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Obiora D, Orikogbo O, Davies BJ, Jacobs BL. Controversies in prostate cancer screening. Urol Oncol 2024:S1078-1439(24)00534-9. [PMID: 39127529 DOI: 10.1016/j.urolonc.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 08/12/2024]
Abstract
Prostate cancer is the second most diagnosed cancer and the fifth leading cause of cancer death among men worldwide. In the 1980s, the development and implementation of Prostate-Specific Antigen (PSA) testing for diagnosing prostate cancer led to a surge in the number of prostate cancer diagnoses. We explore the trends in recommendations and new innovations in adjunctive testing for prostate cancer screening.
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Affiliation(s)
- Daisy Obiora
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center
| | - Oluwaseun Orikogbo
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center
| | - Benjamin J Davies
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center
| | - Bruce L Jacobs
- Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center.
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James ND, Tannock I, N'Dow J, Feng F, Gillessen S, Ali SA, Trujillo B, Al-Lazikani B, Attard G, Bray F, Compérat E, Eeles R, Fatiregun O, Grist E, Halabi S, Haran Á, Herchenhorn D, Hofman MS, Jalloh M, Loeb S, MacNair A, Mahal B, Mendes L, Moghul M, Moore C, Morgans A, Morris M, Murphy D, Murthy V, Nguyen PL, Padhani A, Parker C, Rush H, Sculpher M, Soule H, Sydes MR, Tilki D, Tunariu N, Villanti P, Xie LP. The Lancet Commission on prostate cancer: planning for the surge in cases. Lancet 2024; 403:1683-1722. [PMID: 38583453 DOI: 10.1016/s0140-6736(24)00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/28/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Nicholas D James
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - Ian Tannock
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Felix Feng
- University of California, San Francisco, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Syed Adnan Ali
- University of Manchester, Manchester, UK; The Christie Hospital, Manchester, UK
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Eva Compérat
- Tenon Hospital, Sorbonne University, Paris; AKH Medical University, Vienna, Austria
| | - Ros Eeles
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Áine Haran
- The Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | | | - Stacy Loeb
- New York University, New York, NY, USA; Manhattan Veterans Affairs, New York, NY, USA
| | | | | | | | - Masood Moghul
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Michael Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Declan Murphy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | | | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Türkiye
| | - Nina Tunariu
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Li-Ping Xie
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Jani C, Mouchati C, Abdallah N, Mariano M, Jani R, Salciccioli JD, Marshall DC, Singh H, Sheng I, Shalhoub J, McKay RR. Trends in prostate cancer mortality in the United States of America, by state and race, from 1999 to 2019: estimates from the centers for disease control WONDER database. Prostate Cancer Prostatic Dis 2023; 26:552-562. [PMID: 36522462 DOI: 10.1038/s41391-022-00628-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND In the United States of America (USA), prostate cancer (PC) is the most common cancer in men and the second cause of cancer mortality. Black men (BM) have a higher incidence and worse mortality when compared to white men (WM). We compared trends in PC mortality in the USA by race and state from 1999 to 2019. METHODS We extracted PC mortality data from the Centers for Disease Control (CDC) WONDER database using the International Classification of Diseases (ICD) 10 code C61. Age-Standardized Mortality Rates (ASMR) were divided into racial groups and reported by year and state. Due to the lack of available data in many states, analyses were conducted only for WM and BM using Joinpoint regression for trend comparisons. RESULTS Between 1999-2019, ASMR decreased at the national level in Black (-44.6%), Asian (-44.8%), White (-31.8%), and American Indian or Alaskan native men (-19.0%). ASMR decreased in all states for both races. The greatest drop in ASMR was in Kentucky (-47.0%) for WM and Delaware (-57.8%) for BM. In 2019, ASMRs in BM (13.4/100 000) were significantly higher than WM (7.3/100 000), American Indian or Alaskan Native (3.2/100 000), and Asian men (3.2/100 000) (p < 0.001). The highest ASMRs were in Nebraska (33.5/100 000) for BM and Alaska (11/100 000) for WM. CONCLUSIONS During the last 20 years, the PC mortality rate dropped in all states for all races, suggesting an advancement in management strategies. Although a higher decrease in ASMR was observed in BM, ASMR remain higher among BM. ASMRs were also found to be increasing in many states post USPSTF guideline change (2012), indicating a need for more education around optimized prostate cancer screening.
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Affiliation(s)
- Chinmay Jani
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Christian Mouchati
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nour Abdallah
- Department of Urology Research, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Melissa Mariano
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ruchi Jani
- Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Justin D Salciccioli
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Dominic C Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Harpreet Singh
- Division of Pulmonary and Critical Care, University of Wisconsin, Milwaukee, WI, USA
| | - Iris Sheng
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Hematology and Oncology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rana R McKay
- University of California San Diego, San Diego, CA, 2021, USA
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4
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Leapman MS, Wang R, Park H, Yu JB, Sprenkle PC, Cooperberg MR, Gross CP, Ma X. Changes in Prostate-Specific Antigen Testing Relative to the Revised US Preventive Services Task Force Recommendation on Prostate Cancer Screening. JAMA Oncol 2021; 8:41-47. [PMID: 34762100 DOI: 10.1001/jamaoncol.2021.5143] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance In April 2017, the US Preventive Services Task Force (USPSTF) published a draft guideline that reversed its 2012 guidance advising against prostate-specific antigen (PSA)-based screening for prostate cancer in all men (grade D), instead endorsing individual decision-making for men aged 55 to 69 years (grade C). Objective To evaluate changes in rates of PSA testing after revisions in the USPSTF guideline on prostate cancer screening. Design, Setting, and Participants This retrospective cohort study used deidentified claims data from Blue Cross Blue Shield beneficiaries aged 40 to 89 years from January 1, 2013, through December 31, 2019. Exposures Publication of the USPSTF's draft (April 2017) and final (May 2018) recommendation on prostate cancer screening. Main Outcomes and Measures Age-adjusted rates of PSA testing in bimonthly periods were calculated, and PSA testing rates from calendar years before (January 1 to December 31, 2016) and after (January 1 to December 31, 2019) the guideline change were compared. Interrupted time series analyses were used to evaluate the association of the draft (April 2017) and published (May 2018) USPSTF guideline with rates of PSA testing. Changes in rates of PSA testing were further evaluated among beneficiaries within the age categories reflected in the guideline: 40 to 54 years, 55 to 69 years, and 70 to 89 years. Results The median number of eligible beneficiaries for each bimonthly period was 8 087 565 (range, 6 407 602-8 747 308), and the median age of all included eligible beneficiaries was 53 years (IQR, 47-59 years). Between 2016 and 2019, the mean (SD) rate of PSA testing increased from 32.5 (1.1) to 36.5 (1.1) tests per 100 person-years, a relative increase of 12.5% (95% CI, 1.1%-24.4%). During the same period, mean (SD) rates of PSA testing increased from 20.6 (0.8) to 22.7 (0.9) tests per 100 person-years among men aged 40 to 54 years (relative increase, 10.1%; 95% CI, -2.8% to 23.7%), from 49.8 (1.9) to 55.8 (1.8) tests per 100 person-years among men aged 55 to 69 years (relative increase, 12.1%; 95% CI, -0.2% to 25.2%), and from 38.0 (1.4) to 44.2 (1.4) tests per 100 person-years among men aged 70 to 89 years (relative increase, 16.2%; 95% CI, 4.2%-29.0%). Interrupted time series analysis revealed a significantly increasing trend of PSA testing after April 2017 among all beneficiaries (0.30 tests per 100 person-years for each bimonthly period; P < .001). Conclusions and Relevance This large national cohort study found that rates of PSA testing increased after the USPSTF's draft statement in 2017, reversing trends seen after earlier guidance against PSA testing for all patients. Increased testing was also observed among older men, who may be less likely to benefit from prostate cancer screening.
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Affiliation(s)
- Michael S Leapman
- Department of Urology, Yale School of Medicine, New Haven, Connecticut.,Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Henry Park
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - James B Yu
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | | | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, San Francisco.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, Connecticut.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
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5
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Carneiro A, Racy D, Bacchi CE, Leite KRM, Filippi RZ, Martins IAF, Salvajoli JV, Hanriot RDM, Baroni RH, Sarkis AS, Pompeo ACL, Benigno BS, Guimarães GC, Aldousari S, Nardi AC, Pompeo ASFL, Nowier A, Nardozza A, Adamy A, Freitas CHD, Chade DC, Otero DAC, Neto DCVDS, Carvalhal EF, Korkes F, Ferrigno R. Consensus on Screening, Diagnosis, and Staging Tools for Prostate Cancer in Developing Countries: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC). JCO Glob Oncol 2021; 7:516-522. [PMID: 33856895 PMCID: PMC8162957 DOI: 10.1200/go.20.00527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To generate and present the survey results on critical issues relevant to screening, diagnosis, and staging tools for prostate cancer (PCa) focused on developing countries. METHODS A total of 36 of 300 questions concern the main areas of interest of this paper: (1) screening, (2) diagnosis, and (3) staging for various risk levels of PCa in developing countries. A panel of 99 international multidisciplinary cancer experts voted on these questions to create recommendations for screening, diagnosing, and staging tools for PCa in areas of limited resources discussed in this manuscript. RESULTS The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time. CONCLUSION The voting results and recommendations presented in this document can be used by physicians to support the screening, diagnosis, and staging of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for screening, diagnosis, and staging of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.
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Affiliation(s)
- Arie Carneiro
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Douglas Racy
- Hospital Beneficiencia Portuguesa de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ari Adamy
- Hospital Santa Cruz, Santa Cruz do Sul, Brazil
| | | | | | | | | | | | | | - Robson Ferrigno
- Hospital Beneficiencia Portuguesa de São Paulo, São Paulo, Brazil
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6
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Clinical utility of a serum biomarker panel in distinguishing prostate cancer from benign prostate hyperplasia. Sci Rep 2021; 11:15052. [PMID: 34302010 PMCID: PMC8302659 DOI: 10.1038/s41598-021-94438-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/06/2021] [Indexed: 12/17/2022] Open
Abstract
Prostate-specific antigen (PSA) screening for prostate cancer (PCa) is limited by the lack of specificity but is further complicated in the benign prostatic hyperplasia (BPH) population which also exhibit elevated PSA, representing a clear unmet need to distinguish BPH from PCa. Herein, we evaluated the utility of FLNA IP-MRM, age, and prostate volume to stratify men with BPH from those with PCa. Diagnostic performance of the biomarker panel was better than PSA alone in discriminating patients with negative biopsy from those with PCa, as well as those who have had multiple prior biopsies (AUC 0.75 and 0.87 compared to AUC of PSA alone 0.55 and 0.57 for patients who have had single compared to multiple negative biopsies, respectively). Of interest, in patients with PCa, the panel demonstrated improved performance than PSA alone in those with Gleason scores of 5–7 (AUC 0.76 vs. 0.56) and Gleason scores of 8–10 (AUC 0.74 vs. 0.47). With Gleason scores (8–10), the negative predictive value of the panel is 0.97, indicating potential to limit false negatives in aggressive cancers. Together, these data demonstrate the ability of the biomarker panel to perform better than PSA alone in men with BPH, thus preventing unnecessary biopsies.
