Use Of Prostate Cancer Screening Research Articles

Prostate Cancer Screening, Diagnostic, Treatment Procedures and Costs in Sub-Saharan Africa: A Situational Analysis.

PurposeProstate cancer mortality is predicted to nearly double by 2040 in Sub-Saharan Africa (SSA). The lack of prostate cancer screening in SSA contributes to late-stage diagnosis, treatment delays, and poor survival among patients. We analyzed the availability and use of prostate cancer screening, diagnostic and treatment guidelines, procedures, and costs in few SSA countries to determine factors for consideration in the development of prostate cancer screening guidelines for SSA.MethodsWe applied mixed methods approaches to collect data through an electronic survey administered to clinicians (oncologists, urologists, pathologists, nurses, and radiation oncologists) providing prostate cancer screening, diagnosis, and treatment services in multiple sub-Saharan countries.ResultsInconsistencies in respondents’ understanding of the availability and use of prostate cancer screening guidelines in their countries were noted. Prostate Specific Antigen (PSA) and Digital Rectal Examination (DRE) were the most commonly available screening modalities. Available diagnostic procedures included a combination of prostate biopsies, transrectal ultrasonography, and DRE. Our study’s data suggest that PSA and DRE exams are available for early diagnosis and screening procedures. Availability of treatment modalities with curative intent and costs for prostate cancer related procedures varied between and within countries.ConclusionsPSA and DRE are available for detecting prostate cancer and may detect aggressive cancers early, leading to improved outcomes. However, PSA screening is also associated with overdiagnosis and over-treatment. National prostate cancer policies should consider health systems, evidence-based guidelines, population characteristics and healthcare financing to ensure access to clinically relevant and safe prostate cancer related care.

Prostate Cancer Screening in Middle-Aged and Older American Men: Combined Effects of Ethnicity and Years of Schooling

Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown. The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association. This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African-American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one's lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis. A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test. Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.

Accountable care organizations and the use of prostate cancer screening and breast cancer screening.

e18308 Background: Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a non-recommended test, would be unaffected by ACO assignment. Methods: Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in women aged < 75, (evidence-based cancer screening), and PCa-S in men < 75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria following the review of guideline recommendations. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiary-level file. Propensity-score weighting was performed to balance out patient and sociodemographic covariates. Results: Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included 52,987 and 526,063 women for BCa-S; 86,936 and 814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p < 0.001) Conclusions: The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-à-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model.

