Undergoing Prostate-specific Antigen Screening Research Articles

The Association of County-level Prostate-specific Antigen Screening with Metastatic Prostate Cancer and Prostate Cancer Mortality

Background and objectiveThere exists ongoing debate about the benefits and harms of prostate-specific antigen (PSA) screening for prostate cancer. This study sought to evaluate the association of county-level PSA screening rates with county-level incidence of metastatic prostate cancer and prostate cancer mortality in the USA. MethodsThis ecological study used data from the 2004–2012 Behavioral Risk Factor Surveillance System (BRFSS) to build a multilevel mixed-effect model with poststratification using US Census data to estimate county-level PSA screening rates for all 3143 US counties adjusted for age, race, ethnicity, and county-level poverty rates. The exposure of interest was average county-level PSA screening rate from 2004 to 2012, defined as the proportion of men aged 40–79 yr who underwent PSA screening within the prior 2 yr. The primary outcomes were county-level age-adjusted incidence of regional/distant prostate cancer during 2015–2019 and age-adjusted prostate cancer mortality during 2016–2020. Key findings and limitationsA total of 416221 male BRFSS respondents aged 40–79 yr met the inclusion criteria and were used in the multilevel mixed-effect model. The model was poststratified using 63.4 million men aged 40–79 yr from all 3143 counties in the 2010 Decennial Census. County-level estimated PSA screening rates exhibited geographic variability and were pooled at the state level for internal validation with direct BRFSS state-level estimates, showing a strong correlation with Pearson correlation coefficients 0.77–0.90. A 10% higher county-level probability of PSA screening in 2004–2012 was associated with a 14% lower county-level incidence of regional/distant prostate cancer in 2015–2019 (rate ratio 0.86, 95% confidence interval [CI] 0.85–0.87, p < 0.001) and 10% lower county-level prostate cancer mortality in 2016–2020 (rate ratio 0.90, 95% CI 0.89–0.91, p < 0.001). Conclusions and clinical implicationsIn this population-based ecological study of all US counties, higher PSA screening rates were associated with a lower incidence of regional/distant prostate cancer and lower prostate cancer mortality at extended follow-up. Patient summaryUS counties with higher rates of prostate-specific antigen (PSA) screening had significantly lower rates of metastatic prostate cancer and prostate cancer mortality in subsequent years. These data may inform shared decision-making regarding PSA screening for prostate cancer.

Prostate Specific Antigen Screening on a Nationwide Level: Featuring the Contribution of Race and Life Expectancy in Decision Making

BackgroundEstimation of life expectancy (LE) is important for the relative benefit of prostate specific antigen (PSA) screening. Limited data exists regarding screening for Black men with extended LE. The aim of the current study was to assess temporal trends in screening in United States (US) Black men with limited vs. extended LE, using a nationally representative dataset. Materials and MethodsUsing the National Health Institution Survey (NHIS) 2000 to 2018, men aged ≥40 without prior history of prostate cancer (PCa) who underwent PSA screening in the last 12 months were stratified into limited LE (ie, LE <15 years) and extended LE (ie, LE≥15 years) using the validated Schonberg index. LE-stratified temporal trends in PSA screening were analyzed for all men, and then in Black men. Weighted multivariable analyses and dominance analyses identified the predictors of PSA screening. ResultsPSA screening declined over the study period both for all eligible men with limited and extended LE, particularly between NHIS 2008 and 2013 (27.9%-20.7% in the extended). Screening increased significantly in Black men with extended LE (17.6% in 2010-25.7% in 2018). However, LE was not an independent predictor of screening in the Black cohort. Prior recipient of colonoscopy (55%-57%) and visit to health care provider (24%-32%) were the most important determinants for screening. ConclusionFor US men with extended LE, only 1 in 4 receive PSA screening, with a decline over the study-period. Screening rates increased for Black men. However, these changes were not driven by LE consideration itself, but participation in other screenings and access to a provider.

Racial Disparities in Prostate Cancer Screening: The Role of Shared Decision Making

The 2018 U.S. Preventive Services Task Force recommendations endorsed shared decision making for men aged 55-69 years, encouraging consideration of patient race/ethnicity for prostate-specific antigen screening. This study aimed to assess whether a proxy shared decision-making variable modified the impact of race/ethnicity on the likelihood of prostate-specific antigen screening. A cross-sectional analysis of men aged between 55 and 69 years, who responded to the prostate-specific antigen screening portions of the 2020 U.S.-based Behavioral Risk Factor Surveillance System survey, was performed between September and December 2022. Complex sample multivariable logistic regression models with an interaction term combining race and estimated shared decision making were used to test whether shared decision making modified the impact of race/ethnicity on screening. Of a weighted sample of 26.8 million men eligible for prostate-specific antigen screening, 25.7% (6.9 million) reported for prostate-specific antigen screening. In adjusted analysis, estimated shared decision making was a significant predictor of prostate-specific antigen screening (AOR=2.65, 95% CI=2.36, 2.98, p<0.001). The interaction between race/ethnicity and estimated shared decision making on the receipt of prostate-specific antigen screening was significant (pint=0.001). Among those who did not report estimated shared decision making, both non-Hispanic Black (OR=0.77, 95% CI=0.61, 0.97, p=0.026) and Hispanic (OR=0.51, 95% CI=0.39, 0.68, p<0.001) men were significantly less likely to undergo prostate-specific antigen screening than non-Hispanic White men. On the contrary, among respondents who reported estimated shared decision making, no race-based differences in prostate-specific antigen screening were found. Although much disparities research focuses on race-based differences in prostate-specific antigen screening, research on strategies to mitigate these disparities is needed. Shared decision making might attenuate the impact of race/ethnic disparities on the likelihood of prostate-specific antigen screening.