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Wang J, Xia HHX, Zhang Y, Zhang L. Trends in treatments for prostate cancer in the United States, 2010-2015. Am J Cancer Res 2021; 11:2351-2368. [PMID: 34094691 PMCID: PMC8167696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/15/2021] [Indexed: 02/07/2023] Open
Abstract
Although annual mortality trends for prostate cancer were stabilized in recent years, understanding the exact treatment changes is necessary for optimal management. Utilization of not-otherwise specified (NOS) treatments for prostate cancer was unclear. Thus, this study aimed to analyze trends in treatment for prostate cancer in the U.S. from 2010 to 2015 and examine whether the treatment for the prostate cancer in the U.S. is compliant with clinical practice guidelines. Using joinpoint regression models, we examined trends in the rate and proportion of age-standardized utilization (ASUR and ASUP) of treatments for prostate cancer diagnosed during 2010-2015 in the U.S. based on the data from the Surveillance, Epidemiology, and End Results (SEER, 2018 data-release, with linkage to active surveillance/watchful waiting [AS/WW]) cancer registry program. Among 316,690 men with prostate cancer diagnosed during 2010-2015, ASUR and ASUP for radical prostatectomy, radiotherapy, AS/WW and NOS treatment were 32.7, 34.4, 10.0 and 40.1 per 100,000, and 27.9%, 29.3%, 8.5% and 34.2%, respectively. Trends in the overall ASUR for prostate cancer treatments differed by cancer risk group, patients' age, race/ethnicity, Gleason score, insurance status, and the average education level, average poverty-level and foreign-born person percentage of the patient's residence-county, but not by rural-urban continuum or region. ASUP of radical prostatectomy decreased from 9.8% in 2010 to 4.8% in 2015 (annual percent change [APC] = -12.0%, 95% CI, -15.9 to -7.9%), and the decrease was observed in all different risk groups. ASUP of AS/WW increased from 16.4% in 2010 to 30.2% in 2013 (APC = 22.7%, 95% CI, 4.6 to 44.0%) and then remained stable through 2013 to 2015 (APC = 1.9%, 95% CI, -24.1 to 36.9%). The increasing tendency of AS/WW only occurred in the low-risk and intermediate-risk groups. The ASUP of NOS treatment has increased from 32.3% in 2010 to 36.8% in 2015 (P<0.01). In conclusion, ASUR and ASUP for prostate cancer treatments, including NOS treatment, had changed during 2010-2015. Their trends appeared to differ by cancer risk-group, age, race/ethnicity, Gleason score and socioeconomic factors. Future studies are warranted to understand the impacts of upward trends in ASUP of NOS treatments and AS/WW on patient survival and prostate cancer mortality.
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Affiliation(s)
- Jianwei Wang
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking UniversityBeijing, China
| | - Harry Hua-Xiang Xia
- Department of Gastroenterology, First Affiliated Hospital, Guangdong Pharmaceutical UniversityGuangzhou, China
| | - Yuanyuan Zhang
- Department of Pharmacology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan UniversityChengdu 610041, China
| | - Lanjing Zhang
- Department of Pathology, Princeton Medical CenterPlainsboro, NJ, USA
- Department of Biological Sciences, Rutgers UniversityNewark, NJ, USA
- Rutgers Cancer Institute of New JerseyNew Brunswick, NJ, USA
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers UniversityPiscataway, NJ, USA
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Michel KF, Spaulding A, Jemal A, Yabroff KR, Lee DJ, Han X. Associations of Medicaid Expansion With Insurance Coverage, Stage at Diagnosis, and Treatment Among Patients With Genitourinary Malignant Neoplasms. JAMA Netw Open 2021; 4:e217051. [PMID: 34009349 PMCID: PMC8134994 DOI: 10.1001/jamanetworkopen.2021.7051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer. OBJECTIVE To assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This case-control study included adults aged 18 to 64 years with a new primary diagnosis of kidney, bladder, or prostate cancer, selected from the National Cancer Database from January 1, 2011, to December 31, 2016. Patients in states that expanded Medicaid were the case group, and patients in nonexpansion states were the control group. Data were analyzed from January 2020 to March 2021. EXPOSURES State Medicaid expansion status. MAIN OUTCOMES AND MEASURES Insurance status, stage at diagnosis, and receipt of cancer and stage-specific treatments. Cases and controls were compared with difference-in-difference analyses. RESULTS Among a total of 340 552 patients with newly diagnosed genitourinary cancers, 94 033 (27.6%) had kidney cancer, 25 770 (7.6%) had bladder cancer, and 220 749 (64.8%) had prostate cancer. Medicaid expansion was associated with a net decrease in uninsured rate of 1.1 (95% CI, -1.4 to -0.8) percentage points across all incomes and a net decrease in the low-income population of 4.4 (95% CI, -5.7 to -3.0) percentage points compared with nonexpansion states. Expansion was also associated with a significant shift toward early-stage diagnosis in kidney cancer across all income levels (difference-in-difference, 1.4 [95% CI, 0.1 to 2.6] percentage points) and among individuals with low income (difference-in-difference, 4.6 [95% CI, 0.3 to 9.0] percentage points) and in prostate cancer among individuals with low income (difference-in-difference, 3.0 [95% CI, 0.3 to 5.7] percentage points). Additionally, there was a net increase associated with expansion compared with nonexpansion in receipt of active surveillance for low-risk prostate cancer of 4.1 (95% CI, 2.9 to 5.3) percentage points across incomes and 4.5 (95% CI, 0 to 9.0) percentage points among patients in low-income areas. CONCLUSIONS AND RELEVANCE These findings suggest that Medicaid expansion was associated with decreases in uninsured status, increases in the proportion of kidney and prostate cancer diagnosed in an early stage, and higher rates of active surveillance in the appropriate, low-risk prostate cancer population. Associations were concentrated in population residing in low-income areas and reinforce the importance of improving access to care to all patients with cancer.
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Affiliation(s)
- Katharine F. Michel
- University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Aleigha Spaulding
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K. Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Daniel J. Lee
- University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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9
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King ML, Nittala MR, Gordy XZ, Roberts P, Lirette ST, Thomas TV, Gordy DP, Albert AA, Vijayakumar V, Vijayakumar S. Prostate Cancer Screening Recommendations for General and Specific Populations in the
Western Nations. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/20-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is a chaotic scenario that exists in the field of prostate cancer (PCa) screening. To balance goals, such as decreasing mortality, avoiding unnecessary procedures, and decreasing the cost of medical care, the pendulum seems to have swung to the side of more restricted screening. The decrease in PCa screening has led to a slowly creeping decline in the favourable outcomes that existed among patients with PCa. If a potential patient or a family member is trying to get clear guidance about PCa screening by searching the internet, they will end up confused by several recommendations from many organisations. It is even more challenging to obtain any clarity about PCa screening for special populations, such as those with a family history of PCa, those of African descent/African Americans, and the elderly. The advent of genomic medicine and precision medicine is an opportunity to identify those at a very high risk of developing aggressive PCa, so that PCa screening can be more actively undertaken among them. In this paper, the authors review the current recommendations by different entities and summarise emerging molecular markers that may help bring clarity to PCa screening. The authors predict that concrete, consensual guidelines will emerge in less than one decade. Meanwhile, this article suggests intermediary steps that will help save lives from PCa mortality, especially for under-represented populations. This paper is a catalyst to stimulate further discussion and serves as a guide to noncancer-specialists for the near future as precision medicine progresses to better understand risk–benefit and cost–benefit ratios in PCa screening.
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Affiliation(s)
- Maurice L. King
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Mary R. Nittala
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Xiaoshan Z. Gordy
- Department of Health Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Roberts
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Seth T. Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Toms V. Thomas
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - David P. Gordy
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ashley A. Albert
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Vani Vijayakumar
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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10
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Gomez SL, Washington SL, Cheng I, Huang FW, Cooperberg MR. Monitoring Prostate Cancer Incidence Trends: Value of Multiple Imputation and Delay Adjustment to Discern Disparities in Stage-specific Trends. Eur Urol 2020; 79:42-43. [PMID: 33153814 DOI: 10.1016/j.eururo.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA; Greater Bay Area Cancer Registry, UCSF, San Francisco, CA, USA.
| | - Samuel L Washington
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA; Department of Urology, UCSF, San Francisco, CA, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA; Greater Bay Area Cancer Registry, UCSF, San Francisco, CA, USA
| | - Franklin W Huang
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA; Department of Urology, UCSF, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Medicine, UCSF, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA, USA; Department of Urology, UCSF, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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11
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Hewitt K, Son J, Glencer A, Borowsky AD, Cooperberg MR, Esserman LJ. The Evolution of Our Understanding of the Biology of Cancer Is the Key to Avoiding Overdiagnosis and Overtreatment. Cancer Epidemiol Biomarkers Prev 2020; 29:2463-2474. [PMID: 33033145 DOI: 10.1158/1055-9965.epi-20-0110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/06/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022] Open
Abstract
There has been a tremendous evolution in our thinking about cancer since the 1880s. Breast cancer is a particularly good example to evaluate the progress that has been made and the new challenges that have arisen due to screening that inadvertently identifies indolent lesions. The degree to which overdiagnosis is a problem depends on the reservoir of indolent disease, the disease heterogeneity, and the fraction of the tumors that have aggressive biology. Cancers span the spectrum of biological behavior, and population-wide screening increases the detection of tumors that may not cause harm within the patient's lifetime or may never metastasize or result in death. Our approach to early detection will be vastly improved if we understand, address, and adjust to tumor heterogeneity. In this article, we use breast cancer as a case study to demonstrate how the approach to biological characterization, diagnostics, and therapeutics can inform our approach to screening, early detection, and prevention. Overdiagnosis can be mitigated by developing diagnostics to identify indolent disease, incorporating biology and risk assessment in screening strategies, changing the pathology rules for tumor classification, and refining the way we classify precancerous lesions. The more the patterns of cancers can be seen across other cancers, the more it is clear that our approach should transcend organ of origin. This will be particularly helpful in advancing the field by changing both our terminology for what is cancer and also by helping us to learn how best to mitigate the risk of the most aggressive cancers.See all articles in this CEBP Focus section, "NCI Early Detection Research Network: Making Cancer Detection Possible."