MP32-08 ACCOUNTABLE CARE ORGANIZATIONS AND THE USE OF PROSTATE CANCER SCREENING

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures II1 Apr 2017MP32-08 ACCOUNTABLE CARE ORGANIZATIONS AND THE USE OF PROSTATE CANCER SCREENING Christian P. Meyer, Anna Krasnova, Jesse D. Sammon, Philipp Gild, Nicolas von Landenberg, Stuart R. Lipsitz, Joel S. Weissman, Felix K.H. Chun, Margit Fisch, Maxine Sun, and Quoc-Dien Trinh Christian P. MeyerChristian P. Meyer More articles by this author , Anna KrasnovaAnna Krasnova More articles by this author , Jesse D. SammonJesse D. Sammon More articles by this author , Philipp GildPhilipp Gild More articles by this author , Nicolas von LandenbergNicolas von Landenberg More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , Joel S. WeissmanJoel S. Weissman More articles by this author , Felix K.H. ChunFelix K.H. Chun More articles by this author , Margit FischMargit Fisch More articles by this author , Maxine SunMaxine Sun More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.983AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Accountable Care Organizations (ACOs) were established under the Affordable Care Act as a new payment model intended to impose greater responsibility on all stakeholders for cost control and quality improvement. Preventive services are an ideal target to monitor the effectiveness of new health care delivery models. We sought to examine and compare the prevalence of breast cancer screening (BCa-S), and prostate cancer screening (PCa-S) between ACO and traditional Medicare beneficiaries. We hypothesized that the use of BCa-S is higher among beneficiaries attributed to an ACO, whereas the use of PCa-S, a non-recommended test, would be unaffected by ACO assignment. METHODS Using a random 20% sample of Medicare beneficiaries, we assessed BCa-S in those aged <75, (evidence-based cancer screening), and PCa-S in those <75 (non-recommended cancer screening) between January 1, 2013 and December 31, 2013 with appropriate exclusion criteria. ACO coverage was ascertained from the quarterly assignment in the Shared Savings Program ACO Beneficiary-level file. RESULTS Following propensity-score weighting, our final cohorts of ACO and traditional Medicare beneficiaries included, 52,987/526,063 women for BCa-S, and 86,936/814,221 men for PCa-S, respectively. The prevalence of screening in ACO vs. traditional Medicare were 35.0% vs. 25.2% for BCa-S, and 54.6% vs. 41.7% for PCa-S (all p<.001). CONCLUSIONS The ACO model appears to have a salutary effect on preventive service utilization. Our findings vis-a-vis PCa-S among ACOs are likely a reflection of improved health care access rather than vetted screening practices. There is hope that such nonrecommended screening will decrease if more ACOs are required to move towards a “two-sided” risk shared savings and loss model. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e411 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christian P. Meyer More articles by this author Anna Krasnova More articles by this author Jesse D. Sammon More articles by this author Philipp Gild More articles by this author Nicolas von Landenberg More articles by this author Stuart R. Lipsitz More articles by this author Joel S. Weissman More articles by this author Felix K.H. Chun More articles by this author Margit Fisch More articles by this author Maxine Sun More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract C85: Do African-American veterans need distinct “Prostate Cancer Screening Guidelines” to overcome outcome disparities?

Abstract Background: The United States Preventive Task Force recommended against the prostate-specific antigen (PSA)-based screening for prostate cancer in 2012, a recommendation that applies to all American men. African-American men, however, have the highest incidence of prostate cancer and are more likely to be diagnosed with an advanced stage and poor prognostic-form of prostate cancer. The incidence of prostate cancer is almost 60% higher, and the mortality rate is two- to three-times greater among African Americans than that of Caucasian men1. The Veteran's Health Administration is an unbiased, race-color blind, equal and open access, single-payor, government run health care system2. Yet, due to complex interactions of ethnicity, biology, comorbidities, environmental interactions, as well as social causes, African-American veterans are present with more aggressive disease and carry a worse outcome. Therefore African-American veterans need specific interventions to improve prostate cancer outcomes; i.e., improve survivals and quality of life. We hypothesize that by developing specific and structured prostate cancer screening recommendations, we can improve the overall prostate cancer outcomes among African-American veterans. Methods: We performed a PubMed search using the keywords: African American, African American veterans, Prostate cancer, Outcomes, Molecular markers, Prostate-specific Antigen velocity, and PSA density to derive data relevant to our hypothesis. Results: 1. Men over the age of 65 are most susceptible to prostate cancer, and the average age of veterans is 582. So, they are at a nearly optimal age for preventative prostate cancer screening. 2. The USPSTF guidelines were based on two studies, and one of these studies reported that only 4% of its participants were African American. So, it is inappropriate to use the same guidelines for African American veterans. 3. Several aspects of prostate cancer are different between African Americans and Caucasians. These differences include prostate cancer incidence and outcome, genetic differences, comorbidity, PSA levels, social barriers, and course of the disease. 4. Prior to the new USPSTF guidelines, African American veterans were just as likely as white veterans to undergo PSA testing3. 5. Among the diseases linked to comorbidity with prostate cancer, cardiovascular disease is the most frequent. Hence, the leading cause of death in both the African-American population and the African-American veteran population is cardiovascular disease.2 Conclusion: 1. Because there is no cure for metastatic prostate cancer, early diagnosis and intervention for African-American veterans will lead to saving lives; specific guidelines for prostate cancer will be very beneficial. 2. This will also decrease the costs of treating recurrent and metastatic disease and conserve the resources of the VA Health System. 3. Because the Veterans Health System is equal access, it is an optimal environment to test different prostate cancer screening guidelines for African Americans. 4. Specific draft guidelines will be presented.

