancer specific survival. RESULTS: Among 840,852 prostate cancer patients, 47,343 (5.6%) had metastatic disease. This proportion increased from 4.2% in 2004–2008 to 8.1% in 2017–2018 (p <0.001). Over time, a greater proportion of men with metastatic prostate cancer were Asian/Hispanic (16.0% in 2004–2008 to 17.7% in 2017–2018, p <0.001). Survival after 1 year was most common for men diagnosed in 2017–2018 (81.3% vs 67.9% alive in 2004–2008, p <0.001). Median cancer-specific survival was longest for men diagnosed from 2013–2016 (36 vs 31 months for 2004–2008, p <0.001). After adjusting for other factors, men diagnosed in 2013–2016 had 15% improved survival compared to those diagnosed earlier (vs 2004-2008; adjusted HR 0.85, 95% CI 0.82–0.88). CONCLUSIONS: Men presenting with metastatic prostate cancer in more recent years are living longer. More work will need to evaluate the relative contribution to this finding from therapeutic successes with novel systemic therapies, stage migration with adoption of PET scans, and the impact of earlier cancer detection with screening. Source of Funding: ACS MRSG 18-1-CPHPS © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e254 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nina Wyatt More articles by this author Christopher Filson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Number of prostate-specific antigen (PSA) screening tests in the last five years reported by men in the United States in 2010, 2015, and 2018.

Longer intervals between prostate-specific antigen (PSA) tests for routine prostate cancer screening can reduce the harms while maintaining the benefits of screening. Limited information has been published on PSA screening frequency. The purpose of this report is to describe the number of PSA tests in the last 5 years reported by men in the United States. Using data from National Health Interview Survey Cancer Control Supplements in 2010, 2015, and 2018, the number of PSA tests in the last 5 years reported by men ≥40 years was categorized as 4 to 5 PSA tests, 1 to 3 PSA tests, and no PSA tests. Logistic regression was used to calculate model-adjusted prevalence risk ratios (aPRs) for the number of PSA tests in the last 5 years, adjusting for age, racial-ethnic group, education, marital status, and health insurance. The proportion of men aged ≥70 years who reported 4 to 5 PSA tests in the last 5 years decreased from 37.2% in 2010 to 31.1% in 2018, while the proportion reporting 1 to 3 PSA tests increased from 25.5% to 31.9%. In 2018, aPRs for 4 to 5 PSA tests vs. 1 to 3 PSA tests in the last 5 years were significantly higher among men aged 70 to 79 years than among men aged 55 to 69 years. Men aged ≥70 years reported a small shift to less intense PSA testing between 2010 and 2018, but PSA testing intensity remained higher in men aged ≥70 years than in men aged 55 to 69 years.

Preferences for More or Less Health Care and Association With Health Literacy of Men Eligible for Prostate-Specific Antigen Screening in Australia