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Affiliation(s)
- Kelly Hewitt
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Jennifer Son
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Alexa Glencer
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Alexander D Borowsky
- Department of Pathology, University of California, Davis, Davis, California.,Athena Breast Health Network
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, San Francisco, California.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California
| | - Laura J Esserman
- Department of Surgery, University of California, San Francisco, San Francisco, California. .,Athena Breast Health Network
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12
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Mohler JL, Antonarakis ES, Armstrong AJ, D'Amico AV, Davis BJ, Dorff T, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Hurwitz M, Ippolito JE, Kane CJ, Kuettel MR, Lang JM, McKenney J, Netto G, Penson DF, Plimack ER, Pow-Sang JM, Pugh TJ, Richey S, Roach M, Rosenfeld S, Schaeffer E, Shabsigh A, Small EJ, Spratt DE, Srinivas S, Tward J, Shead DA, Freedman-Cass DA. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:479-505. [PMID: 31085757 DOI: 10.6004/jnccn.2019.0023] [Citation(s) in RCA: 861] [Impact Index Per Article: 215.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The NCCN Guidelines for Prostate Cancer include recommendations regarding diagnosis, risk stratification and workup, treatment options for localized disease, and management of recurrent and advanced disease for clinicians who treat patients with prostate cancer. The portions of the guidelines included herein focus on the roles of germline and somatic genetic testing, risk stratification with nomograms and tumor multigene molecular testing, androgen deprivation therapy, secondary hormonal therapy, chemotherapy, and immunotherapy in patients with prostate cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Joseph E Ippolito
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Jesse McKenney
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - George Netto
- University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | - Sylvia Richey
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Mack Roach
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Edward Schaeffer
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Ahmad Shabsigh
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Eric J Small
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | - Jonathan Tward
- Huntsman Cancer Institute at the University of Utah; and
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13
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Clements MB, Abdalla B, Culp SH, Costabile RA, Krupski TL. Prostate Cancer Characteristics in the US Preventive Services Task Force Grade D Era: A Single-Center Study and Meta-Analysis. Urol Int 2020; 104:692-698. [PMID: 32759606 DOI: 10.1159/000507656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In May 2012, the US Preventive Services Task Force assigned prostate-specific antigen-based screening a grade D recommendation, advising against screening at any age. Our objective was to compare prostate cancer characteristics pre- and post-recommendation with an adjusted analysis of our data and a pooled analysis including other primary data sources. METHODS We identified all incident prostate cancer diagnoses at our institution from 2007 to 2016. Multivariable log binomial regression was used to determine the relative risk (RR) of metastasis at diagnosis, ≥Gleason Group 4, and high D'Amico risk disease pre- versus post-recommendation. The meta-analysis included primary data studies evaluating these outcomes. RESULTS At our institution, 287 (44.6%) and 224 (48.8%) patients were diagnosed in the pre- and post-cohorts. The RR of metastatic disease at diagnosis did not differ between groups (p = 0.224), nor did the risk of high D'Amico category disease (p = 0.089). The risk of ≥Gleason Group 4 was 1.58 times higher post-recommendation (p = 0.007). The pooled risk of ≥Gleason Group 4 disease was 1.5 (p < 0.001) post-recommendation and was 1.29 (p = 0.006) for high D'Amico risk disease. CONCLUSIONS While the number of metastatic cases did not differ after the recommendation, the risk of high-grade cancers increased at both a local and aggregated level.
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Affiliation(s)
- Matthew B Clements
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA,
| | - Basil Abdalla
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen H Culp
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Raymond A Costabile
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
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14
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Ko YH, Huynh LM, See K, Lall C, Skarecky D, Ahlering TE. Impact of surgically maximized versus native membranous urethral length on 30-day and long-term pad-free continence after robot-assisted radical prostatectomy. Prostate Int 2020; 8:55-61. [PMID: 32647641 PMCID: PMC7336015 DOI: 10.1016/j.prnil.2019.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/20/2019] [Accepted: 12/26/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pelvic multiparametric magnetic resonance imaging (mpMRI)-determined membranous urethral length (MUL) and its surgical maximization have been reported to impact early- and long-term pad-free urinary continence after robot-assisted radical prostatectomy (RARP). OBJECTIVE The objective of this study was to present evidence (data and video) of important effects on post-RARP continence recovery from both innate mpMRI-assessed and surgical preservation of MUL. DESIGN SETTING AND PARTICIPANTS Of 605 men undergoing RARP, 580 with complete follow-up were included: Group 1, prior (N = 355), and Group 2, subsequent (N = 225) to technique change of MUL maximization. Effect of innate, mpMRI-assessed MUL on postoperative continence was assessed. SURGICAL PROCEDURE Before technique change, the dorsal venous complex was stapled before transection of the membranous urethra. After the change, the final step of extirpation was transection of the dorsal venous complex and periurethral attachments, thus facilitating surgical maximization of MUL. MEASUREMENTS Primary and secondary outcomes for technique change and mpMRI-assessed MUL were both patient-reported 30-day and 1-year pad-free continence after RARP, respectively. RESULTS Preoperative prostate-specific antigen, age, and disease aggressiveness were significantly higher in Group 2. After technique change and surgical maximization of MUL, 30-day and 1-year pad-free continence were both significantly improved (p < 0.05). In multivariate analysis, maximization of MUL significantly increased the likelihood of both early- and long-term continence recovery. For men undergoing MUL preservation, mpMRI-assessed MUL>1.4 cm also independently predicted higher 30-day (odds ratio: 4.85, 95% confidence interval: 1.24-18.9) and 1-year continence recovery (odds ratio: 11.26, 95% confidence interval: 1.07-118). CONCLUSIONS Prostatic rotation and circumferential release of apical attachments and maximization of MUL improves continence after RARP. Separately, innate MUL>1.4 cm independently increased 30-day and 1-year continence recovery. PATIENT SUMMARY Surgeon efforts to maximize MUL during radical prostatectomy are highly encouraged, as maximally preserved MUL likely improves post-RARP continence recovery. In addition, individual patients' mpMRI-assessed MUL (approximately >1.4 cm) independently limits continence recovery.
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Affiliation(s)
- Young Hwii Ko
- Department of Urology, Yeoungnam University, Daegu, Korea
| | - Linda My Huynh
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Kaelyn See
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Douglas Skarecky
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Thomas E. Ahlering
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
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15
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Chipollini J, Pollock GR. National trends in the management of low-risk prostate cancer: analyzing the impact of Medicaid expansion in the United States. Int Urol Nephrol 2020; 52:1611-1615. [PMID: 32285285 DOI: 10.1007/s11255-020-02463-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/04/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate recent trends in the management of low-risk prostate cancer (PCa) and analyze differences in adoption of surveillance based on state Medicaid-expansion status in the United States (US). METHODS Using the National Cancer Database, we identified men diagnosed from 2012 to 2016. Men with histologically confirmed low-risk PCa defined as PSA less than 10 ng/ml, Gleason score ≤ 6, and cT1-T2a were included. The Cochran Armitage test was used to evaluate trends in surveillance versus treatment. Comparisons on surveillance adoption based on 2014 Medicaid expansion status and difference-in-difference analysis were performed. RESULTS The cohort included 84,340 men. During the study period, surveillance as initial management increased from 13.6% in 2012 to 32.1% in 2016 (p < 0.01). When comparing by Medicaid-expansion status, expansion states had higher rates in adoption of surveillance as compared to non-expansion states over the study period (36.6 vs 28.5%). Following expansion, men in expansion states were 1.94% more likely to be treated with surveillance than in earlier years (p < 0.01). Men in non-expansion states were 1.97% more likely to receive surveillance following expansion (p < 0.01) for a relative 0.03% difference in active surveillance adoption among men with low-risk PCa (95% CI - 0.004 to 0.013, p = 0.344). CONCLUSION Based on the data from 2012 to 2016, there has been a significant increase in active surveillance as initial management for low-risk PCa in the US. Medicaid expansion was not found to be detrimental in adoption of surveillance. Understanding the impact of payer status on health outcomes can aid in the development of future health care policies aiming to mitigate disparities.
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Affiliation(s)
- Juan Chipollini
- Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Avenue, PO Box 245077, Tucson, AZ, 85724-5077, USA.
| | - Grant R Pollock
- Department of Urology, University of Arizona College of Medicine, 1501 N. Campbell Avenue, PO Box 245077, Tucson, AZ, 85724-5077, USA
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16
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Gopalani SV, Janitz AE, Martinez SA, Gutman P, Khan S, Campbell JE. Trends in Cancer Incidence Among American Indians and Alaska Natives and Non-Hispanic Whites in the United States, 1999-2015. Epidemiology 2020; 31:205-213. [PMID: 31764279 PMCID: PMC7386857 DOI: 10.1097/ede.0000000000001140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Female breast, prostate, lung, and colorectal cancers are the leading incident cancers among American Indian and Alaska Native (AI/AN) and non-Hispanic White (NHW) persons in the United States. To understand racial differences, we assessed incidence rates, analyzed trends, and examined geographic variation in incidence by Indian Health Service regions. METHODS To assess differences in incidence, we used age-adjusted incidence rates to calculate rate ratios (RRs) and 95% confidence intervals (CIs). Using joinpoint regression, we analyzed incidence trends over time for the four leading cancers from 1999 to 2015. RESULTS For all four cancers, overall and age-specific incidence rates were lower among AI/ANs than NHWs. By Indian Health Service regions, incidence rates for lung cancer were higher among AI/ANs than NHWs in Alaska (RR: 1.46; 95% CI: 1.37, 1.56) and Northern (RR: 1.29; 95% CI: 1.25, 1.33) and Southern (RR: 1.06; 95% CI: 1.03, 1.09) Plains. Similarly, colorectal cancer incidence rates were higher in AI/ANs than NHWs in Alaska (RR: 2.29; 95% CI: 2.14, 2.45) and Northern (RR: 1.04; 95% CI: 1.00, 1.09) and Southern (RR: 1.11; 95% CI: 1.07, 1.15) Plains. Also, AI/AN women in Alaska had a higher incidence rate for breast cancer than NHW women (RR: 1.05; 95% CI: 1.05, 1.20). From 1999 to 2015, incidence rates for all four cancers decreased in NHWs, but only rates for prostate (average annual percent change: -4.70) and colorectal (average annual percent change: -1.80) cancers decreased considerably in AI/ANs. CONCLUSION Findings from this study highlight the racial and regional differences in cancer incidence.