Ever and Annual Use of Prostate Cancer Screening in African American Men.

Since prostate cancer continues to disproportionately affect African American men in terms of incidence, morbidity, and mortality, prostate-specific antigen (PSA) screening plays an important role in early detection, especially when men engage in informed decision making to accept or decline this test. The authors evaluated utilization of PSA testing among African American men based on factors that are important components of making informed decisions. Utilization of PSA testing was evaluated based on whether men had ever had PSA testing and PSA testing during the past year in a community-based sample of African American men ages 50 to 75 ( n = 132). Overall, 64% of men ( n = 85) reported that they had ever had a PSA test; the mean ( SD) age for first use of PSA testing was 47.7 ( SD = 7.4). The likelihood of ever having a PSA test increased significantly with physician communication (odds ratio [OR] = 14.2; 95% confidence interval [CI] = 4.20, 48.10; p = .0001) and with having an annual household income that was greater than $20,000 (OR = 9.80; 95% CI = 3.15, 30.51; p = .0001). The odds of ever having a PSA test were also decreased with each unit increase in future temporal orientation (OR = 0.66; 95% CI = 0.47, 0.93; p = .02). Of the men who had ever had PSA testing, 57% were screened during the past year. Only health insurance status had a significant independent association with having annual PSA testing (OR = 5.10; 95% CI = 1.67, 15.60; p = .004). Different factors were associated significantly with ever having PSA testing and annual testing among African American men. African American men may not be making an informed decision about prostate cancer screening.

MP21-10 THE IMPACT OF MEDICARE ELIGIBILITY ON PROSTATE CANCER SCREENING BEHAVIORS

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2016MP21-10 THE IMPACT OF MEDICARE ELIGIBILITY ON PROSTATE CANCER SCREENING BEHAVIORS Christian Meyer, Jesse Sammon, Björn Löppenberg, Jeffrey Leow, Nawar Hanna, Julian Hanske, Alexander Cole, Firas Abdollah, Mani Menon, Maxine Sun, and Quoc-Dien Trinh Christian MeyerChristian Meyer More articles by this author , Jesse SammonJesse Sammon More articles by this author , Björn LöppenbergBjörn Löppenberg More articles by this author , Jeffrey LeowJeffrey Leow More articles by this author , Nawar HannaNawar Hanna More articles by this author , Julian HanskeJulian Hanske More articles by this author , Alexander ColeAlexander Cole More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Mani MenonMani Menon More articles by this author , Maxine SunMaxine Sun More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.644AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lack of health insurance limits access to preventive services, including cancer screening. We examined effects of Medicare eligibility on the appropriate use of prostate cancer screening in the United States. METHODS We performed a cross-sectional analysis of the 2012 Behavioral Risk Factor and Surveillance System (analyzed in 2014). Univariable and logistic regression analyses were performed for participants aged 60-64 and 66-70 to examine effects of Medicare eligibility on the prevalence of self-reported screening for prostate cancer. Sub-analyses were performed among low-income (<$25,000 annual/household) and among insured and uninsured individuals. RESULTS Medicare-eligible individuals were significantly more likely to undergo prostate cancer screening OR: 1.29; 95%CI 1.17-1.43; and the effect was most pronounced among low-income individuals OR: 1.39; 95%CI 1.12-1.72. Access to a health care provider was the strongest independent predictor of undergoing screening in the entire cohort (OR 4.0; 95% CI 3.35-4.80) and the low income bracket (OR 3.71; 95%CI 2.58-5.33). The difference in screening was more pronounced when comparing Medicare-eligible participants to uninsured Medicare-ineligible participants (+33.2%), than to insured Medicare-ineligible participants (+4.9%). CONCLUSIONS Medicare eligibility impacts prostate cancer screening rates, likely as a result of increased access to primary care providers. Low-income individuals benefit most from Medicare eligibility. Expanded public insurance coverage to these individuals may improve access to preventive services. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e248 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Christian Meyer More articles by this author Jesse Sammon More articles by this author Björn Löppenberg More articles by this author Jeffrey Leow More articles by this author Nawar Hanna More articles by this author Julian Hanske More articles by this author Alexander Cole More articles by this author Firas Abdollah More articles by this author Mani Menon More articles by this author Maxine Sun More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate cancer screening in Switzerland: 20-year trends and socioeconomic disparities