Understanding personal factors that influence diverse responses to health care information, such as preferences for more or less health care, might be beneficial to more effective communication and better involvement in health care choices. To determine whether individuals' preferences for more or less health care are associated with informed choice and understanding of overdiagnosis in routine prostate cancer screening and to examine associations among preferences, educational status, and health literacy. This survey study included a community-based sample of men in Australia aged 45 to 60 years eligible for prostate-specific antigen (PSA) screening, recruited via an international social research company. Survey data were collected online from June 27 to July 26, 2018. Data were analyzed in April 2020. Participants were randomized to 1 of 2 versions of an online decision aid (full-length or abbreviated) about PSA screening and completed an online survey that included a measure of preference for more or less health care, the Medical Maximizer-Minimizer Scale (MMS), in which higher score indicates preference for more health care. The primary outcome was informed choice; knowledge, attitudes, and intentions about screening for prostate cancer were also measured. Of 3722 participants who began the survey, 2993 (80.4%) completed it (mean [SD] age, 52.15 [6.65] years). Stronger preferences for more heath care were observed in those without tertiary education (mean difference, 0.15; 95% CI, 0.09-0.22; P < .001) and with inadequate health literacy (mean difference, 0.16; 95% CI, 0.09-0.22; P < .001). After controlling for health and demographic variables, a 1-unit increase in MMS score was associated with reduced relative risk (RR) of making an informed choice (RR, 0.78; 95% CI, 0.74-0.82; P < .001) and of having adequate conceptual knowledge (RR, 0.87; 95% CI, 0.84-0.90; P < .001), correct numerical knowledge (RR, 0.93; 95% CI, 0.89-0.97; P = .001), and correct understanding of overdiagnosis (RR, 0.84; 95% CI, 0.79-0.90; P < .001). A 1-unit increase in MMS score was associated with a more positive attitude toward screening (RR, 1.18; 95% CI, 1.15-1.21; P < .001) and more positive intention to screen (RR, 1.20; 95% CI, 1.16-1.25; P < .001) after adjusting for control variables. This survey study examined associations between preferences for more or less health care and knowledge about overdiagnosis and informed choice among men in Australia. These results may motivate clinicians to elicit individual patient preferences to facilitate tailored discussions with patients about low-value care, such as prostate cancer screening, for which benefit is uncertain.

Dealing with cancer screening in the COVID-19 era.

This article aims to alert health professionals for cancer screening in the face of the possibility of new waves of disease. A narrative review was conducted through a search in MEDLINE, Lilacs, Chinese Biomedical Literature Database, and international medical societies publications. Breast cancer: in high-risk patients (confirmed familial cancer syndrome or with high-risk tools scores), clinicians should act according to usual recommendations; in average-risk individuals, consider screening with mammography with a longer time span (maximum of two years). Cervical cancer: women turning 25 years old who have already been immunized and with no previous Pap test can have the test postponed during the pandemic; if there is no previous dose of Human Papillomavirus vaccination, initiation of screening should be recommended following a more rigid approach for COVID prevention; in women over 30 years of age who have never participated in cervical screening, the first screening exam is also essential. Colorectal cancer: if the individual is at elevated risk for familial cancer, the screening with colonoscopy according to usual recommendations should be supported; if at average risk consider screening with Fecal Occult Blood Test. Prostate cancer: there is a trend to postpone routine prostate cancer screening until the pandemic subsides. The decision to keep cancer screening must be discussed and individualized, considering the possibility of new waves of COVID-19.

Abstract PR12: Detection of EV-based signatures in prostate cancer using microflow cytometry and machine learning

Abstract Microflow cytometry (µFCM) has recently emerged as a viable technology to enumerate and quantify individual EVs from complex biologic fluids. This method is a promising alternative to biopsy collection because it is highly sensitive and allows for longitudinal assessment of patients. EVs are highly abundant and analysis by µFCM allows for sophisticated multiparametric analysis of organ-specific, disease-specific, and outcome-specific proteins, genes, or metabolites. Detection of EVs with µFCM requires very little sample yet provides exceptional specificity and sensitivity for low abundance events. By combining µFCM analysis of EVs with advanced machine learning approaches, we have developed a platform technology called ClarityDX to generate EV fingerprints that significantly improve the diagnosis of diseases such as prostate cancer using a few drops of blood. Here I will discuss the development and clinical validation of new blood tests for prostate cancer that utilize the ClarityDX platform. Prostate cancer is the most commonly diagnosed cancer and the third leading cause of cancer deaths in men. Screening has enabled the early detection of many latent prostate cancers, and it is estimated that up to 50% of new prostate cancer diagnoses detect a tumor that was unlikely to surface clinically in the absence of PSA screening. In the majority of cases, the treatment of indolent cancer causes a patient more harm than good. Consequently, there is an urgent need for a noninvasive test to detect clinically significant prostate cancer, or perhaps even more importantly, to detect metastatic disease. ClarityDX Prostate is a µFCM-based test to predict clinically significant prostate cancer prior to a prostate biopsy. A prospective clinical validation of ClarityDX Prostate was performed in a cohort of 377 Albertan men. The overall average AUC for ClarityDX Prostate in this population was 0.83, which was significantly higher than PSA alone. While PSA alone provided only 17% specificity for aggressive prostate cancer at a 95% sensitivity, ClarityDX Prostate was 56% specific for aggressive prostate cancer. We are now conducting a pivotal clinical validation study, in which up to 2,800 men will be enrolled to assess the performance of ClarityDX Prostate in a “real-world” clinical environment. Overall, we have established a robust µFCM EV platform for the development of novel and clinically viable diagnostic tests. Incorporating ClarityDX Prostate into routine prostate cancer screening could reduce the number of unnecessary biopsies by up to 40%. This abstract is also being presented as Poster B57. Citation Format: John D. Lewis, Robert J. Paproski, Desmond B. Pink, Catalina Vasquez, Eric Hyndman, Adrian Fairey, APCaRI. Detection of EV-based signatures in prostate cancer using microflow cytometry and machine learning [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr PR12.