Disparities Associated with Shared Decision-making in Prostate Cancer Screening

BackgroundProstate cancer screening guidelines recommend shared decision-making (SDM) regarding prostate-specific antigen (PSA) testing. However, it is unclear who undergoes SDM and whether any disparities exist. ObjectiveTo examine sociodemographic differences in participation of SDM and its association with PSA testing in prostate cancer screening. Design, setting, and participantsA retrospective cross-sectional study was conducted among men aged 45–75 yr undergoing PSA screening, using the 2018 National Health Interview Survey database. The evaluated sociodemographic features included age, race, marital status, sexual orientation, smoking status, working status, financial difficulty, US geographic regions, and cancer history. Questions regarding self-reported PSA testing and whether respondents discussed its advantages and disadvantages with their healthcare provider were analyzed. Outcome measurements and statistical analysisOur primary outcome was to evaluate the possible associations between various sociodemographic factors and undergoing PSA screening and SDM. We used multivariable logistic regression analyses to detect potential associations. Results and limitationsA total of 59596 men were identified, of whom 5605 answered the question regarding PSA testing, with 2288 (40.6%) undergoing PSA testing. Of these men, 39.5% (n = 2226) discussed the advantages and 25.6% (n = 1434) discussed the disadvantages of PSA testing. On a multivariable analysis, older (odds ratio [OR] 1.092; 95% confidence interval [CI] 1.081–1.103, p < 0.001) and married (OR 1.488; 95% CI 1.287–1.720, p < 0.001) men were more likely to undergo PSA testing. Although Black men were more likely to discuss PSA advantages (OR 1.421; 95% CI 1.150–1.756, p = 0.001) and disadvantages (OR 1.554; 95% CI 1.240–1.947, p < 0.001) than White men, this did not correlate with higher rates of PSA screening (OR 1.086; 95% CI 0.865–1.364, p = 0.477). The lack of important clinical data remains a limitation. ConclusionsOverall, SDM rates were low. Older and married men had an increased likelihood of SDM and PSA testing. Despite higher rates of SDM, Black men had similar rates of PSA testing to White men. Patient summaryWe evaluated sociodemographic differences in shared decision-making (SDM) in prostate cancer screening using a large national database. We found that SDM had varying results in different sociodemographic groups.

Racial Disparities in Patient Perspectives on Shared Decision Making in Prostate Cancer Screening Following 2018 Guideline Changes

<h3>Purpose/Objective(s)</h3> The 2018 US Preventive Services Task Force (USPSTF) guidelines recommend individualizing prostate cancer screening in 55–69-year-old men with discussion of risks, benefits, values, and preferences. Given the two-fold higher incidence of prostate cancer in African-American (AA) compared to non-Hispanic white (NHW) men, we compared patient perspectives on shared decision making on prostate specific antigen (PSA) screening, hypothesizing that the rate of screening and discussion of risks/benefits would not be commensurate with the relative risk between these two groups. <h3>Materials/Methods</h3> We used the Behavioral Risk Factor Surveillance System's nationwide survey data on screening-eligible men based on these guidelines to assess patterns of PSA testing. We also performed subset analysis of men interviewed on perspectives of shared decision making for PSA screening. We used weighted Poisson regression and Kruskal-Wallis rank sum tests to compare the rate of PSA screening in the past 2 years; rate of shared, individual, and provider decision to perform PSA testing; and patient-reported education on PSA advantages and disadvantages. <h3>Results</h3> We identified 43,685 men (40,301 NHW and 3,384 AA) aged 55-70 interviewed about PSA screening in 2020. AA men were more likely than NHWs to be uninsured (10.5% versus 5.6% p<0.001) and to report cost barriers to accessing care (10.7% versus 5.5% p<0.001). AA men reported 12.8% lower rate of screening (95% confidence interval (95% CI) -12.6 to -13.0 p<0.001) than NHWs. Estimates remained similar and statistically significant in multivariable and sequential regression analyses adjusting for socioeconomic and care access factors. AA and NHW men reported similar rates of education regarding advantages of PSA screening: 54.6% and 55.4%, respectively (p = 0.38), although AA men were significantly more likely than NHWs to report education on disadvantages of screening: 32% versus 24.6% (p<0.001). Finally, in subset analysis of 735 men asked about who made the decision to undergo PSA screening, AA men were 31.8% less likely to report a shared decision with their provider (95% CI -30.2 to -33.3 p<0.001) and 14.6% (95% CI 12.5 to 16.6 p<0.001) more likely to report making the decision themselves than NHWs. <h3>Conclusion</h3> Despite prostate cancer being more common and fatal in AA than NHW men, PSA screening and education patterns do not reflect this increased risk even when adjusting for socioeconomic and health access disparities. In addition to lower PSA screening rates, AA men reported lower rates of shared decision making than NHW men and a greater recollection of education on the disadvantages of PSA screening. This could represent distrust in the medical system by AA men, as well as systemic racial bias leading to reduced screening or poorer communication with AA men. Overall, these findings suggests that there remains room for improvement in how physicians address risk stratification and racial biases in counseling patients on PSA screening.