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Affiliation(s)
- Sameer V. Gopalani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Amanda E. Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sydney A. Martinez
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Pamela Gutman
- Cherokee Nation Health Research, Cherokee Nation, Tahlequah, OK
| | - Sohail Khan
- Cherokee Nation Health Research, Cherokee Nation, Tahlequah, OK
| | - Janis E. Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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17
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Guo L, Zhu Z, Zhang X. Adding radiotherapy to androgen deprivation therapy in men with node-positive prostate cancer after radical prostatectomy: A meta-analysis. Medicine (Baltimore) 2020; 99:e19153. [PMID: 32150055 PMCID: PMC7478562 DOI: 10.1097/md.0000000000019153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Several studies have tested the addition of adjuvant radiotherapy (RT) to androgen deprivation therapy (ADT) in node-positive prostate cancer (PCa) after radical prostatectomy (RP). This meta-analysis aims to assess the effects of adding RT to ADT in the treatment of PCa patients with lymph node invasion. METHODS We systematically searched PubMed and Embase through June 2018 for human studies comparing RT plus ADT versus ADT in men with node-positive PCa after RP. The primary end point was overall survival (OS). Secondary end point was cancer-specific survival (CSS). Hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of RT plus ADT on OS and CSS were combined across studies using meta-analysis. RESULTS Five studies were selected for inclusion. Overall, 15,524 patients were enrolled in the 5 studies. This included 6309 (40.6%) patients receiving ADT, 4389 (28.3%) patients receiving adjuvant RT plus ADT, and 4826 (31.1%) patients receiving observation. In lymph node-positive PCa patients, the addition of adjuvant RT was associated with improved OS (HR: 0.74; 95% CI, 0.59-0.92; P = .008). Moreover, the addition of adjuvant RT was also associated with a dramatic CSS improvement (HR: 0.40; 95% CI, 0.27-0.59; P = .000). CONCLUSIONS Adding RT to ADT may be a clinically effective treatment option for men with lymph node-positive PCa after RP.
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Affiliation(s)
- Lijuan Guo
- Department of Disease Prevention and Control
| | - Zhaowei Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
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18
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Abstract
Following detection of high levels of serum prostate-specific antigen, many men are advised to have transrectal ultrasound-guided biopsy in an attempt to locate a cancer. This nontargeted approach lacks accuracy and carries a small risk of potentially life-threatening sepsis. Worse still, it can detect clinically insignificant cancer cells, which are unlikely to be the origin of advanced-stage disease. The detection of these indolent cancer cells has led to overdiagnosis, one of the major problems of contemporary medicine, whereby many men with clinically insignificant disease are advised to undergo unnecessary radical surgery or radiotherapy. Advances in imaging and biomarker discovery have led to a revolution in prostate cancer diagnosis, and nontargeted prostate biopsies should become obsolete. In this Perspective article, we describe the current diagnostic pathway for prostate cancer, which relies on nontargeted biopsies, and the problems linked to this pathway. We then discuss the utility of prebiopsy multiparametric MRI and novel tumour markers. Finally, we comment on how the incorporation of these advances into a new diagnostic pathway will affect the current risk-stratification system and explore future challenges.
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19
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Kensler KH, Rebbeck TR. Cancer Progress and Priorities: Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:267-277. [PMID: 32024765 PMCID: PMC7006991 DOI: 10.1158/1055-9965.epi-19-0412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/10/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Kevin H Kensler
- Division of Population Sciences, Dana-Farber Cancer Institute and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Timothy R Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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20
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Gustavsen G, Gullet L, Cole D, Lewine N, Bishoff JT. Economic burden of illness associated with localized prostate cancer in the United States. Future Oncol 2019; 16:4265-4277. [PMID: 31802704 DOI: 10.2217/fon-2019-0639] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Aim: Prior studies have established the economic burden of prostate cancer on society. However, changes to screening, novel therapies and increased use of active surveillance (AS) create a need for an updated analysis. Methods: A deterministic, decision-analytic model was developed to estimate medical costs associated with localized prostate cancer over 10 years. Results: 10-year costs averaged $45,957, $99,445 and $188,928 for low-, intermediate- and high-risk patients, respectively. For low-risk patients, AS 10-year costs averaged $33,912/patient, whereas definitive treatment averaged $49,667/patient. Despite higher failure rates in intermediate-risk patients, AS remained less costly than definitive treatment, with 10-year costs averaging $90,614/patient and $99,394/patient, respectively. Conclusion: Broader incorporation of AS, guided by additional prognostic tools, may mitigate this growing economic burden.
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Affiliation(s)
| | | | - Doria Cole
- Health Advances LLC, Weston, MA 02493, USA
| | | | - Jay T Bishoff
- Intermountain Healthcare, Salt Lake City, UT 84103, USA
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21
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Joshi SS, Filson CP. Long‐term consequences of the USPSTF Grade D recommendation for prostate‐specific antigen screening. Cancer 2019; 126:694-696. [DOI: 10.1002/cncr.32605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Shreyas S. Joshi
- Department of Urology Emory University School of Medicine Atlanta Georgia
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22
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England T, Li J, Cohen RJ. Fifteen-year analysis of prostate biopsies in Western Australia including recent impact of multiparametric magnetic resonance imaging. ANZ J Surg 2019; 89:1605-1609. [PMID: 31769189 DOI: 10.1111/ans.15566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The number of men undergoing prostate biopsy and subsequent cancer detection rates has changed significantly over the past 15 years. We aim to evaluate changes in the diagnostic pathway of prostate cancer between 2003 and 2018. METHODS A total of 13 844 Western Australian biopsy-naive men were assessed to determine trends in age, prostate-specific antigen levels, number of core samples, positive cores and tumour grade (Gleason) between 2003 and 2018. Further, in 2018, the impact of pre-biopsy multiparametric magnetic resonance imaging (mpMRI) was also assessed. RESULTS Between 2003 and 2012, the number of men undergoing biopsy increased from 1445 to 3100. During this time, the prostate cancer detection rate (%) remained unchanged. However, in 2018, 2042 men underwent prostate biopsy (reduction of 34.1%) and the detection rate increased to 72.6%. The incidence of low-grade cancer (Gleason score <7) increased from 28.1% in 2003 to 36.2% in 2012, but it decreased significantly to 15.1% by 2018. High-grade cancer (Gleason score >7) declined from 21.3% in 2003 to 15.2% in 2012 but then increased to 35.7% in 2018. The use of mpMRI in 2018 improved the detection rate of high-grade cancer. However, its specificity remains low (29.7%) and a considerable proportion of low Prostate Imaging Reporting and Data System score lesions was later diagnosed with cancer unsuitable for active surveillance. CONCLUSION In recent years, there has been a significant increase in the diagnosis high-grade cancer and a reduction in cancer suitable for active surveillance. mpMRI identifies high-grade tumours but is not a reliable alternative to prostate biopsy.
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Affiliation(s)
- Thomas England
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Jian Li
- Uropath Pty Ltd, Perth, Western Australia, Australia
| | - Ronald J Cohen
- School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,Uropath Pty Ltd, Perth, Western Australia, Australia
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23
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Rezaee ME, Goddard B, Sverrisson EF, Seigne JD, Dagrosa LM. 'Dr Google': trends in online interest in prostate cancer screening, diagnosis and treatment. BJU Int 2019; 124:629-634. [PMID: 31206954 DOI: 10.1111/bju.14846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To examine trends in online search behaviours related to prostate cancer on a national and regional scale using a dominant major search engine. MATERIALS AND METHODS Google Trends was queried using the terms 'prostate cancer', 'prostate-specific antigen' (PSA), and 'prostate biopsy' between January 2004 and January 2019. Search volume index (SVI), a measure of relative search volume on Google, was obtained for all terms and examined by region and time period: pre-US Preventive Services Task Force (USPSTF) Grade D draft recommendation on PSA screening; during the active Grade D recommendation; and after publication of the recent Grade C draft recommendation. RESULTS Online interest in PSA screening differed by time period (P < 0.01). The SVI for PSA screening was greater pre-Grade D draft recommendation (82.7) compared to during the recommendation (74.5), while the SVI for PSA screening was higher post-Grade C draft recommendation (90.4) compared to both prior time periods. Similar results were observed for prostate biopsy and prostate cancer searches. At the US state level, online interest in prostate cancer was highest in South Carolina (SVI 100) and lowest in Hawaii (SVI 64). For prostate cancer treatment options, online interest in cryotherapy, prostatectomy and prostate cancer surgery overall increased, while searches for active surveillance, external beam radiation, brachytherapy and high-intensity focused ultrasonography remained stable. CONCLUSION Online interest in prostate cancer has changed over time, particularly in accordance with USPSTF screening guidelines. Google Trends may be a useful tool in tracking public interest in prostate cancer screening, diagnosis, and treatment, especially as it relates to major shifts in practice guidelines.