BackgroundDespite important controversy in its efficacy, prostate cancer (PCa) screening has become widespread. Important socioeconomic screening disparities have been reported. However, trends in PCa screening and social disparities have not been investigated in Switzerland, a high risk country for PCa. We used data from five waves (from 1992-2012) of the population-based Swiss Health Interview Survey to evaluate trends in PCa screening and its association with socioeconomic indicators. MethodsWe used multivariable Poisson regression to estimate prevalence ratios (PR) and 95% Confidence Intervals (CI) adjusting for demographics, health status, and use of healthcare. ResultsThe study included 12,034 men aged ≥50 years (mean age: 63.9). Between 1992 and 2012, ever use of PCa screening increased from 55.3% to 70.0% and its use within the last two years from 32.6% to 42.4% (p-value <0.05). Income, education, and occupational class were independently associated with PCa screening. PCa screening within the last two years was greater in men with the highest (>$6,000/month) vs. lowest income (≤$2,000) (46.5% vs. 38.7% in 2012, PR for overall period =1.29, 95%CI: 1.13-1.48). These socioeconomic disparities did not significantly change over time. ConclusionsThis study shows that about half of Swiss men had performed at least one PCa screening. Men belonging to high socioeconomic status are clearly more frequently screened than those less favored. Given the uncertainty of the usefulness of PCa screening, men, including those with high socioeconomic status, should be clearly informed about benefits and harms of PCa screening, in particular, the adverse effect of over-diagnosis and of associated over-treatment.

Editorial Comment

This study documents changes in prostate cancer screening patterns in a defined medical practice. 1 Wallner L.P. Hsu J.W. Loo R.K. Palmer-Toy D.E. Schottinger J.E. Jacobsen S.J. Trends in prostate-specific antigen screening, prostate biopsies, urology visits, and prostate cancer treatments from 2000 to 2012. Urology. 2015; 86: 498-505 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Since 2008, there is a decline especially among older men without a change in the rate of prostate cancer diagnosis. The pattern suggests that the doctors in the study became more discriminating in their decision to screen. This may be a model for the teaching about and use of prostate cancer screening. Trends in Prostate-specific Antigen Screening, Prostate Biopsies, Urology Visits, and Prostate Cancer Treatments From 2000 to 2012UrologyVol. 86Issue 3PreviewTo determine whether the rates of prostate-specific antigen (PSA) screening, related biopsies and subsequent prostate cancer utilization decreased between 2000 and 2012 in a large, managed care organization. Full-Text PDF ReplyUrologyVol. 86Issue 3PreviewWe thank Drs. Brawley1 and Loeb2 for their thoughtful comments about screening for prostate cancer and the results reported here at Kaiser Permanente Southern California. The evidence about prostate-specific antigen screening for prostate cancer is controversial, particularly in an age where risk stratification is inexact. However, there is little controversy regarding when prostate cancer screening is no longer beneficial, and as such, we have chosen to focus our efforts in reducing unnecessary overscreening, overdiagnosis, and overtreatment in older men. Full-Text PDF Editorial CommentUrologyVol. 86Issue 3PreviewIn 2008, the United States Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen (PSA) screening for men aged >75 years and extended this to men of all ages in a 2011 draft recommendation that was finalized in 2012.1 Similar recommendations against PSA were issued by the Canadian Preventive Health Task Force in 2014.2 These guidelines have generated significant controversy and contrast with the recommendations of numerous professional societies for shared decision making about PSA. Full-Text PDF