Increasing the uptake in a general practice prostate cancer screening programme

BackgroundProstate cancer (PC) is the second most common cause of cancer deaths among males worldwide. Prostate-specific antigen (PSA) is a predictive indicator of prostate pathology. Men with elevated PSA levels...

Does Veteran Status Mitigate Racial Disparities in Prostate Cancer Screening? Analysis of Prostate Specific Antigen Screening Patterns in the 2018 Behavioral Risk Factor Surveillance System Data.

We examined the effect of veteran status on prostate specific antigen (PSA) screening and whether health coverage available to veterans mitigates racial disparities in PSA screening. We conducted a cross-sectional analysis of non-Hispanic White (NHW) and non-Hispanic Black (NHB) men aged between 55 and 69 years who responded to the PSA screening survey in the 2018 Behavioral Risk Factor Surveillance System data. Complex weighted logistic regression models were used to evaluate predictors of PSA screening. Screening prevalence was 43% in veterans (95% CI 42%-45%) versus 40% in nonveterans (95% CI 39%-40%, p <0.001). Among nonveterans, the prevalence of PSA screening was significantly lower in NHB (34%, 95% CI 31%-37%) versus NHW men (40%, 95% CI 39%-41%, p <0.001). Among veterans, NHB men had a significantly higher screening prevalence (48%, 95% CI 43%-54%) versus NHW men (42%, 95% CI 41%-44%, p=0.04). In adjusted analysis, veteran status (OR 1.11, 95% CI 1.01-1.21, p=0.02) and NHB race (OR 1.29, 95% CI 1.12-1.48, p <0.001) were significantly associated with receipt of PSA screening. Given that we found an interaction between veteran status and race (pint=0.03), a marginal analysis was performed. Compared to NHB nonveterans, NHB veterans had higher odds of undergoing PSA screening (OR 1.46, 95% CI 1.11-1.91, p=0.01). However, this association was not demonstrated when comparing NHW veterans versus nonveterans (OR 1.06, CI 0.97-1.16, p=0.22). Veteran status and NHB race were found to be independent predictors of PSA screening. The interaction between veteran status and race suggests that access to health coverage available to veterans may mitigate racial differences in prostate cancer screening behaviors. Further studies are needed to translate such findings into the civilian health care system.

Prostate Cancer Incidence and Mortality Following a Negative Biopsy in a Population Undergoing PSA Screening

ObjectiveTransrectal ultrasound guided biopsy for diagnostic workup for prostate cancer (PCa) has a substantial false negative rate. We sought to estimate PCa incidence and mortality following negative biopsy in a cohort of men undergoing prostate cancer screening. Subjects and MethodsThe Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial randomized participants 55-74 years to an intervention vs control arm. Intervention arm men received annual prostate-specific antigen (PSA) tests for 6 years and digital rectal exams (DRE) for 4 years. We examined the cohort of men with a positive PSA (> 4 ng/mL) or DRE screen followed within one year by a negative biopsy. PCa incidence and mortality rates from time of first negative biopsy were analyzed as a function of PSA level at diagnosis and other factors. Cumulative incidence and mortality rates accounting for competing risk were estimated. Multivariate proportional hazards regression was utilized to estimate hazard ratios (HRs) of PCa outcomes by PSA level, controlling for age and race. ResultsThe negative biopsy cohort included 2855 men. Median (25th/75th) age at biopsy was 65 (61/69) years; biopsies occurred between 1994 and 2006. Median (25/75th) follow-up was 13.2 (6.5/16.8) years for incidence and 16.6 (12.3/19.2) years for mortality. 740 PCa cases were diagnosed, with 33 PCa deaths. Overall 20-year cumulative PCa incidence and mortality rates were 26.4% (95% CI: 24.8-28.1) and 1.2% (95% CI: 0.9-1.7), respectively. HRs for PCa incidence and mortality increased significantly with increasing PSA. ConclusionThe mortality rate from PCa through 20 years following a negative biopsy is low.