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Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon
| | | | - Einar F Sverrisson
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon
| | - John D Seigne
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon
| | - Lawrence M Dagrosa
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon
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24
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Bleyer A, Spreafico F, Barr R. Prostate cancer in young men: An emerging young adult and older adolescent challenge. Cancer 2019; 126:46-57. [DOI: 10.1002/cncr.32498] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/12/2019] [Accepted: 05/27/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Archie Bleyer
- Oregon Health and Science Center Portland Oregon
- McGovern Medical School University of Texas Houston Texas
| | - Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit Foundation IRCCS National Cancer Institute Milan Italy
| | - Ronald Barr
- Departments of Pediatrics, Medicine, and Pathology McMaster University and McMaster Children's Hospital Hamilton Ontario Canada
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25
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[Trivialization of prostate cancer? : Stage shift and possible causes]. Urologe A 2019; 58:1461-1468. [PMID: 31531694 DOI: 10.1007/s00120-019-01039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND According to the strongly negative grade D recommendation of the U.S. Preventive Services Task Force in 2012, the prostate-specific antigen (PSA) test was not only not recommended but was also warned against. As a result in the USA there was a stage shift towards more advanced tumor stages under the newly detected prostate cancers; however, in contrast to the highly questionable American PLCO study, the European ERSPC study showed a clear reduction in prostate cancer-related mortality. OBJECTIVE In this patient cohort it was investigated whether the tumor stage distribution in curatively treated prostate cancer has significantly changed, whether this has an influence on the perioperative results and complication rates and how these changes could have occurred. MATERIAL AND METHODS Patients after radical prostatectomy from 2008 to 2010 were compared to those from 2017. Demographic data, intraoperative courses, perioperative and postoperative complications and histopathological results were compared. RESULTS A total of 1276 operations were analyzed. Preoperative PSA levels showed a significant increase in 2017 (10.5 ± 13.4 ng/ml vs. 8.4 ± 9.1 ng/ml, p = 0.032). The pathological staging revealed a 20% increase in T3 tumors (49.4% versus 29.0%, p < 0.001). Correspondingly, moderately and poorly differentiated cancers and therefore those with higher aggressiveness were significantly more frequent with 11.2% (p < 0.001) and 10.4% (p < 0.001), respectively. The number of patients with lymph node metastases at prostatectomy even increased fourfold (4.5% vs. 16.9%, p < 0.001). CONCLUSION In the radical prostatectomy group, there was a shift to unfavorable and metastatic tumor stages. This negative trend seems largely to be caused by a lower acceptance of early detection by means of PSA determination.
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Lee HY, Kim DK, Doo SW, Yang WJ, Song YS, Lee B, Kim JH. Time Trends for Prostate Cancer Incidence from 2003 to 2013 in South Korea: An Age-Period-Cohort Analysis. Cancer Res Treat 2019; 52:301-308. [PMID: 31401823 PMCID: PMC6962480 DOI: 10.4143/crt.2019.194] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/28/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Prostate cancer (PCa) incidence is affected by aging phenomenon and performance of screening test. In United States, PCa incidence is affected by period effect of U.S. Preventive Services Task Force (USPSTF) recommendation. However, no study has reported the effect of USPSTF recommendation or aging phenomenon on PCa incidence in South Korea. Thus, the objective of this study was to investigate effects of age, period, and birth cohort on PCa incidence using age-period-cohort analysis. Materials and Methods Annual report of cancer statistics between 2003 and 2013 from National Health Insurance Service (NHIS) in South Korea for the number of PCa patients and Korean Statistical Information Service (KOSIS) data between 2003 and 2013 from national statistics in South Korea for the number of Korean male population were used. Age-period-cohort models were used to investigate effects of age, period, and birth cohort on PCa incidence. RESULTS Overall PCa incidence in South Korea was increased 8.8% in annual percentage (95% confidential interval, 6.5 to 11.2; p < 0.001). It showed an increasing pattern from 2003 to 2011 but a decreasing pattern from 2011 to 2013. Age increased the risk of PCa incidence. However, the speed of increase was slower with increasing age. PCa incidence was increased 1.4 times in 2008 compared to that in 2003 or 2013. Regarding cohort effect, the risk of PCa incidence started to increase from 1958 cohort. CONCLUSION PCa incidence was affected by period of specific year. There was a positive cohort effect on PCa incidence associated with age structural change.
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Affiliation(s)
- Hyun Young Lee
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Do Kyoung Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung Whan Doo
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Won Jae Yang
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yun Seob Song
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bora Lee
- Department of Statistics, Graduate School of Chung-Ang University, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Macleod LC, Yabes JG, Fam MM, Bandari J, Yu M, Maganty A, Furlan A, Filson CP, Davies BJ, Jacobs BL. Multiparametric Magnetic Resonance Imaging Is Associated with Increased Medicare Spending in Prostate Cancer Active Surveillance. Eur Urol Focus 2019; 6:242-248. [PMID: 31031042 DOI: 10.1016/j.euf.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/22/2019] [Accepted: 04/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) may improve prostate cancer risk stratification and decrease the need for repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on AS-related healthcare spending has not been established. OBJECTIVE To characterize the impact of mpMRI on AS-related Medicare expenditures. DESIGN, SETTING, AND PARTICIPANTS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare files, we identified men ≥66 yr old with localized prostate cancer diagnosed during 2008-2013. OUTCOME MEASURES AND STATISTICAL ANALYSIS With a validated algorithm, we classified men into AS with and without mpMRI groups. We then determined Medicare spending on AS in each group using inflation-adjusted, price-standardized Medicare payments for AS-related procedures (ie, prostate-specific antigen [PSA] tests, prostate biopsies, biopsy complications, and mpMRI). Multivariable median regression compared Medicare spending on AS for men who received mpMRI and those who did not. RESULTS AND LIMITATIONS We identified 9081 men on AS with a median follow-up of 45 mo (interquartile range 29-64 mo). Thirteen percent (N = 1225) received mpMRI. On multivariable median regression, receipt of mpMRI was associated with an additional $447 (95% confidence interval $409-487) in Medicare spending per year. We observed greater frequency of AS-related procedures and higher spending for identical procedures (eg, PSA or prostate biopsy) in the mpMRI group than in the non-mpMRI group (all p < 0.001). CONCLUSIONS Among Medicare beneficiaries on AS, mpMRI is associated with additional annual Medicare spending. Future studies are needed to determine optimal use of mpMRI during AS to maximize value. PATIENT SUMMARY Prostate magnetic resonance imaging (MRI) helps physicians determine which prostate cancers are aggressive and which can be monitored safely. We studied whether using MRI during prostate cancer monitoring (also called active surveillance) resulted in increased healthcare spending. There was a modest increase in spending, but this may be worthwhile if the use of MRI allows physicians to monitor prostate cancer more accurately.
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Affiliation(s)
- Liam C Macleod
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Jonathan G Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mina M Fam
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Jathin Bandari
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michelle Yu
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Avinash Maganty
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Martell K, Mendez LC, Chung H, Tseng CL, Zhang L, Alayed Y, Liu S, Vesprini D, Chu W, Paudel M, Cheung P, Szumacher E, Ravi A, Loblaw A, Morton G. Absolute percentage of biopsied tissue positive for Gleason pattern 4 disease (APP4) appears predictive of disease control after high dose rate brachytherapy and external beam radiotherapy in intermediate risk prostate cancer. Radiother Oncol 2019; 135:170-177. [PMID: 31015164 DOI: 10.1016/j.radonc.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE To identify if, in intermediate risk prostate cancer (IR-PCa), the absolute percentage of biopsied tissue positive for pattern 4 disease (APP4) may be a predictor of outcome. MATERIALS AND METHODS 411 patients with IR-PCa were retrospectively reviewed. APP4 was calculated based on biopsy reports. Multivariable competing risk analysis was then performed on optimized APP4 cutpoints to predict for biochemical failure (BF), androgen deprivation use for BF (ADT-BF) and development of metastases (MD). RESULTS Median follow-up for the cohort was 5.2 (Inter Quartile Range: 2.9-6.6) years. Median baseline PSA was 7.3 (5.3-9.8) ng/mL. 234 (56.9%) patients had T1 and 177 (43.1%) had T2 disease. Median APP4 was 2.00 (0.75-7.50)%. 38 (9.3%) patients experienced BF. The optimal cutpoint of APP4 for BF was >3.3% with an area under the curve (AUC) of 0.66. 17 (4.1%) received ADT-BF. The ADT-BF cutpoint was >6.6% with an AUC of 0.72. Eight (2.0%) developed MD. The MD cutpoint was >17.5% with an AUC of 0.86. Using APP4 >3.3 vs ≤ 3.3, log-transformed baseline PSA ln(PSA) (HR 2.5, 1.1-6.1; p = 0.037) and APP4 (HR 2.3, 1.1-4.7; p = 0.031) predicted for BF. Using APP4 >6.6 vs ≤ 6.6, ln(PSA) (HR 4.2, 1.4-12.4; p = 0.010) and APP4 (HR 3.7, 1.4-10.0; p = 0.009) were predictive of ADT-BF. APP4 >17.5 vs ≤ 17.5 alone was predictive of MD (HR 25.7, 4.9-135.3; p < 0.001). CONCLUSION APP4 cutpoints of >3.3%, >6.6% and >17.5% were strongly associated with increased risk of BF, ADT-BF and developing MD respectively. These findings may inform future practice when treating IR-PCa but require external validation.
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Affiliation(s)
- K Martell
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - L C Mendez
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Western University, Department of Radiation Oncology, London, Canada; London Health Sciences Centre, London, Canada
| | - H Chung
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - C L Tseng
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - L Zhang
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Y Alayed
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Radiation Oncology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - S Liu
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - D Vesprini
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - W Chu
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - M Paudel
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - P Cheung
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - E Szumacher
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A Ravi
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A Loblaw
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - G Morton
- University of Toronto, Department of Radiation Oncology, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
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Seniority of primary care physicians is associated with a decrease in PSA ordering habits in the years surrounding the United States Preventative Services Task Force recommendation against PSA screening. Urol Oncol 2018; 36:500.e21-500.e27. [DOI: 10.1016/j.urolonc.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/25/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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Bynum J, Passow H, Carmichael D, Skinner J. Exnovation of Low Value Care: A Decade of Prostate-Specific Antigen Screening Practices. J Am Geriatr Soc 2018; 67:29-36. [PMID: 30291742 DOI: 10.1111/jgs.15591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine prostate-specific antigen (PSA) screening practice change in subgroups of men defined in guidelines and in various regions and to identify factors associated with change in screening practices. DESIGN Observational study using serial cross-sections, 2003 to 2013. SETTING National fee-for-service Medicare. PARTICIPANTS Men aged 68 and older eligible for prostate cancer screening. MEASUREMENTS National PSA screening practices in men aged 68 and older from 2003 to 2013 and change in regional screening rates in men aged 75 and older. RESULTS The PSA screening rate in men aged 68 and older was 17.2% in 2003, 22.3% in 2008, and 18.6% in 2013 (p < .001 for all differences); rates ended slightly lower than rates in 2003 only in men 80 and older. Racial disparities in screening became less pronounced over this period. In men aged 75 and older, change in regional screening rates varied widely, with absolute rates growing by 15 per 100 enrollees in some areas and declining by the same amount in others. Areas with high social capital, a measure associated with diffusion of new ideas, were more likely to decline; malpractice intensity and managed care penetration had no effect. CONCLUSION Studying Medicare enrollees over time, we found little reduction in PSA screening and even increases according to race and in some regions. The heterogeneous changes across regions suggest that consistent reduction in the use of low-value care may require change strategies that go beyond evidence and guidelines to include monitoring and feedback on performance. J Am Geriatr Soc 67:29-36, 2019.