Is COVID-19 Impacting Cancer Screening? A Survey of Prostate-Specific Antigen Test Requests during a Local Outbreak

Background. Although the ongoing coronavirus disease 2019 (COVID-19) pandemics is directly contributing to derange global health and fitness, the restrictive measures applied for containing the outbreaks are also impacting detection and management of many diseases, including cancers. This study aimed to establish if and how the COVID-19 outbreak may have impacted the practice of routine prostate cancer screening in Verona, Italy.Methods. We searched the laboratory information system of the Service of Laboratory Medicine of the University Hospitals of Verona to identify all test requests for prostate-specific antigen (PSA) and vitamin D (Vit D; i.e., the most locally requested immunochemical test) for outpatients during the last five years (December 10, 2016, to December 10, 2020). The weekly requests for these tests placed between February 25 and December 9, 2020, was compared to those placed during the period of the previous four years (i.e., 2016-2019).Results. The volume of test requests for both Vit D and PSA did not differ in 2020 compared to the previous four years. However, a dramatic decline was observed during the local lockdown period (between March 10 and May 17, 2020), with a median decrease of 76% for Vit D and 62% for PSA, respectively. This reduction was compensated by 13% increase for Vit D and 43% increase for PSA in the post-lockdown period. Conclusion. These results show that the lockdown period established during the first peak of the COVID-19 outbreak in Italy’s Verona province was associated with a dramatic decrease in routine prostate cancer screening.

Reducing overuse of PSA screening in primary care practices.

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

Prostate Cancer Screening in Men of African Descent: 15-year Results of the Tobago Prostate Cancer Survey

Objective: To compare all-cause-mortality in screening-detected prostate cancer cases versus non-cases after a median 12.2-year follow-up. Methods: In this prospective, population-based study of 3089 Afro-Caribbean men aged 40–79 years in Tobago, Trinidad and Tobago, West Indies, all men were screened for prostate cancer (serum prostate specific antigen and/or digital rectal exam) one to three times between 1997 and 2007 and followed for mortality to 2012. Among 502 men diagnosed with prostate cancer, 81 younger men underwent radical retropubic prostatectomy. Minimal treatment was available for older men. Survival curves compared all-cause-mortality in cases versus non-cases within 10-year age groups at first screening. Results: There were 350 all-cause-deaths over 34 089 person-years of follow-up. All-cause-survival curves in men aged 60 years or above at first screening did not diverge between cases and non-cases until after 10–12 years of follow-up (p &gt; 0.36). In contrast, among men first screened at age 50–59 years, survival was lower in cases, with survival curves diverging at seven years (p = 0.003). Survival in men aged 50–59 years who underwent prostatectomy was similar to survival in non-cases (p = 0.63). Conclusion: Among men aged 60 years or above, the absence of excess all-cause-mortality among screening-detected prostate cancer cases provides argument against the utility of routine prostate cancer screening in this older population of African descent. However, the significantly poorer survival in men aged 50–59 years with screening-detected prostate cancer, compared with screened men without prostate cancer, along with the potential for prostate cancer treatment to improve survival, supports the continuation of prostate cancer screening in this age group, pending further research to assess the risks and benefits.