Prostate-specific antigen testing in the disabled population: A cross-sectional analysis of the Health Information National Trends Survey (HINTS).

e17000 Background: Disabled patients are a unique minority population that may have lower literacy levels and difficulty communicating with physicians. Furthermore, their knowledge for cancer prevention recommendations is unknown. Herein, we aim to compare prostate-specific antigen (PSA) testing rates and associated predictors among disabled men and non-disabled men in the USA. Methods: We performed a cross-sectional study utilizing the Health Information National Trends Survey (HINTS) to analyze factors predicting PSA testing rates in men with disabilities (disabled, deaf, blind). Multivariable logistic regression models were used to determine clinically significant predictors of PSA testing in men with disabilities compared to that of the healthy cohort. Results: A total of 782 (14.6%) disabled men were compared to 4,569 (85.4%) non-disabled men. Disabled men were older with a mean age of 65.0 ± 14.2 vs. 55.0 ± 15.9 years (p &lt; 0.001). On multivariable analysis, after adjusting for all available confounders including race, age, geographical region, survey year, marital status, health insurance, healthcare provider, amongst others, men with any disability were less likely to undergo PSA screening (OR 0.772, 95% CI 0.623-0.956, p = 0.018). Variables associated with increased PSA screening rates included age, having a healthcare provider or health insurance, and living with a partner. Although prostate cancer detection rates were shown to be higher among disabled men, this did not reach statistical significance. Conclusions: Our data suggests that significant inequalities in PSA screening exist among men with disabilities in the USA, with disabled men, especially the deaf and the blind, being less likely to be offered PSA screening. There is a clear need to implement strategies to reduce existing gaps in the care of disabled men and strive to reach equality in PSA screening in this unique population.

Multilevel Small Area Estimation of Prostate-Specific Antigen Screening Test in the United States by Age Group: 2018 Behavioral Risk Factor Surveillance System.

In 2018, the US Preventive Services Task Force (USPSTF) recommended prostate cancer screening for men aged 55 to 69 years who express a preference for being screened after being informed about and understanding prostate-specific antigen (PSA) test benefits and risks. USPSTF recommended against screening men aged ≥70 years. We aim to generate county-level prevalence estimates, masked by national and state estimates, to identify counties with high PSA screening prevalence. We fitted multilevel logistic regression mixed models for 4 age groups (≥40, 40 to 54, 55 to 69, ≥70 years), using data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 116,654) and other sources. We evaluated consistency between our model-based state and BRFSS direct state estimates with Spearman and Pearson correlation coefficients. PSA screening prevalence increased with increasing age groups: 7.7% for men aged 40 to 54 years, 27.2% for men aged 55 to 69 years, and 33.7% among men age ≥70 years, and was largely clustered in the South and Appalachia. Many county estimates among men aged ≥70 years exceeded 40%, especially in the South. Correlation coefficients were 0.94 for men aged ≥40, and ≥0.85 for men aged 40 to 54 years, 55 to 69 years, and ≥70 years. PSA screening was highest among men ≥70 years, for whom it is not recommended, and in the South among all age groups. Screening varied substantially within states. In 2018, on average, more than 1 in 4 men aged 55 to 69 years and 1 in 3 men aged ≥70 years underwent PSA screening in the prior year, suggesting potential overuse among some men.

Racial Disparities in Prostate Specific Antigen Screening and Referral to Urology in a Large, Integrated Health Care System: A Retrospective Cohort Study.

Contemporary trends and racial disparities in prostate cancer screening and referral to urology for prostate cancer risk are not well characterized, despite consensus that Black men are at higher risk for poor prostate cancer outcomes. The objective of this study was to characterize current racial disparities in prostate cancer screening and referral from primary care to urology for prostate cancer concern within our large, integrated health care system. This retrospective cohort study used data from Atrium Health's enterprise data warehouse, which includes patient information from more than 900 care locations across North Carolina, South Carolina and Georgia. We included all men seen in the ambulatory or outpatient setting between 2014 and 2019 who were ≥40 years old. Clinical and demographic data were collected for all men, including age and race. Racial outcomes were reported for all groups with >2% representation in the population. Between-group comparisons were determined using chi-squared analysis, Wilcoxon rank sum testing and multivariable logistic regression, with significance defined as p <0.05. We observed a significant decrease in prostate specific antigen testing across all age and racial groups in a cohort of 606,985 men at Atrium Health, including 87,189 Black men, with an overall relative decline of 56%. As compared to White men, Black men were more likely to undergo prostate specific antigen testing (adjusted OR 1.24, 95% CI 1.22-1.26) and be referred to urology for prostate cancer (adjusted OR 1.94, 95% CI 1.75-2.16). There was a continued significant decline in prostate cancer screening between 2014 and 2019. Despite having modestly elevated odds of being screened for prostate cancer compared to White men, Black men are relatively underscreened when considering that those who undergo prostate specific antigen screening are more likely to be referred by primary care to urology for additional prostate cancer diagnostic evaluation.