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Affiliation(s)
- Julie Bynum
- Department of Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan.,Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Honor Passow
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Donald Carmichael
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Jonathan Skinner
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Economics, Dartmouth College, Hanover, New Hampshire.,National Bureau of Economic Research, Cambridge, Massachusetts
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Capogrosso P, Capitanio U, Vertosick EA, Ventimiglia E, Chierigo F, Oreggia D, Moretti D, Briganti A, Vickers AJ, Montorsi F, Salonia A. Temporal Trend in Incidental Prostate Cancer Detection at Surgery for Benign Prostatic Hyperplasia. Urology 2018; 122:152-157. [PMID: 30138683 DOI: 10.1016/j.urology.2018.07.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/14/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess changes in the rate of incidental prostate cancer (PCa) after benign prostatic hyperplasia (BPH) surgery over the last decade. MATERIALS AND METHODS We identified 1177 patients surgically treated for BPH (open prostatectomy, transurethral resection or holmium laser enucleation [HoLEP] of the prostate) in 2007-2016 at a single European academic center. Local polynomial regression was used to explore changes in the rate of incidental PCa detected after BPH surgery and of preoperative biopsy performed over time. Logistic regression analyses tested the association of incidental PCa diagnosis with year of surgery and preoperative biopsy. RESULTS Incidental PCa was found in 6.4% (74) of cases, 67 (91%) with Grade group 1 disease. We observed an increased incidence of PCa diagnosis after BPH surgery over time (odds ratio [OR]: 1.12; 95%confidence interval [CI]: 1.02-1.24, P = .02) along with a concomitant decrease in the rate of preoperative prostate biopsies (OR: 0.83; 95%CI: 0.79-0.88, P < .0001). Patients undergoing a preoperative biopsy showed a lower risk of being diagnosed with PCa after surgery (OR: 0.29; 95% CI: 0.12, 0.72 P = .007). Patients treated with HoLEP had a higher chance of incidental PCa detection (OR: 2.28; 95%CI: 1.30-4.00; P = .004), although this may be related to the significantly higher number of HoLEP performed over the last years. CONCLUSION The increased rate of low-risk PCa detected after BPH surgery in the last decade reflects the clinical practice changes in PCa screening and diagnosis leading to a reduced number of unnecessary biopsies and indolent cancer diagnosis.
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Affiliation(s)
- Paolo Capogrosso
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Umberto Capitanio
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Eugenio Ventimiglia
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Chierigo
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Davide Oreggia
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Donatella Moretti
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Francesco Montorsi
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Università Vita-Salute San Raffaele, Milan, Italy; Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Zakaria AS, Dragomir A, Brimo F, Kassouf W, Tanguay S, Aprikian A. Changes in the outcome of prostate biopsies after preventive task force recommendation against prostate-specific antigen screening. BMC Urol 2018; 18:69. [PMID: 30126402 PMCID: PMC6102901 DOI: 10.1186/s12894-018-0384-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/13/2018] [Indexed: 11/23/2022] Open
Abstract
Background The benefits of PSA-based screening for prostate cancer (PCa) are controversial. The Canadian and American Task Forces on Preventive Health Care (CTFPHC & USPSTF) have released recommendations against the use of routine PSA-based screening for any men. We thought to assess the impact of these recommendations on the outcomes and trends of prostate needle biopsies. Methods A complete chart review was conducted for all men who received prostate needle biopsies at McGill University Health Center between 2010 and 2016. Of those, we included 1425 patients diagnosed with PCa for analysis. We Compared 2 groups of patients (pre and post recommendations’ release date) using Welch’s t-tests and Chi-square test. A multivariate logistic regression model was used to analyze variables predicting worse pathological outcomes. Results When the release date of the USPSTF draft (October 2011) was used as a cut-off, we found an average annual decrease of 10.6% in the total number of biopsies. The median (IQR) baseline PSA levels were higher in post-recommendations group (n = 977) when compared to pre-recommendations group (n = 448) [8 ng/ml (5.7–12.9) versus 6.4 ng/ml (4.9–10.1), respectively. P = 0.0007]. Also, post-recommendations group’s patients had higher Gleason score (G7: 35.4% versus 28.4% and G8-G10: 31.2% versus 18.1%, respectively. P < 0.0001). Moreover, they had higher intermediate and high-risk PCa classification (36.4% versus 32.8% and 35.5% versus 22.1%, respectively. P < 0.0001). The recommendations release date was an independent variable associated with higher Gleason score in prostate biopsies (OR: 2.006, 95%CI: 1.477–2.725). Using the CTFPHC recommendations release date (October 2014) as a cut-off in further analysis, revealed similar results. Conclusions Our results revealed a reduction in the number of prostate needle biopsies performed over time after the recommendations of the preventive task forces. Furthermore, it showed a significant relative increase in the higher risk PCa diagnosis. The oncological outcomes associated with this trend need to be examined in further studies.
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Affiliation(s)
- Ahmed S Zakaria
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Alice Dragomir
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Simon Tanguay
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada
| | - Armen Aprikian
- Department of Surgery, Division of Urology, McGill University, McGill University Health Centre, 1001 Boulevard Decarie, Montreal, Quebec, H4A 3J1, Canada.
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Carroll PR. USPTF Prostate Cancer Screening Recommendations—A Step in the Right Direction. JAMA Surg 2018; 153:701-702. [DOI: 10.1001/jamasurg.2018.1283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter R. Carroll
- UCSF–Helen Diller Family Comprehensive Cancer Center, Department of Urology, University of California, San Francisco
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34
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Preisser F, Nazzani S, Bandini M, Marchioni M, Tian Z, Montorsi F, Saad F, Briganti A, Steuber T, Budäus L, Huland H, Graefen M, Tilki D, Karakiewicz PI. Increasing rate of lymph node invasion in patients with prostate cancer treated with radical prostatectomy and lymph node dissection. Urol Oncol 2018; 36:365.e1-365.e7. [DOI: 10.1016/j.urolonc.2018.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/11/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
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35
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Wang LL, Begashaw K, Evans M, Earnest A, Evans SM, Millar JL, Murphy DG, Moon D. Patterns of care and outcomes for men diagnosed with prostate cancer in Victoria: an update. ANZ J Surg 2018; 88:1037-1042. [PMID: 30047208 DOI: 10.1111/ans.14722] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/09/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND To update patterns of care for men diagnosed with prostate cancer in Victoria, Australia between 2008 and 2015. METHODS From August 2008 to December 2015, 14 025 men diagnosed with prostate cancer were included. These data were obtained from the Prostate Cancer Outcome Registry - Victoria (PCOR-Vic). Frequencies were used to describe hospital and patient characteristics and treatment types. Comparisons were made between previous period of analysis (2008-2011) to the most recent period (2011-2015). Survival analysis using a stepwise Cox proportional hazards regression model was performed. RESULTS Mean age of diagnosis was 66.5 years and 44% of patients were diagnosed with Gleason 7 prostate cancer. Majority of notifications (63.6%) were received from a private institution and 70.2% of patients were diagnosed at a metropolitan institution. Most patients (95.3%) were diagnosed with clinically localized disease. Within 12 months of diagnosis, 55.9% of patients with low-risk disease received no active treatment. Radical prostatectomy was the most common primary treatment with curative intent (47%). When comparing of patterns of care between 2008-2011 and 2011-2015, the proportion of patients diagnosed with Gleason 9-10 disease increased, as has the proportion of patients diagnosed with metastatic disease. CONCLUSION With the PCOR-Vic, we were able to identify that increasing number of patients were diagnosed with high-risk and metastatic disease. There has been an overall decrease in radical treatment rates, likely due to active surveillance playing a significant role especially in patients with low-risk prostate cancer.
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Affiliation(s)
- Luke L Wang
- Australian Urology Associates, Melbourne, Victoria, Australia
| | | | - Melanie Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue M Evans
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeremy L Millar
- Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Daniel Moon
- Australian Urology Associates, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Ahlering T, Huynh LM, Kaler KS, Williams S, Osann K, Joseph J, Lee D, Davis JW, Abaza R, Kaouk J, Patel V, Kim IY, Porter J, Hu JC. Unintended consequences of decreased PSA-based prostate cancer screening. World J Urol 2018; 37:489-496. [PMID: 30003374 DOI: 10.1007/s00345-018-2407-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/08/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In May 2012, the US Preventive Services Task Force issued a grade D recommendation against PSA-based prostate cancer screening. Epidemiologists have concerns that an unintended consequence is a problematic increase in high-risk disease and subsequent prostate cancer-specific mortality. MATERIALS AND METHODS To assess the effect of decreased PSA screening on the presentation of high-risk prostate cancer post-radical prostatectomy (RP). Nine high-volume referral centers throughout the United States (n = 19,602) from October 2008 through September 2016 were assessed and absolute number of men presenting with GS ≥ 8, seminal vesicle and lymph node invasion were compared with propensity score matching. RESULTS Compared to the 4-year average pre-(Oct. 2008-Sept. 2012) versus post-(Oct. 2012-Sept. 2016) recommendation, a 22.6% reduction in surgical volume and increases in median PSA (5.1-5.8 ng/mL) and mean age (60.8-62.0 years) were observed. The proportion of low-grade GS 3 + 3 cancers decreased significantly (30.2-17.1%) while high-grade GS 8 + cancers increased (8.4-13.5%). There was a 24% increase in absolute numbers of GS 8+ cancers. One-year biochemical recurrence rose from 6.2 to 17.5%. To discern whether increases in high-risk disease were due to referral patterns, propensity score matching was performed. Forest plots of odds ratios adjusted for age and PSA showed significant increases in pathologic stage, grade, and lymph node involvement. CONCLUSIONS All centers experienced consistent decreases of low-grade disease and absolute increases in intermediate and high-risk cancer. For any given age and PSA, propensity matching demonstrates more aggressive disease in the post-recommendation era.