African American Women's Involvement in Promoting Informed Decision-Making for Prostate Cancer Screening Among Their Partners/Spouses.

Routine prostate cancer screening is not recommended but African American men who are at higher risk for the disease should be offered the opportunity for shared decision-making with their health-care providers. This qualitative study sought to better understand the potential role of women in educating their male spouses/partners about prostate cancer screening. Nine focus groups were conducted (n = 52). Women were recruited from a variety of community venues. Those eligible were African American and married to or in a partnership with an African American male age ≥ 45. Women provide numerous types of support to their male partners in an effort to facilitate participation in preventive health care. While women agreed that they would like to educate their partners about prostate cancer screening, they had little information about screening guidelines or the potential harms and limitations. The current findings suggest that women are eager information-seekers and can disseminate information to men and facilitate their efforts to make more informed decisions about prostate cancer screening. Women should be included in educational interventions for to promote informed decision-making for prostate cancer screening.

RASTREIO DO CÂNCER DE PRÓSTATA: REVISÃO SISTEMÁTICA DA LITERATURA SOBRE AS PERSPECTIVAS MUNDIAIS

Introduction: Over the last decade increased the debate regarding prostate cancer screening and one of the main discussed topics were: when, in whom, and how to use PSA levels and/or DRE in a population based level. Once different institutions, government and RCT’s provide distinct, and sometimes, controversial recommendations, an attempt to summarize these studies is valuable. Aim: The study aimed to assess the actual state of the art of recommendations regarding the use of routine mass, selective, or opportunistic screening for prostate cancer with PSA levels and/or DRE. Material and methods: A narrative review of the literature was undertaken through MEDLINE, LILACS, Embase and Cochrane Library database, using pre-established search terms at University of Santo Amaro (Unisa), Sao Paulo, Brazil. Initial selection was performed based on title and abstracts assessment. Full-text analysis and critical appraisal of large, prospective RCT, comprehensive meta-analysis, National Taskforces, Medical and National organizations recommendations were accomplished. Results: Search strategy yielded 1046 citations. Thirteen recommendations had their levels of evidence and points of divergence or agreement evaluated. Conclusion: Existing RCT’s exhibit insufficient levels of agreement and additionally governmental guidelines are based on them. Some worldwide recommendations are currently summarized in opposite extremes. Until high grade of recommendation studies determine the best methodology and group of population that would benefit from screening, the shared decision-making in well-informed individuals currently seems to be an appropriated recommendation regarding the population screening of prostate cancer and, by now, it seems reasonable to forgo mass screening as a public heatlh policy.

Prostate-specific antigen testing for prostate cancer screening: A national survey of Canadian primary care physicians' opinions and practices.

In 2014, the Canadian Task Force on Preventive Health Care (CTFPHC) recommended against routine prostate cancer screening with the prostate-specific antigen (PSA) blood test. We surveyed Canadian primary care physicians (PCPs) to understand their opinions and attitudes towards prostate cancer screening in 2016. Twenty PCPs piloted the survey to assess its accessibility. We distributed a flyer to 19 633 PCPs as an insert in a large mailed package inviting them to attend a national meeting, and later promoted the survey at the meeting. Multinomial logistic regression models examined factors associated with agreement of key guideline statements and the overall benefit of PSA screening. A total of 1254 PCPs responded (rate of 6.4%); 54.7% of physicians aware of the CTFPHC recommendations report screening less often as a result. Overall, 55.6% of PCPs feel that the risks of PSA screening outweigh the benefits. On multivariable analysis, physicians who did not read the guidelines, did not have an academic appointment, or were in practice for over 20 years were significantly more likely to disagree with the statement that men 55-69 years old should not be screened for prostate cancer with PSA. Our national survey found that the prostate cancer screening practices of Canadian PCPs varies widely across physician demographic groups, with almost equal numbers for or against. This has significant ethical, medical, and legal implications. The poor response rate to highly incentivized survey request may suggest a reluctance or general apathy towards this subject because of the Task Force recommendations. Future efforts should provide physicians with objective guidance around PSA screening, incorporating input from all stakeholders, including PCPs, urologists, and patients.