Randomized trial of community health worker-led decision coaching to promote shared decision-making for prostate cancer screening among Black male patients and their providers

BackgroundBlack men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality.MethodsWe proposed a CHW-led decision-coaching program to facilitate SDM for prostate cancer screening discussions in Black men at a primary care FQHC. This study enrolled Black men who were patients at the participating clinical site and up to 15 providers who cared for them. We estimated to recruit 228 participants, ages 40–69 to be randomized to either (1) a decision aid along with decision coaching on PSA screening from a CHW or (2) receiving a decision aid along with CHW-led interaction on modifying dietary and lifestyle to serve as an attention control. The independent randomization process was implemented within each provider and we controlled for age by dividing patients into two strata: 40–54 years and 55–69 years. This sample size sufficiently powered the detection differences in the primary study outcomes: knowledge, indicative of decision quality, and differences in PSA screening rates.Primary outcome measures for patients will be decision quality and decision regarding whether to undergo PSA screening. Primary outcome measures for providers will be acceptability and feasibility of the intervention. We will examine how decision coaching about prostate cancer screening impact patient-provider communication. These outcomes will be analyzed quantitatively through objective, validated scales and qualitatively through semi-structured, in-depth interviews, and thematic analysis of clinical encounters. Through a conceptual model combining elements of the Preventative Health Care Model (PHM) and Informed Decision-Making Model, we hypothesize that the prostate cancer screening decision coaching intervention will result in a preference-congruent decision and decisional satisfaction. We also hypothesize that this intervention will improve physician satisfaction with counseling patients about prostate cancer screening.DiscussionDecision coaching is an evidence-based approach to improve decision quality in many clinical contexts, but its efficacy is incompletely explored for PSA screening among Black men in primary care. Our proposal to evaluate a CHW-led decision-coaching program for PSA screening has high potential for scalability and public health impact. Our results will determine the efficacy, cost-effectiveness, and sustainability of a CHW intervention in a community clinic setting in order to inform subsequent widespread dissemination, a critical research area highlighted by USPSTF.Trial registrationThe trial was registered prospectively with the National Institute of Health registry (www.clinicaltrials.gov), registration number NCT03726320, on October 31, 2018.

Fitness and prostate cancer screening, incidence, and mortality: Results from the Henry Ford Exercise Testing (FIT) Project.

The relation between cardiorespiratory fitness (CRF) and prostate cancer is not well established. The objective of this study was to determine whether CRF is associated with prostate cancer screening, incidence, or mortality. The Henry Ford Exercise Testing Project is a retrospective cohort study of men aged 40 to 70 years without cancer who underwent physician-referred exercise stress testing from 1995 to 2009. CRF was quantified in metabolic equivalents of task (METs) (<6 [reference], 6-9, 10-11, and ≥12 METs), estimated from the peak workload achieved during a symptom-limited, maximal exercise stress test. Prostate-specific antigen (PSA) testing, incident prostate cancer, and all-cause mortality were analyzed with multivariable adjusted Poisson regression and Cox proportional hazard models. In total, 22,827 men were included, of whom 739 developed prostate cancer, with a median follow-up of 7.5 years. Men who had high fitness (≥12 METs) had an 28% higher risk of PSA screening (95% CI, 1.2-1.3) compared with those who had low fitness (<6 METs. After adjusting for PSA screening, fitness was associated with higher prostate cancer incidence (men aged <55 years, P = .02; men aged >55 years, P ≤ .01), but not with advanced prostate cancer. Among the men who were diagnosed with prostate cancer, high fitness was associated with a 60% lower risk of all-cause mortality (95% CI, 0.2-0.9). Although men with high fitness are more likely to undergo PSA screening, this does not fully account for the increased incidence of prostate cancer seen among these individuals. However, men with high fitness have a lower risk of death after a prostate cancer diagnosis, suggesting that the cancers identified may be low-risk with little impact on long-term outcomes.

Prostate Cancer Screening Patterns Among Sexual and Gender Minority Individuals

One in six gay and bisexual men will be diagnosed with prostate cancer in their lifetime. Lesbian, gay, bisexual, and transgender (LGBT) populations are under-represented in cancer research, and guidelines on prostate-specific antigen (PSA) screening are limited. We performed a cross-sectional study to assess patterns of PSA screening and decision-making in this cohort. The Behavioral Risk Factor Surveillance System database was queried for LGBT adults for 2014–2016 and 2018, when PSA questions were asked in the annual survey. Multivariable logistic regression was performed to evaluate the association of LGBT status with PSA screening and informed and shared decision-making. A total of 164 370 participants were eligible for PSA screening, representing a weighted estimate of 1.2 million LGBT individuals. Compared to cisgender (CG) straight individuals, CG gay/bisexual cohorts were more likely to participate in PSA screening (CG gay: odds ratio [OR] 1.07; p < 0.001; CG bisexual: OR 1.06; p < 0.001). CG gay participants were more likely to make informed decisions (OR 1.10; p < 0.001) and engage in shared decision-making (OR 2.55; p < 0.001). Select gay populations were more likely to undergo PSA screening recommended by their clinicians and participate in informed and shared decision-making. Patient summaryThis large study of sexual and gender minorities in the USA suggests that gay and bisexual individuals were more likely to undergo prostate cancer screening and that select gay individuals were more likely to make informed and shared decisions. However, transgender individuals were less likely to have prostate cancer screening and make informed decisions.