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Affiliation(s)
- Thomas Ahlering
- Department of Urology, University of California, Irvine Health, 333 City Blvd West, Suite 2100, Orange, CA, 92868, USA.
| | - Linda My Huynh
- Department of Urology, University of California, Irvine Health, 333 City Blvd West, Suite 2100, Orange, CA, 92868, USA
| | - Kamaljot S Kaler
- Department of Urology, University of California, Irvine Health, 333 City Blvd West, Suite 2100, Orange, CA, 92868, USA
| | - Stephen Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Kathryn Osann
- Division of Hematology-Oncology, Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Jean Joseph
- Department of Urology, University of Rochester, Rochester, NY, USA
| | - David Lee
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ronney Abaza
- Department of Urology, Ohio Health Robotic Urologic Surgeons, Dublin, OH, USA
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Vipul Patel
- Department of Urology, Florida Celebration Health, Kissimmee, FL, USA
| | - Isaac Yi Kim
- Department of Urology, Rutgers Cancer Center of New Jersey, New Brunswick, NJ, USA
| | - James Porter
- Department of Urology, Swedish Medical Center, Seattle, WA, USA
| | - Jim C Hu
- Weill Cornell Medicine, New York, NY, USA
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Leyh-Bannurah SR, Karakiewicz PI, Pompe RS, Preisser F, Zaffuto E, Dell’Oglio P, Briganti A, Nafez O, Fisch M, Steuber T, Graefen M, Budäus L. Inverse stage migration patterns in North American patients undergoing local prostate cancer treatment: a contemporary population-based update in light of the 2012 USPSTF recommendations. World J Urol 2018; 37:469-479. [DOI: 10.1007/s00345-018-2396-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/28/2018] [Indexed: 12/19/2022] Open
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Modi PK, Kaufman SR, Borza T, Yan P, Miller DC, Skolarus TA, Hollingsworth JM, Norton EC, Shahinian VB, Hollenbeck BK. Variation in prostate cancer treatment and spending among Medicare shared savings program accountable care organizations. Cancer 2018; 124:3364-3371. [PMID: 29905943 DOI: 10.1002/cncr.31573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 04/27/2018] [Accepted: 05/03/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Accountable care organizations (ACOs) have been shown to reduce prostate cancer treatment among men unlikely to benefit because of competing risks (ie, potential overtreatment). This study assessed whether the level of engagement in ACOs by urologists affected rates of treatment, overtreatment, and spending. METHODS A 20% sample of national Medicare data was used to identify men diagnosed with prostate cancer between 2012 and 2014. The extent of urologist engagement in an ACO, as measured by the proportion of patients in an ACO managed by an ACO-participating urologist, served as the exposure. The use of treatment, potential overtreatment (ie, treatment in men with a ≥75% risk of 10-year noncancer mortality), and average payments in the year after diagnosis for each ACO were modeled. RESULTS Among 2822 men with newly diagnosed prostate cancer, the median rates of treatment and potential overtreatment by an ACO were 71.3% (range, 23.6%-79.5%) and 53.6% (range, 12.4%-76.9%), respectively. Average Medicare payments among ACOs in the year after diagnosis ranged from $16,523.52 to $34,766.33. Stronger urologist-ACO engagement was not associated with treatment (odds ratio, 0.87; 95% confidence interval, 0.6-1.2; P = .4) or spending (9.7% decrease in spending; P = .08). However, urologist engagement was associated with a lower likelihood of potential overtreatment (odds ratio, 0.29; 95% confidence interval, 0.1-0.86; P = .03). CONCLUSIONS ACOs vary widely in treatment, potential overtreatment, and spending for prostate cancer. ACOs with stronger urologist engagement are less likely to treat men with a high risk of noncancer mortality, and this suggests that organizations that better engage specialists may be able to improve the value of specialty care. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Parth K Modi
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Samuel R Kaufman
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Tudor Borza
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Phyllis Yan
- Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - David C Miller
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Ted A Skolarus
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - John M Hollingsworth
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Edward C Norton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan.,Department of Economics, University of Michigan, Ann Arbor, Michigan.,National Bureau of Economic Research, Cambridge, Massachusetts
| | - Vahakn B Shahinian
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
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Impact of the United States Preventive Services Task Force 'D' recommendation on prostate cancer screening and staging. Curr Opin Urol 2018; 27:205-209. [PMID: 28221220 DOI: 10.1097/mou.0000000000000383] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW In 2012, the United States Preventive Services Task Force (USPSTF) issued a grade 'D' recommendation against the use of routine prostate-specific antigen (PSA)-based screening for any men. This recommendation reflects critical misinterpretations of the available evidence base regarding benefits and harms of PSA screening and has influenced the nationwide landscape of prostate cancer screening, diagnosis, and treatment. RECENT FINDINGS Following the USPSTF recommendation, a substantial decline in PSA screening was noted for all age groups. Similarly, overall rates of prostate biopsy and prostate cancer incidence have significantly decreased with a shift toward higher grade and stage disease upon diagnosis. Concurrently, the incidence of metastatic prostate cancer has significantly risen in the United States. These trends are concerning particularly for the younger men with occult high-grade disease who are expected to benefit the most from early detection and definitive prostate cancer treatment. SUMMARY These emerging trends in PSA screening and prostate cancer incidence following the USPSTF recommendation may have significant public health implications. Due to the long natural history of the disease, a long-term follow-up is needed to provide a better understanding on the implications of such recommendations on disease progression and mortality rates in prostate cancer patients. The future of US screening policy should reflect a targeted 'smarter' screening strategy rather than dichotomizing the decision between 'screen all' or 'screen none'.
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Reply by Authors. J Urol 2018; 199:1232. [DOI: 10.1016/j.juro.2017.10.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Patel NH, Bloom J, Hillelsohn J, Fullerton S, Allman D, Matthews G, Eshghi M, Phillips JL. Prostate Cancer Screening Trends After United States Preventative Services Task Force Guidelines in an Underserved Population. Health Equity 2018; 2:55-61. [PMID: 29806045 PMCID: PMC5963250 DOI: 10.1089/heq.2018.0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Prostate cancer screening is a controversial topic. We examined trends in Prostate Specific Antigen (PSA) testing in an underserved population before and after the United States Preventative Services Task Force (USPSTF) recommendation against screening. Methods: Data were collected on all PSA and cholesterol screening tests from 2008 to 2014. We examined the trend of these tests and prostate biopsies while comparing this data to lipid panel data to adjust for changes in patient population. Results: A decrease in PSA screening was observed from 2010 through 2014, with the greatest decline in 2012. The age group most affected was patients aged 55–69 years. The amount of prostate biopsies during this period decreased as well. Conclusions: Decreased rates of PSA screening were observed in our urban hospital population that preceded the publication of the USPSTF guidelines. The incidence of prostate biopsies decreased in this timeframe. It now remains to be demonstrated whether decreased PSA screening rates impact the diagnosis of and ultimately the survival from prostate cancer.
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Affiliation(s)
- Neel H Patel
- Department of Urology, New York Medical College, Valhalla, New York
| | - Jonathan Bloom
- Urologic Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Joel Hillelsohn
- Department of Urology, New York Medical College, Valhalla, New York
| | - Sean Fullerton
- Department of Urology, New York Medical College, Valhalla, New York
| | - Denton Allman
- Department of Urology, New York Medical College, Valhalla, New York
| | - Gerald Matthews
- Department of Urology, New York Medical College, Valhalla, New York
| | - Majid Eshghi
- Department of Urology, New York Medical College, Valhalla, New York
| | - John L Phillips
- Department of Urology, New York Medical College, Valhalla, New York
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Resnick MJ, Graves AJ, Thapa S, Gambrel R, Tyson MD, Lee D, Buntin MB, Penson DF. Medicare Accountable Care Organization Enrollment and Appropriateness of Cancer Screening. JAMA Intern Med 2018; 178:648-654. [PMID: 29554179 PMCID: PMC5876897 DOI: 10.1001/jamainternmed.2017.8087] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite rapid diffusion of Accountable Care Organizations (ACOs), whether ACO enrollment results in observable changes in cancer screening remains unknown. OBJECTIVE To determine whether Medicare Shared Savings Program (MSSP) ACO enrollment changes the appropriateness of screening for breast, colorectal, and prostate cancers. DESIGN, SETTING, AND PARTICIPANTS For this population-based analysis of Medicare beneficiaries, we used Medicare data from 2007 through 2014 and evaluated changes in screening associated with ACO enrollment using differences-in-differences (DD) analyses. We then performed difference-in-difference-in-differences (DDD) analyses to determine whether observed changes in cancer screening associated with ACO enrollment were different across strata of appropriateness, defined using age (65-74 years vs ≥75 years) and predicted survival (top vs bottom quartile). MAIN OUTCOMES AND MEASURES Rates of breast, colorectal, and prostate cancer screening measured yearly as a proportion of eligible Medicare beneficiaries undergoing relevant screening services. RESULTS Among Medicare beneficiaries, comprising 39 218 652 person-years before MSSP enrollment and 17 252 345 person-years after MSSP enrollment, breast cancer screening declined among both ACO (42.7% precontract, 38.1% postcontract) and non-ACO (37.3% precontract, 34.1% postcontract) populations. The adjusted rate of decline (DD) in the ACO population exceeded the non-ACO population by 0.79% (P < .001). This decline was most pronounced among elderly women (-2.1%), with minimal observed change among younger women (-0.26%). Baseline colorectal cancer screening rates were lower than those for breast cancer among both ACO (10.1% precontract, 10.3% postcontract) and non-ACO (9.2% precontract, 9.1% postcontract) populations. We observed an adjusted 0.24% (P = .03) increase in screening associated with ACO enrollment, most pronounced among younger Medicare beneficiaries (0.36%). For breast and colorectal cancer, we observed statistically significant differences in estimates of effect between age strata, suggesting that the ACO effect on cancer screening is mediated by age (DDD for both P < .001). Prostate cancer screening declined among ACO (35.1% precontract, 28.5% postcontract) and non-ACO (31.2% precontract, 25.7% postcontract) populations. The adjusted rate of decline in the ACO population exceeded that of the non-ACO population by 1.2%. We observed no difference in estimate of effect between age strata, suggesting that the ACO-mediated changes in prostate cancer screening are similar among younger and elderly men. Results characterizing appropriateness with predicted survival mirrored those when stratified by age. CONCLUSIONS AND RELEVANCE Medicare Shared Savings Program ACO enrollment is associated with more appropriate breast and colorectal screening, although the magnitude of the observed ACO effect is modest in the early ACO experience.