Prise en charge des tumeurs de la prostate à faible risque évolutif

The widespread use of prostate cancer screening has led to a stage migration resulting in an increase in the diagnosis of low-risk disease, which currently accounts for 40-50% of diagnosed forms. New therapeutic strategies have been developed in order to minimize the risk of overtreatment. A systematic review of the literature over the past 20 years was performed using the Medline database. The literature selection was based on evidence and practical considerations. Low-risk tumors are conventionally defined by the d'Amico classification. The use of multiparametric MRI helps to better characterize these tumors. The contribution of molecular biology remains to be determined in clinical practice. Novel therapeutic options for low-risk disease are currently being evaluated. The new therapeutic strategies are evolving. They seek to reduce overtreatment without compromising oncological success.

Do racial disparities exist in the use of prostate cancer screening and detection tools in veterans?

ObjectiveTo determine whether racial disparities exist in the use of prostate cancer screening and detection tools in veterans. Methods and materialsAdministrative data were obtained from the Corporate Data Warehouse on a national cohort of 275,831 veterans (21% African American [AA]) between the ages of 40 and 70 years who were free of heart disease, did not have an elevated prostate specific antigen (PSA) level (>4 ng/ml), did not have other clinical signs of prostate cancer, had not been diagnosed with prostate cancer, and had not received treatment for prostate cancer between January 10, 1998 and September 30, 2000. Subjects were followed up until September 30, 2007. Regular users were defined as those with at least 1 annual visit to the Veterans Healthcare Administration (VHA) between October 1, 1998 and September 30, 2000. We sought to determine if race was significantly associated with PSA testing, the time to elevated PSA detection, the time to prostate biopsy, and the time to diagnosis of prostate cancer. Chi-square tests, logistic regression, and Cox proportional hazard models were used to test for associations between race and prostate cancer variables. ResultsEighty-four percent of the veterans between the ages 40 and 70 years undergo PSA testing. AA veterans are as likely as white veterans to undergo PSA testing. Screened AA veterans are more likely to have a PSA>4ng/ml, undergo prostate biopsy, and be diagnosed with prostate cancer than screened white veterans. The time intervals between undergoing a prostate biopsy and being diagnosed with prostate cancer were statistically significantly shorter (although unlikely of clinical significance) for AA veterans with a PSA level>4ng/ml than that for white veterans with a PSA level>4ng/ml. When routine care in regular VHA users was compared with that of participants in major screening trials such as Prostate, Lung, Ovarian and Colon Cancer Trial and European Study of Screening for Prostate Cancer, prostate biopsy rates were lower (30% vs. 40%–86%), prostate cancer detection rates/person biopsied were higher (49% vs. 31%–45%), and incidence of prostate cancer was 1.1% vs. 4.9% to 8.3%. ConclusionsAmong regular users of the VHA for healthcare, no disparities toward AA veterans exist in the use of prostate cancer screening and detection tools. Any differences in prostate cancer treatment outcomes are not likely because of inequalities in the use of prostate cancer screening or detection tools.

“Is Prostate Cancer Screening Worthy in Southern European Male Populations? A Case Study in Eleusina, Greece: Prostate Cancer Screening in Eleusina

Objective To investigate the frequency of PSA-detected prostate cancer among non-symptomatic Greek males. Methods A prospective study on prostate cancer (PC) screening was performed in a representative sample of asymptomatic Greek males aged 40–75 years in Eleusina, (Greece) between January and November 2001. Indication for prostate biopsy was a PSA value above 3.0 ng/mL on repeat examination. Patients found with PC at biopsy received the appropriate treatment. Ten years later, patients initially diagnosed with PC were surveyed between June and July 2011 by telephone interview, in order to evaluate PC screening effects. Outcomes examined included: overall survival, disease-free survival and cancer mortality. Results 309 asymptomatic males were screened. The mean age of the study population was 62 years (median 62). The PSA median was 1.1 ng/mL with 90.2% presenting with &lt;3.0 ng/mL. Seven out of 29 patients found with a serum PSA value above 3.0 ng/mL (9.8%) were finally diagnosed with PC at biopsy. During the survey time the two patients with prostate carcinoma of low differentiation died despite aggressive treatment. Of the remaining 5 patients diagnosed with PC, one died of causes other than PC, 2 are disease-free while 2 patients are alive with the disease. Conclusions The low PC detection rate questions the overall usefulness of PC screening in a geographical region where histological PC is not very common.