Impact of health literacy on shared decision making for prostate-specific antigen screening in the United States.

Current guidelines endorse shared decision making (SDM) for prostate-specific antigen (PSA) screening. The relationship between a patient's health literacy (HL) and SDM remains unclear. In the current study, the authors sought to identify the impact of HL on the rates of PSA screening and on the relationship between HL and SDM following the 2012 US Preventive Services Task Force recommendations against PSA screening. Using data from the 2016 Behavioral Risk Factor Surveillance System, the authors examined PSA screening in the 13 states that administered the optional "Health Literacy" module. Men aged ≥50 years were examined. Complex samples multivariable logistic regression models were computed to assess the odds of undergoing PSA screening. The interactions between HL and SDM were also examined. A weighted sample of 12.249 million men with a rate of PSA screening of 33.4% were identified. Approximately one-third self-identified as having optimal HL. Rates of PSA screening were found to be highest amongst the highest HL group (42.2%). Being in this group was a significant predictor of undergoing PSA screening (odds ratio, 1.214; 95% confidence interval, 1.051-1.403). There was a significant interaction observed between HL and SDM (P for interaction, <.001) such that higher HL was associated with a lower likelihood of undergoing PSA screening when SDM was present. In the uncertain environment of multiple contradictory screening guidelines, men who reported higher levels of HL were found to have higher levels of screening. The authors demonstrated that increased HL may reduce the screening-promoting effect of SDM. These findings highlight the dynamic interplay between HL and SDM that should inform the creation and promulgation of SDM guidelines, specifically when considering patients with low HL.

Sudden PSA rise to ≥20 ng/ml and prostate cancer diagnosis in the United States: A population-based study.

While prostate-specific antigen (PSA) screening protocols vary, many clinicians have anecdotes of screened men with low PSA levels that rise significantly and are associated with high-risk prostate cancer (PC). We sought to better understand the frequency of high-risk cases that appear suddenly in a screened population. We utilized data from a Commercial and Medicare advantage claims database to identify all US men ages 50 and above undergoing PSA screening who then had a sudden interval rise in PSA (e.g., PSA ≥ 20) and diagnosis of PC. We determined associations with age, race, screening intensity, and baseline PSA levels. In all, 526,120 men met entry criteria with an average age of 60.7 and follow-up of 5.6 years. As the baseline PSA increased, the rate of high-risk PC increased from 2/10,000 persons among men with the lowest baseline PSA (<1 ng/ml) to 14/10,000 person-years among men with a baseline PSA < 5 ng/ml. Moreover, as a man's age at baseline PSA increased, the rate of high-risk PC also increased. In contrast, the incidence of high-risk PC did not vary significantly by race/ethnicity. More screening PSAs and shorter intervals between PSA screenings were associated with a lower incidence of high-risk PC. The incidence of high-risk PC in a screened population is low (<0.1%). Our findings suggest that systematic screening cannot eliminate all PC deaths and provide an estimate for the risk of the rapid development of high-risk cancers that is comparable to that observed in active surveillance populations.

Prostate cancer screening patterns among LGBT populations.