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Affiliation(s)
- Matthew J Resnick
- Departments of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Departments of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research and Education Center, Tennessee Valley VA Health Care System, Nashville
| | - Amy J Graves
- Departments of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunita Thapa
- Departments of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Gambrel
- Departments of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark D Tyson
- Department of Urology, Mayo Clinic, Scottsdale, Arizona
| | - Daniel Lee
- Departments of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda B Buntin
- Departments of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Departments of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Departments of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research and Education Center, Tennessee Valley VA Health Care System, Nashville
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Gupta M, Patel HD, Schwen ZR, Tran PT, Partin AW. Adjuvant radiation with androgen-deprivation therapy for men with lymph node metastases after radical prostatectomy: identifying men who benefit. BJU Int 2018; 123:252-260. [DOI: 10.1111/bju.14241] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mohit Gupta
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Hiten D. Patel
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Zeyad R. Schwen
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Phuoc T. Tran
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Radiation Oncology and Molecular Radiation Sciences and Oncology; The Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Alan W. Partin
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
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Abstract
Since prostate-specific antigen (PSA) testing was approved in 1994, the incidence of metastasis and mortality from prostate cancer have significantly decreased. However, PSA screening for prostate cancer has limitations and few large randomized controlled trials have been conducted to determine the mortality benefit of PSA screening. Two studies that have been conducted are the Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC). These were the two main studies the US Preventive Services Task Force (USPSTF) used in its recommendation against prostate cancer screening in 2012. However, new evidence has demonstrated that the PLCO trial had significant limitations and the results of the ERSPC trial were more significant than previously thought. This article describes the strengths and weaknesses of the USPSTF's recommendation, along with current guidelines for prostate cancer screening.
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Leung AK, Hugar L, Patil D, Wong L, Carthon B, Carney KJ, Birdsong G, Moses KA, Master VA. The Clinical Course of Patients With Prostate-Specific Antigen ≥100 ng/ml: Insight Into a Potential Population for Targeted Prostate-Specific Antigen Screening. Urology 2018; 117:101-107. [PMID: 29656066 PMCID: PMC10182889 DOI: 10.1016/j.urology.2018.01.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/04/2018] [Accepted: 01/24/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To characterize men presenting to a tertiary care safety-net hospital with prostate-specific antigen (PSA) values ≥100 ng/mL and to identify a potential population for targeted PSA screening. MATERIALS AND METHODS Retrospective review of 100 randomly selected patients of a total of 204 who presented to Grady Memorial Hospital from 2004 to 2011 with initial PSA ≥100 ng/mL was performed. Demographics, disease characteristics, and survival status were obtained via the Tumor Registry and a combination of electronic medical records and older paper charts, with missing data from paper charts excluded on analyses. RESULTS Sixty-five patients were newly diagnosed with prostate cancer on presentation and 35 were previously diagnosed. Median PSA at presentation was 405.5 ng/mL (minimum, 100 and maximum, 7805), 81% had metastatic disease, and 94% had Gleason ≥7. Median Cancer of the Prostate Risk Assessment score was 8. Median age at presentation was 67.4 years (minimum, 40.8 and maximum, 90.6). Eighty-nine percent of patients were African American, 24% lived alone, 12% were homeless or incarcerated, 51% were insured by Medicare or Medicaid, and 47% were uninsured. Only 1% had human immunodeficiency virus, 19% had diabetes, and 13% had chronic kidney disease. Of the 65 newly diagnosed patients, only 23% had ever been screened and 9% were previously biopsied. Median time from presentation to death was 17.8 months (minimum, 0.16 and maximum, 107.1). CONCLUSION Among men presenting with PSA ≥100 ng/ml at a safety-net hospital, the majority were African American, of lower socioeconomic status, and had metastatic disease. Uniform absence of prostate cancer screening may expose greater numbers of at-risk men to similar outcomes. Discussion is needed regarding targeted PSA screening in higher risk, vulnerable patients.
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Affiliation(s)
- Andrew K Leung
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Lee Hugar
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Lisa Wong
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Bradley Carthon
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - K Jeff Carney
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - George Birdsong
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Kelvin A Moses
- Department of Urologic Surgery, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA.
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Impact of Accountable Care Organizations on Diagnostic Testing for Prostate Cancer. Urology 2018; 116:68-75. [PMID: 29630957 DOI: 10.1016/j.urology.2018.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 12/30/2017] [Accepted: 01/16/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine if Accountable Care Organizations (ACOs) have the potential to accelerate the impact of prostate cancer screening recommendations. METHODS We performed a retrospective cohort study using Medicare data evaluating the rates of PSA testing and prostate biopsy among men without prostate cancer between 2011 and 2014. We assessed PSA testing and biopsy rates before and after policy implementation among patients of ACO and non-ACO-aligned physicians. To control for secular trends, difference-in-differences methods were used to determine the effects of ACO implementation. RESULTS We identified 1.1 million eligible men without prostate cancer. From 2011 to 2014, the rates of PSA testing and biopsy declined by 22.3% and 7.0%, respectively. PSA testing declined similarly regardless of ACO participation-from 618 to 530 tests per 1000 beneficiaries among ACO-aligned physicians and from 607 to 516 tests per 1000 beneficiaries among non-ACO-aligned physicians (difference-in-differences P = .11). Whereas rates of prostate biopsy remained constant for patients of non-ACO-aligned physicians at 12 biopsies per 1000 beneficiaries, these rates increased from 11.6 to 12.5 biopsies per 1000 beneficiaries of patients of ACO-aligned physicians (difference-in-differences P = .03). CONCLUSION PSA testing and prostate biopsy rates decreased significantly between 2011 and 2014. The rate of PSA testing was not differentially affected by ACO participation. Conversely, there was an increase in the rate of prostate biopsy among patients of ACO-aligned physicians. ACOs did not accelerate deimplementation of PSA testing for eligible Medicare beneficiaries without prostate cancer.
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Faiena I, Holden S, Cooperberg MR, Holden S, Soule HR, Simons JW, Morgan TM, Penson DF, Morgans AK, Hussain M. Prostate Cancer Screening and the Goldilocks Principle: How Much Is Just Right? J Clin Oncol 2018; 36:937-941. [PMID: 29401003 PMCID: PMC6804825 DOI: 10.1200/jco.2017.76.4050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Izak Faiena
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Stuart Holden
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Mathew R. Cooperberg
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Stuart Holden
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Howard R. Soule
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Jonathan W. Simons
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Todd M. Morgan
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - David F. Penson
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Alicia K. Morgans
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
| | - Maha Hussain
- Izak Faiena and Stuart Holden, David Geffen School of Medicine at UCLA, Los Angeles, CA; Mathew R. Cooperberg, University of California, San Francisco, San Francisco, CA; Stuart Holden, Howard R. Soule, and Jonathan W. Simons, Prostate Cancer Foundation, Santa Monica, CA; Todd M. Morgan, University of Michigan, Ann Arbor, MI; David F. Penson, Vanderbilt University Medical Center, Nashville, TN; and Alicia K. Morgans and Maha Hussain, Northwestern University, Chicago, IL
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Modesto AAD, Lima RLBD, D’Angelis AC, Augusto DK. Um novembro não tão azul: debatendo rastreamento de câncer de próstata e saúde do homem. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2018. [DOI: 10.1590/1807-57622016.0288] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A campanha Novembro Azul, promovida no Brasil pelo Instituto Lado a Lado pela Vida em parceria com a Sociedade Brasileira de Urologia, busca alertar para o câncer de próstata e estimular o rastreamento da neoplasia. Pesquisas internacionais, entretanto, têm mostrado que esse rastreamento traz mais danos que benefícios. Comprometida com o conceito de prevenção quaternária, a Sociedade Brasileira de Medicina de Família e Comunidade questionou publicamente a campanha e sua proposta em 2015. Esta revisão narrativa discute esse posicionamento e sua repercussão, analisando criticamente os argumentos favoráveis e contrários ao rastreamento. A partir disso, discutimos alguns limites da prevenção, comentamos a relação entre mídia e saúde, e refletimos sobre ações mais adequadas para o cuidado dos homens, com base em estudos multicêntricos, revisões sistemáticas, documentos institucionais, reportagens e pesquisas qualitativas. Tal debate ajuda a promover um cuidado integral para a população masculina.
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Tumor characteristics, treatments, and oncological outcomes of prostate cancer in men aged ≤50 years: a population-based study. Prostate Cancer Prostatic Dis 2018; 21:71-77. [DOI: 10.1038/s41391-017-0006-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/09/2017] [Indexed: 12/19/2022]
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Gejerman G, Ciccone P, Goldstein M, Lanteri V, Schlecker B, Sanzone J, Esposito M, Rome S, Ciccone M, Margolis E, Simon R, Guo Y, Pentakota SR, Sadeghi-Nejad H. US Preventive Services Task Force prostate-specific antigen screening guidelines result in higher Gleason score diagnoses. Investig Clin Urol 2017; 58:423-428. [PMID: 29124241 PMCID: PMC5671961 DOI: 10.4111/icu.2017.58.6.423] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/17/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the impact that the 2012 US Preventive Services Task Force (USPSTF) prostate-specific antigen (PSA) screening guidelines have had on the diagnosis of prostate cancer, we compared the incidence and distribution of new cases diagnosed in 2011-before the USPSTF PSA screening recommendations versus 2014 at which time the guidelines were widely adopted. Materials and Methods We identified all prostate biopsies performed by a large urology group practice utilizing a centralized pathology lab. We examined total biopsies performed, percentage of positive biopsies, and for those with positive biopsies examined for differences in patient age, PSA, and Gleason score. Results A total of 4,178 biopsies were identified - 2,513 in 2011 and 1,665 in 2014. The percentage of positive biopsies was 27% in 2011 versus 34% in 2014 (p<0.0001). Among patients with positive biopsies, we found statistically significant differences between the 2 cohorts in the median ages and Gleason scores. Patients were about 1 year younger in 2014 compared to 2011 (t-test; p=0.043). High Gleason scores (8-10) were diagnosed in 19% of the 2014 positive biopsies versus 9% in the 2011 positive biopsies (chi square; p<0.0001). Conclusions After the widespread implementation of the 2011 USPTF PSA screening guidelines, 34% fewer biopsies were performed with a 29% increase in positive biopsy rates. We found a significantly higher incidence of high grade disease in 2014 compared with 2011. The percentage of patients with positive biopsies having Gleason scores 8-10 more than doubled in 2014. The higher incidence of these more aggressive cancers must be part of the discussion regarding PSA screening.
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Affiliation(s)
- Glen Gejerman
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Patrick Ciccone
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Martin Goldstein
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Vincent Lanteri
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Burton Schlecker
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - John Sanzone
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael Esposito
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sergey Rome
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Michael Ciccone
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Eric Margolis
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Robert Simon
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Yijun Guo
- New Jersey Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sri-Ram Pentakota
- Division of Urology, Rutgers New Jersey Medical School, Bloomfield, NJ, USA
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