Changes in stage at diagnosis of screenable cancers after the Affordable Care Act.

6521 Background: Extensive evidence links inadequate insurance with later stage at cancer diagnosis, particularly for cancers that can be detected by screening. The Affordable Care Act (ACA) implemented in 2014 has substantially increased insurance coverage for Americans 18-64 years old. This study aims to examine any changes in stage at diagnosis after the ACA for the following cancers for which screening is recommended for individuals at risk: female breast cancer, colorectal cancer, cervical cancer, prostate cancer, and lung cancer. Methods: We used National Cancer Data Base, a nationally hospital-based cancer registry capturing 70% new cancer cases in the US each year, to identify nonelderly cancer patients with screening-appropriate age who were diagnosed during 2013-2014. The percentage of stage I disease was calculated for each cancer type before (2013 Q1-Q3) and after (2014 Q2-Q4) the ACA. 2013 Q4-2014 Q1 was excluded as a washout/phase-in period. Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated using log-binomial models controlling for age, race/ethnicity and sex if applicable. Results: 121,855 female breast cancer patients aged 40-64 years, 39,568 colorectal cancer patients aged 50-64 years, 11,265 cervical cancer patients aged 21-64 years, 59,626 prostate cancer patients aged 50-64 years, and 41,504 lung cancer patients aged 55-64 years were identified. After the implementation of the ACA, the percentage of stage I disease increased statistically significantly for female breast cancer (47.8% vs. 48.9%; PR = 1.02 [95%CI 1.01-1.03]), colorectal cancer (22.8% vs. 23.7%; PR = 1.04 [95%CI 1-1.08]), and lung cancer (16.6% vs. 17.7%; PR = 1.06 [95% CI 1.02-1.11]). A shift to stage I disease was also observed for cervical cancer (47.2% vs. 48.7%; PR = 1.02 [95% CI 0.98-1.06]) although not statistically significant. In contrast, the percentage of stage I decreased for prostate cancer (18.5% vs. 17.2%; PR = 0.93 [95%CI 0.9-0.96]) in 2014. Conclusions: The implementation of the ACA is associated with a shift to early stage at diagnosis for all screenable cancers except prostate cancer, which may reflect the recent US Preventive Services Task Force recommendations against routine prostate cancer screening.

Association between features of patient-provider discussions and routine prostate-specific antigen testing.

IntroductionAlthough the US Preventive Services Task Force recommends against routine prostate cancer screening with prostate-specific antigen (PSA) testing, specialty organizations support screening via shared decision making between providers and selected patients. While discussions about advantages and disadvantages of testing are a feature of patient-centered care, it is unclear how provider recommendations and the presence of a personal doctor influence testing in the presence of such discussions.Materials and methodsWe used the 2013 Behavioral Risk Factor Surveillance System to identify 1,737 male respondents surveyed about their PSA testing decisions. We describe the prevalence of provider recommendations and utilize weighted multivariable logistic regression models to examine the impact of provider recommendations and presence of a personal doctor on routine testing while accounting for patient-provider discussions about advantages and disadvantages.ResultsThe majority (70.4%) of respondents reported some form of discussion with providers about testing and most underwent screening in accordance with provider recommendations. In multivariable analyses, men whose providers had never recommended PSA test were less likely to receive screening [OR 0.03, 95% CI (0.02–0.05)], and patients who did not identify a personal doctor in their care were less likely to undergo testing [OR 0.12, 95% CI (0.04–0.32)].DiscussionProvider recommendations and having a personal doctor are associated with routine PSA testing. These findings suggest that providers and policymakers should be aware of how the content and context of communication with patients, beyond discussions of risks and benefits, can influence routine PSA testing behaviors.