e19077 Background: More than 10 million Americans identify themselves as lesbian, gay, bisexual, and transgender (LGBT), and the majority of male-to-female (MTF) transgender individuals still have prostates even after surgical transitions. Guidelines on prostate specific antigen (PSA) screening for LGBT populations are limited, and informed and shared decision making are encouraged by various organizations. However, patterns of care for PSA screening in LGBT populations remains unclear. To address this knowledge gap, we conducted a cross sectional study to evaluate self-reported PSA screening and decision making among LGBT populations. Methods: The Behavioral Risk Factor Surveillance System database was queried for LGBT adults from 2014-2016 and 2018. Those with prior prostate cancer were excluded. Multivariable logistic regression was performed to evaluate the association of LGBT status with PSA screening, informed and shared decision making, after adjusting for demographic characteristics and survey weights. Results: A total of 164,370 participants were eligible for PSA screening (n = 156,548 for cisgender [CG]+straight, n = 156 for MTF+straight, n = 33 for MTF+gay, n = 52 for MTF+bisexual, n = 51 for MTF+other sexual orientation [SO], n = 3354 for CG+gay, n = 1641 for CG+bisexual, n = 2535 for CG+other SO), representing a weighted estimate of 1.2 million LGBT populations. When compared to CG+straight, CG+gay/bisexual cohorts were more likely to undergo PSA screening within the past 2 years (CG+gay: OR 1.08, p &lt; 0.001; CG+bisexual: OR 1.06, p &lt; 0.001), have ever received PSA screening (CG+gay: OR 1.30, p &lt; 0.001; CG+bisexual: OR 1.12, p &lt; 0.001), and be recommended for PSA screening by their physicians (CG+gay and bisexual: OR 1.16, p &lt; 0.001). All other cohorts were less likely to do so (all OR &lt; 1, p &lt; 0.05). MTF+gay and CG+gay participants were more likely to make informed decision (MTF+gay: OR 3.13, p &lt; 0.001; CG+gay: OR 1.09, p &lt; 0.001), while all other cohorts were less likely to do so (all OR &lt; 1, p &lt; 0.05). CG+gay participants were also more likely to share decision (OR 2.51, p &lt; 0.001), while there were no associations for all other cohorts (all p &gt; 0.05). Conclusions: Select gay populations were more likely to undertake PSA screening recommended by their physicians and participate in informed and shared decision making. However, other LGBT populations were less likely to make informed decisions, and transgender participants were less likely to undergo PSA screening. Further research efforts are needed to improve informed and shared decision making for PSA screening in such underserved population.

PD38-01 VALIDITY OF PSA SCREENING TRIALS IN A 'REAL WORLD' SETTING: A NATIONWIDE SURVEY ANALYSIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (PD38)1 Apr 2020PD38-01 VALIDITY OF PSA SCREENING TRIALS IN A 'REAL WORLD' SETTING: A NATIONWIDE SURVEY ANALYSIS Deepansh Dalela*, Akshay Sood, Jacob Keeley, Sohrab Arora, Marcus Jamil, Chandler Bronkema, Nikola Rakic, James Peabody, Craig Rogers, Quoc-Dien Trinh, Mani Menon, and Firas Abdollah Deepansh Dalela*Deepansh Dalela* More articles by this author , Akshay SoodAkshay Sood More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Marcus JamilMarcus Jamil More articles by this author , Chandler BronkemaChandler Bronkema More articles by this author , Nikola RakicNikola Rakic More articles by this author , James PeabodyJames Peabody More articles by this author , Craig RogersCraig Rogers More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh 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.0000000000000917.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The efficacy of prostate specific antigen (PSA) screening is predicated on, amongst other factors, age and ethnicity of recipients. The goal of the current study was to compare the age and ethnicity of men undergoing PSA screening the United States (US) to those represented in the Prostate, Lung, Colorectal and Ovarian cancer (PLCO) and the European Randomized Study of Screening for Prostate Cancer (ERSPC) trials. Such a comparison is a key to assess the external validity of these trials in the “real world” setting. METHODS: We used publicly-available data from National Health Institution Survey (NHIS) 2000-2018, the world’s oldest continuously administered survey of non-institutionalized US population. Men aged 50-74 without prior history of prostate cancer (PCa) who underwent PSA testing in the last 12 months as a part of routine test were considered to have undergone PSA screening. Age at PSA screening and self-reported ethnicity were compared with results reported in the PLCO (Andriole, NEJM 2009) and ERSPC (Schroeder, NEJM 2009) trials, using Rao-Scott Chi-Square tests. RESULTS: Overall, 10,854 (weighted n=11,257,531) men underwent annual PSA screening within the available years. The median (IQR) age for PSA screening recipients was 60.9 (55.3-66.4) years (compared to 61.7 years in ERSPC). While PLCO did not report the median age of their cohort, they reported the percentages in each age category. Interestingly, 59.2% of men were aged 60-74 in our cohort vs 68% in PLCO cohort (p<0.001). In terms of ethnicity, 1276 (weighted n=976,126; 8.7%) men in our dataset were African-American, compared to 4.4% in PLCO (p<0.001). CONCLUSIONS: Our analyses shows that compared to PLCO, US men undergoing PSA screening over the last two decades were younger and twice as likely to be African-American. Interestingly, the age distribution in NHIS was similar to men in the ERSPC study (that showed mortality benefit with PSA screening). As such, results of PLCO study may not be extrapolatable to US men, and our findings should be kept in mind when counseling men about the potential risks vs benefits of PSA screening. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e801-e801 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepansh Dalela* More articles by this author Akshay Sood More articles by this author Jacob Keeley More articles by this author Sohrab Arora More articles by this author Marcus Jamil More articles by this author Chandler Bronkema More articles by this author Nikola Rakic More articles by this author James Peabody More articles by this author Craig Rogers More articles by this author Quoc-Dien Trinh More articles by this author Mani Menon More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

PD48-09 PROSTATE SPECIFIC ANTIGEN (PSA) SCREENING UTILIZATION HAS SIGNIFICANTLY DROPPED OVER THE LAST TWO DECADES, EVEN IN MEN WITH EXTENDED LIFE-EXPECTANCY: A NATIONWIDE ANALYSIS

