You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History (II)1 Apr 2013343 PRESENTATION OF HIGH GRADE PROSTATE CANCER IN THE UNDERINSURED Thomas O'Grady, Jed Robinson, Marc Bjurlin, Naveen Divakaruni, Matthew Houlihan, Saad Muktar Emhmed Ali, Andrew Drago, and Courtney Hollowell Thomas O'GradyThomas O'Grady Chicago, IL More articles by this author , Jed RobinsonJed Robinson Chicago, IL More articles by this author , Marc BjurlinMarc Bjurlin Chicago, IL More articles by this author , Naveen DivakaruniNaveen Divakaruni Chicago, IL More articles by this author , Matthew HoulihanMatthew Houlihan Downers Grove, IL More articles by this author , Saad Muktar Emhmed AliSaad Muktar Emhmed Ali Chicago, IL More articles by this author , Andrew DragoAndrew Drago Chicago, IL More articles by this author , and Courtney HollowellCourtney Hollowell Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1729AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A major barrier to preventive healthcare maintenance and cancer screening is low socioeconomic status and being underinsured. Previous studies have demonstrated that patients who may benefit most from prostate cancer screening are those with risk factors such as African American race and low socioeconomic status. In order to investigate the presentation and disease burden of unscreened men, specifically those with high grade prostate cancer, we assessed the prostate cancer screening status and clinical presentation of underinsured men with Gleason 8-10 prostate cancer at our institution. METHODS We performed a retrospective cohort study of men diagnosed with Gleason 8-10 prostate cancer from 2002-2011 at our institution and analyzed by race, age, presenting prostate specific antigen (PSA), and previous PSA screening status. Clinical TNM staging was determined by chart review, with locally advanced disease defined as clinical stage T3 and higher and nodal and bone metastasis by suspicion on radiographic imaging. RESULTS A total of 1,402 men were diagnosed with prostate cancer at our institution from 2002-2011, with 238 (16.9%) men having Gleason 8-10 pathology, which were evaluated in our study. Racial distribution was predominantly minorities: 67% were African American, 14% White, 13% Hispanic, and 5% Asian. All patients were uninsured or publically insured. The mean age at diagnosis was 64 years and the mean PSA at diagnosis was 386 ng/mL (median 62.7 ng/mL). Nearly all (97%) of the cohort had no previous PSA screening before their diagnostic PSA, and PSA levels at diagnosis exceeded 10 ng/mL in 89% of patients. Nearly a quarter (21%) presented with locally advanced disease, a third (31%) presented with radiographic evidence of nodal metastasis, and a half (46%) presented with bone metastasis, all of which are significantly higher than historically reported screened cohorts of prostate cancer. CONCLUSIONS Our underinsured, predominantly minority patient population, the vast majority of whom are without previous prostate cancer screening, present with a significant disease burden, specifically high grade, locally advanced, and metastatic disease. While much attention focuses on potential overdiagnosis and overtreatment of men with screen detected prostate cancer, our findings suggest that for the uninsured, underscreening is a significant concern. Future efforts should be focused on overcoming the barriers of access to PSA screening in this population. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e139 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas O'Grady Chicago, IL More articles by this author Jed Robinson Chicago, IL More articles by this author Marc Bjurlin Chicago, IL More articles by this author Naveen Divakaruni Chicago, IL More articles by this author Matthew Houlihan Downers Grove, IL More articles by this author Saad Muktar Emhmed Ali Chicago, IL More articles by this author Andrew Drago Chicago, IL More articles by this author Courtney Hollowell Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...