What Have Patients Been Hearing From Providers Since the 2012 USPSTF Recommendation Against Routine Prostate Cancer Screening?

In this study we aimed to determine the relationship between prostate-specific antigen (PSA)-related information obtained from the provider and PSA test uptake. With recent focus on patient-provider communication (PC) and the guidelines recommending against PSA tests for prostate cancer (PCa), PC regarding the PSA test might affect PSA screening rates. We used the fourth edition of the Health Information National Trends Survey, a nationally-representative US survey on the use of cancer-related information. The survey was conducted in 3 cycles: October 2011 to January 2012 (cycle 1); October 2012 to January 2013 (cycle 2); September 2013 to October 2013 (cycle 3). Logistic regression was used to study the effect of PC on respondents' uptake of the PSA test. Most of the respondents were 51 to 65 years old, white, with college or higher education, were married, and had health insurance. PC regarding the PSA test greatly increased the chances of screening for PCa using the PSA test in all 3 cycles (odds ratio [OR], 2.51 [95% confidence interval (CI), 2.03-3.10] in cycle 1; OR, 3.50 [95% CI, 2.51-4.88] in cycle 2; OR, 2.69 [95% CI, 2.02-3.58] in cycle 3). Our study showed that PC increased the likelihood of patients undergoing PSA screening. In light of the 2012 US Preventive Services Task Force guidelines recommending against screening for PCa, PC seemed to have an opposite effect. Although updated PC that educates patients on the risks and benefits of PSA screening is needed, patients classically overemphasize benefits and underemphasize risks-which might increase rather than decrease PSA screening rates.

Active surveillance in Canadian men with low-grade prostate cancer.

Recent guidelines recommend against routine screening for prostate cancer, partly because of the risks associated with overtreatment of clinically indolent tumours. We aimed to determine the proportion of patients whose low-grade prostate cancer was managed by active surveillance instead of immediate treatment. We reviewed data for patients who were referred to the Ottawa regional Prostate Cancer Assessment Clinic with abnormal results for prostate-specific antigen (PSA) or prostate examination between Apr. 1, 2008, and Jan. 31, 2013. Patients with subsequent biopsy-proven low-grade (Gleason score 6) cancer were included. Active surveillance was defined a priori as monitoring by means of PSA, digital rectal examination and repeat biopsies, with the potential for curative-intent treatment in the event of disease progression. Of 477 patients with low-grade cancer, active surveillance was used for 210 (44.0%), and the annual proportion increased from 32% (11/34) in 2008 to 67% (20/30) in 2013. Factors associated with immediate treatment were palpable tumour, PSA density above 0.2 ng/mL(2) and more than 2 positive biopsy cores. Factors associated with surveillance were age over 70 years and higher Charlson comorbidity index. Of 173 men who received immediate surgical treatment, 103 (59.5%) had higher-grade or advanced-stage disease on final pathologic examination. Of the 210 men with active surveillance, 62 (29.5%) received treatment within a median of 1.3 years, most commonly (52 [84%]) because of upgrading of disease on the basis of surveillance biopsy. Active surveillance has become the most common management strategy for men with low-grade prostate cancer at our regional diagnostic centre. Factors associated with immediate treatment reflected those that increase the risk of higher-grade tumours.

Trends in United States Prostate Cancer Incidence Rates by Age and Stage, 1995-2012.