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD48)1 Apr 2020PD48-09 PROSTATE SPECIFIC ANTIGEN (PSA) SCREENING UTILIZATION HAS SIGNIFICANTLY DROPPED OVER THE LAST TWO DECADES, EVEN IN MEN WITH EXTENDED LIFE-EXPECTANCY: A NATIONWIDE ANALYSIS Deepansh Dalela*, Jacob Keeley, Akshay Sood, Sohrab Arora, Marcus Jamil, Isaac Palma-Zamora, Chandler Bronkema, Nikola Rakic, Natalija Kovacevic, Wooju Jeong, Craig Rogers, Mani Menon, and Firas Abdollah Deepansh Dalela*Deepansh Dalela* More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Akshay SoodAkshay Sood More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Marcus JamilMarcus Jamil More articles by this author , Isaac Palma-ZamoraIsaac Palma-Zamora More articles by this author , Chandler BronkemaChandler Bronkema More articles by this author , Nikola RakicNikola Rakic More articles by this author , Natalija KovacevicNatalija Kovacevic More articles by this author , Wooju JeongWooju Jeong 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.0000000000000942.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Estimation of life expectancy (LE) is central to assessing the relative benefit of PSA screening among men. While prior research has suggested high prevalence of PSA screening in men with limited LE, limited data exists regarding screening for those with extended LE (who are arguably more likely to benefit from screening). The aim of the current study was to assess temporal trends in screening in US men with limited vs extended LE using a nationally representative dataset. METHODS: Using data from the National Health Institution Survey (NHIS) 2000-2018, men aged >=40 without prior history of prostate cancer who underwent PSA testing in the last 12 months as a part of routine test were considered to have undergone PSA screening. We used the previously validated Schonberg index to assess LE (based on 11 risk factors derived from function, illnesses, behaviors and demographics). Men with score of >10 were considered to have limited LE (i.e. LE <10 years, or >50% risk of 10-year mortality), while those with score of <6 were considered to have extended LE (i.e. LE>15 years, of <50% risk of 15-year mortality). Temporal trends in PSA screening in either group were compared using weighted chi-square tests. RESULTS: Within the study population, a total of 16,132 (weighted n=16,895,262) men were estimated to have extended LE, while 11,861 (weighted n=10,491,734) were included in the limited LE group. There was no significant difference in PSA screening prevalence based on extended (39.8%) vs. limited LE (39.4%) groups (p=0.5). Prevalence of PSA screening decreased over the study duration (Figure 1), even amongst men with extended LE (55.9% in 2003 to 35.5% in 2018; p<0.001). CONCLUSIONS: Our results show an overall drop in the utilization of PSA screening over the last two decades, without a distinction based on LE. It is highly concerning that even in men with an extended LE (i.e. >15 years), only 1 in 3 receive PSA screening, especially given the increased benefit of PSA screening with longer survival, as reported by level-one-evidence. This may be related to difficulties in estimating and/or discussing LE prior to ordering PSA screening, or the ambivalence of national guidelines regarding efficacy of screening, or a combination of both. Source of Funding: HFHS © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e997-e998 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepansh Dalela* More articles by this author Jacob Keeley More articles by this author Akshay Sood More articles by this author Sohrab Arora More articles by this author Marcus Jamil More articles by this author Isaac Palma-Zamora More articles by this author Chandler Bronkema More articles by this author Nikola Rakic More articles by this author Natalija Kovacevic More articles by this author Wooju Jeong 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 PDF downloadLoading ...

Occupation as a predictor of prostate cancer screening behaviour in Canada.

If prostate cancer screening practices relate to occupation, this would have important implications when studying the aetiological role of workplace exposures on prostate cancer. We identified variations in screening by occupation among men in Montreal, Canada (2005-2012). Prostate specific antigen testing and digital rectal examination (ever-screened and frequency of screening, previous five years) were examined among population controls from the Prostate Cancer & Environment Study. Face-to-face interviews elicited lifestyle and occupational histories. Multivariable logistic regression was used to estimate the odds of ever-screening for the longest-held occupation, adjusting for potential confounders. Negative binomial models were used to examine relationships with screening frequency. Among 1989 controls, 81% reported ever having had a prostate specific antigen test, and 77% a digital rectal examination. Approximately 40% of men reported having a prostate specific antigen test once a year, on average. Compared with those in management or administrative jobs, men in primary industry (odds ratio 0.26, 95% confidence interval 0.10-0.65), construction (0.44, 0.25-0.79), machining (0.45, 0.21-0.97), and teaching (0.37, 0.20-0.70) were less likely to have undergone prostate specific antigen screening. Results were similar when considering the most recent job. Our findings highlight substantial variations in prostate cancer screening by occupation. Men in occupations where carcinogen exposures are more common are less likely to participate in prostate screening activities. This could be an important source of bias, and occupational studies of prostate cancer should account for screening practices.