Profiling prostate cancer

Among men worldwide, prostate cancer has become the second most frequently diagnosed cancer and the sixth leading cause of cancer death, accounting for 240,890 new diagnoses and 33,720 deaths in the United States alone in 2011 (1, 2). Fortunately, with wide use of prostate cancer screening, early detection, and definitive local therapy, prostate cancer mortality rates have been falling in the United States—as much as 39% or more since 1990 (2). Nonetheless, randomized clinical trials of serum prostate-specific antigen (PSA) testing for prostate cancer screening have suggested that these gains have come at a significant cost: by one estimate, to save a single life from prostate cancer death, 1,410 men need to be screened, and 48 cases of prostate cancer need to be diagnosed and treated (3). On October 11, 2011, the US Preventive Services Task Force issued a draft report on PSA screening, assigning the practice a grade D recommendation and weighing in “against the service” because of “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” The firestorm of controversy triggered by this report highlights (i) the need for individualized approaches to prostate cancer screening at a population scale, so that screening services can be targeted in such a way as to minimize overdiagnosis, and (ii) the need to personalize treatment decisions, so that options like the use of active surveillance in lieu of definitive local therapy can be rationally selected in such a way as to reduce overtreatment (4, 5). In PNAS, Markert et al. (6) attempt to address these needs through the discovery of new molecular biomarkers for aggressive prostate cancer.

Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use

: Nonmedical factors may modify the biological risk of prostate cancer (PCa) and contribute to the differential use of early detection; curative care; and, ultimately, greater racial disparities in PCa mortality. In this study, the authors examined patients' usual source of care, continuity of care, and mistrust of physicians and their association with racial differences in PCa screening. : Study nurses conducted in-home interviews of 1031 African-American men and Caucasian-American men aged > or =50 years in North Carolina and Louisiana within weeks of their PCa diagnosis. Medical records were abstracted, and the data were used to conduct bivariate and multivariate analyses. : Compared with African Americans, Caucasian Americans exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical encounters, and historically using any PCa screening. Seeing the same physician for regular care was associated with greater trust and screening use. Men who reported their usual source of care as a physician office, hospital clinic, or Veterans Administration facility were more likely to report prior PCa screening than other men. In multivariate regression analysis, seeing the same provider remained associated with prior screening use, whereas both race and trust lost their association with prior screening. : The current results indicated that systems factors, including those that differ among different sources of care and those associated with the continuity of care, may provide tangible targets to address disparities in the use of PCa early detection, may attenuate racial differences in PCa screening use, and may contribute to reduced racial disparities in PCa mortality. Cancer 2009. Published 2009 by the American Cancer Society.

Dual Use of Veterans Affairs Services and Use of Recommended Ambulatory Care

Use of more than one health care system to obtain care is common among adults receiving care within the Veterans Affairs (VA) medical system. It is not known what effect using care from multiple sources has on the quality of care patients receive. To examine whether use of recommended ambulatory care services differs between exclusive and dual VA users. Cross-sectional analysis of the 2004 Behavior Risk Factor Surveillance System, a nationally-representative survey of community-dwelling adults aged 18 years or older. Our outcome measures were self-reported use of 18 recommended services for cancer prevention, cardiovascular risk reduction, diabetes management, and infectious disease prevention. We used multivariable logistic regression to examine the association between exclusive and dual VA use and use of recommended ambulatory services. There were 3470 exclusive VA users and 4523 dual VA users. Dual users were significantly more likely to be older and white, have higher incomes, have graduated from college, and be insured when compared with exclusive VA users. In unadjusted analyses, dual users received higher rates of recommended services. After adjustment for patient characteristics, use of recommended services was largely similar among exclusive and dual VA users. Exclusive VA users reported 14% greater use of breast cancer screening and 10% greater use of cholesterol monitoring among patients with hypercholesterolemia, and 6% lower use of prostate cancer screening and 7% lower use of influenza vaccination. After adjustment for patient characteristics, exclusive and dual VA users reported similar rates of recommended ambulatory service use.