The advent of PSA testing in the late 1980s substantially increased prostate cancer incidence rates. Concerns about overscreening and overdiagnosis subsequently led professional guidelines (circa 2000 and later) to recommend against routine PSA testing. We evaluated trends in prostate cancer incidence, including late-stage diagnoses, from 1995 through 2012. We used joinpoint regression analyses to evaluate all-, localized/regional-, and distant-stage prostate cancer incidence trends based on Surveillance, Epidemiology, and End Results (SEER) data. We stratified analyses by age (50-69, 70+). We reported incidence trends as annual percent change (APC). Overall age-adjusted incidence rates for localized/regional stage prostate cancer have been declining since 2001, sharply from 2010 to 2012 [APC, -13.1; 95% confidence intervals (CI), -23.5 to -1.3]. Distant-stage incidence rates have declined since 1995, with greater declines from 1995 to 1997 (APC, -8.4; 95% CI, -2.3 to -14.1) than from 2003 to 2012 (APC, -1.0; 95% CI, -1.7 to -0.4). Distant-stage incidence rates declined for men ages 70+ from 1995 to 2012, but increased in men ages 50 to 69 years from 2004 to 2012 (APC, 1.7; 95% CI, 0.2 to 3.2). Guidelines discouraging routine prostate cancer screening were temporally associated with declining localized/regional prostate cancer incidence rates; however, incidence rates of distant-stage disease are now increasing in younger men. This trend may adversely affect prostate cancer mortality rates.

Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida.

To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems.

Informed Decision-Making and Satisfaction with a Church-Based Men's Health Workshop Series for African-American Men: Men-Only vs. Mixed-Gender Format.

Prostate cancer incidence and mortality are highest among African-American men, and coupled with the controversy around routine prostate cancer screening, reaching African-American men with interventions to help them make an informed decision about whether or not to be screened is critical. This study compares two approaches to delivering a church-based peer community health advisor intervention consisting of a series of four men's health workshops on informed decision-making for prostate cancer screening. In the men-only group, male community health advisors teach group workshops consisting only of men. In the health partner group, male-female pairs of community health advisors teach workshops in a mixed-gender format in which enrolled men are asked to invite a significant woman in their lives (e.g., wife/partner, sister, daughter, friend) with them to the workshops. Eighteen African-American churches were randomized to receive one of the two approaches, and 283 eligible men enrolled in the intervention. Main findings suggested that the workshops had an impact on stage of decision-making, and this increased significantly over time in the health partner group only. The intervention was highly rated by men in both groups, and these ratings increased over time, with some study group differences. Within-workshop study group differences favored the health partner group in some instances; however, men in the men-only groups reported greater increases in their ratings of trust in the workshops over time. The health partner intervention strategy appears to be promising for reaching men of color with health information.

Tumor Microenvironment–Released Peptides: Could They Form the Basis for an Early-Diagnosis Breast Cancer Test?

Despite expectations that cancer biomarkers could revolutionize cancer diagnosis and treatment, this promise did not bear fruit (1). That is because cancer-specific circulating biomarkers in serum capable of being measured with a simple technique and identifying cancer in noncancer patients with high sensitivity and specificity have not yet been found. The relatively few clinical biomarkers currently used are more useful for patient management than for early diagnosis or population screening (2). Given that some cancers are relatively rare (e.g., ovarian cancer), a screening test for early diagnosis must have an extremely high specificity (e.g., >99%) and a sensitivity sufficient (e.g., >80%) to achieve a reasonable positive predictive value (e.g., ≥10%) (3). Prostate-specific antigen, the most studied screening cancer biomarker for prostate cancer, has recently been reexamined in prospective clinical trials, and the results are controversial (4–6). That is why the US Preventive Services Task Force does not currently recommend routine screening for prostate cancer (7). Currently available breast cancer biomarkers in the circulation, such as CA15–3 and the associated antigen CA27.29, which recognize different epitopes on the same antigen (mucin 1), have relatively poor characteristics, such as a 30% sensitivity for early-stage disease, 60%–70% sensitivity in advanced cases, and increased values in patients with benign conditions, including ovarian cysts, benign breast diseases, and benign liver diseases. Carcinoembryonic antigen has similar limitations. These biomarkers do not have a place in early-disease diagnosis or in population screening (8). The most widely used screening method for breast cancer is mammography. This procedure is not recommended for women younger than 40 years. For older women, its use is controversial, because women with …