Use of Preventive Care by Elderly Male Veterans Receiving Care Through the Veterans Health Administration, Medicare Fee-for-Service, and Medicare HMO Plans

We compared use of preventive care among veterans receiving care through the Veterans Health Administration (VHA), Medicare fee-for-service (FFS) plans, and Medicare health maintenance organizations (HMOs). Using both the Costs and Use, and Access to Care files of the Medicare Current Beneficiary Survey (2000-2003), we performed a cross-sectional analysis examining self-reported use of influenza vaccination, pneumococcal vaccination, serum cholesterol screening, and serum prostate-specific antigen measurement among male veterans 65 years or older. Veterans' care was categorized as received through VHA, Medicare FFS, Medicare HMOs, VHA and Medicare FFS, or VHA and Medicare HMOs. Veterans receiving care through VHA reported 10% greater use of influenza vaccination (P<.05), 14% greater use of pneumococcal vaccination (P<.01), a nonsignificant 6% greater use of serum cholesterol screening (P=.1), and 15% greater use of prostate cancer screening (P<.01) than did veterans receiving care through Medicare HMOs. Veterans receiving care through Medicare FFS reported less use of all 4 preventive measures (P<.01) than did veterans receiving care through Medicare HMOs. Receiving care through VHA was associated with greater use of preventive care.

Política de actuación de la biopsia transrectal prostática, en mayores de 50 años, en función del valor del PSA, elaborado mediante un árbol de decisión matemático

To decide the action politics (to perform or not transrectal prostatic biopsy) for a PSA cut point of 4 and 10 ng/ml through the construction of a mathematical decision tree.We calculate the usefulness of the biopsy through a subjective score, from 0 to 10, established after a survey of the 20 staff members of the health-care area, applying an global analysis with creation of total profile cards through an orthogonal design.The main usefulness of prostate cancer screening would be not to perform transrectal prostatic biopsies when PSA is lower than 4 ng/ml.

Prostate cancer diagnosed in spinal cord-injured patients is more commonly advanced stage than in able-bodied patients

Objectives To determine the incidence and characteristics of prostate cancer in men with spinal cord injury (SCI). Little is known about the characteristics of prostate cancer in men with SCI, because prostate cancer screening is not aggressively performed in this population. Methods In one fiscal year, 648 men with SCI older than age 50 years were actively enrolled with the SCI service, 20,949 able-bodied men older than age 50 years were actively enrolled in the outpatient clinic database, and 945 patients with prostate cancer were in the cancer registry at our facility. These three databases were cross-referenced for prostate cancer diagnosis and stage and compared with the presence of SCI. Results Of the 648 patients with SCI, 12 patients with a prostate cancer diagnosis that preceded their injury were excluded. Of the remaining 636 patients, 11 (1.7%) had been diagnosed with prostate cancer since their injury. In contrast, of the 20,949 able-bodied men older than age 50 years seen at our facility in fiscal year 1999, 919 (4.4%) had prostate cancer. Of the patients with SCI and prostate cancer, 7 (63.6%) had locally advanced (Stage T3) or metastatic prostate cancer compared with 267 (29.1%) in the able-bodied population ( P = 0.012). Conclusions Although the proportion of patients with a prostate cancer diagnosis was greater in the able-bodied patients, the prostate cancer detected in the patients with SCI tended to be of a more advanced stage and grade. The difference was likely a result of the decreased use of prostate cancer screening in this population.