A Decision Analysis to Assess the Value of Prostate Cancer Screening: A Shift in Focus From Prostate Cancer-specific Mortality to Distant Metastasis-free Survival

2012 ◽  
Vol 84 (3) ◽  
pp. S57
Author(s):  
A.P. Dosoretz ◽  
N.H. Lester-Coll ◽  
J.B. Yu
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Decision Analysis ◽  
Distant Metastasis ◽  
Prostate Cancer Screening ◽  
Free Survival ◽  
Distant Metastasis Free Survival ◽  
Specific Mortality ◽  
Cancer Specific Mortality

scholarly journals Furthering the prostate cancer screening debate (prostate cancer specific mortality and associated risks)

2011 ◽  
Vol 5 (6) ◽  
pp. 416-421 ◽  
Author(s):  
G. Michael Allan ◽  
Michael P. Chetner ◽  
Bryan J. Donnelly ◽  
Neil A. Hagen ◽  
David Ross ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Specific Mortality ◽  
Cancer Specific Mortality

scholarly journals Furthering the prostate cancer screening debate (prostate cancer specific mortality and associated risks)

2013 ◽  
Vol 5 (6) ◽  
pp. 416
Author(s):  
G. Michael Allan ◽  
Michael P. Chetner ◽  
Bryan J. Donnelly ◽  
Neil A. Hagen ◽  
David Ross ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Poor Quality ◽  
Good Evidence ◽  
Screening Programs ◽  
Fecal Occult ◽  
Actual Compliance ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Screening for prostate cancer remains a contentious issue. As withother cancer screening programs, a key feature of the debate isverification of cancer-specific mortality reductions. Unfortunatelythe present evidence, two systematic reviews and six randomizedcontrolled trials, have reported conflicting results. Furthermore, halfof the studies are poor quality and the evidence is clouded by keyweaknesses, including poor adherence to screening in the interventionarm or high rates of screening in the control arm. In highquality studies of prostate cancer screening (particularly prostatespecificantigen), in which actual compliance was anticipated inthe study design, there is good evidence that prostate cancer mortalityis reduced. The numbers needed to screen are at least as goodas those of mammography for breast cancer and fecal occult bloodtesting for colo-rectal cancer. However, the risks associated withprostate cancer screening are considerable and must be weighedagainst the advantage of reduced cancer-specific mortality. Adverseevents include 70% rate of false positives, important risks associatedwith prostate biopsy, and the serious consequences of prostatecancer treatment. The best evidence demonstrates prostate cancerscreening will reduce prostate cancer mortality. It is time for thedebate to move beyond this issue, and begin a well-informed discussionon the remaining complex issues associated with prostatecancer screening and appropriate management.

HSD3B1 and resistance to androgen deprivation therapy in prostate cancer.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 156-156 ◽  
Author(s):  
Jason W.D. Hearn ◽  
Ghada AbuAli ◽  
Cristina Magi-Galluzzi ◽  
Chandana A. Reddy ◽  
Kai-Hsiung Chang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Deprivation Therapy ◽  
Distant Metastasis ◽  
Progression Free Survival ◽  
Wild Type ◽  
Free Survival ◽  
Homozygous Variant ◽  
Distant Metastasis Free Survival ◽  
Variant Alleles

156 Background: The somatic mutation HSD3B1(1245A>C) has been mechanistically linked to castration-resistant prostate cancer by encoding a mutant enzyme that augments intratumoral dihydrotestosterone synthesis. Given the HSD3B1(1245C) allele is also frequently found in the germline, we hypothesized men inheriting this variant allele would exhibit resistance to androgen deprivation therapy (ADT), as manifested by worse clinical outcomes. Methods: We used a prospectively maintained prostate cancer registry to identify men treated with ADT for biochemical failure in the post-prostatectomy setting who were without evidence of metastatic disease at the time of ADT initiation. We analyzed progression-free survival, distant metastasis-free survival, and overall survival according to HSD3B1 genotype using Kaplan-Meier methods. Cox proportional hazards regression was performed to evaluate potential gene-dosage effects, with homozygous wild-type men serving as the reference group. Demographic and treatment characteristics were compared across genotypes to assess for possible confounders using Fisher’s exact test and Kruskal-Wallis analysis of variance. Results: Of 118 men genotyped, 37% were homozygous wild-type, 53% were heterozygous, and 10% were homozygous variant. Demographic and treatment characteristics did not differ across groups. Median progression-free survival diminished as a function of the number of variant alleles inherited (6.6 years in homozygous wild-type men, 4.1 years in heterozygotes, and 2.5 years in homozygous variant men; P=0.01). Median distant metastasis-free survival likewise decreased according to the number of variant alleles inherited (9.1 years in homozygous wild-type men, 6.8 years in heterozygotes, and 3.6 years in homozygous variant men; P=0.01). Finally, overall survival also diminished with the number of variant alleles inherited (5-year and 10-year overall survival: 82% and 55% in homozygous wild-type men, 74% and 35% in heterozygotes, and 58% and 0% in homozygous variant men; P=0.006). Conclusions: Inheritance of the variant HSD3B1(1245C) allele that enhances dihydrotestosterone synthesis may predict resistance to ADT for prostate cancer. These findings require validation.

Concordance of Couples’ Prostate Cancer Screening Recommendations from a Decision Analysis

2008 ◽  
Vol 1 (1) ◽  
pp. 11-19 ◽  
Author(s):  
Scott B Cantor ◽  
Robert J Volk ◽  
Murray D Krahn ◽  
Alvah R Cass ◽  
Jawaria Gilani ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Decision Analysis ◽  
Prostate Cancer Screening

Obstacles in prostate cancer screening: Current issues and future solutions

2018 ◽  
Vol 12 (2) ◽  
pp. 111-116
Author(s):  
Benjamin Patel ◽  
Seshadri Sriprasad ◽  
Jeffrey Cadeddu ◽  
Arron Thind ◽  
Abhay Rane
Keyword(s):  
Prostate Cancer ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Diagnostic Value ◽  
Good Evidence ◽  
Screening Methods ◽  
Level Of Evidence ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Clinically Significant

Prostate cancer is the most common cancer in men and is associated with unacceptably high mortality rates, yet an accurate and acceptable screening programme that detects clinically significant prostate cancer remains elusive. Although there is good evidence that prostate-specific antigen (PSA)-based screening lowers prostate cancer-specific mortality, especially when conducted at high intensity, the harm caused by overinvestigation, overdiagnosis and overtreatment of clinically insignificant cases arguably outweighs these benefits. Several attempts have therefore been made to improve screening, enhancing the diagnostic value of PSA and identifying novel modalities for screening. Here, we provide a comprehensive review of the benefits and harms, and analyse which of these novel screening methods show most promise. Level of evidence: 5, expert opinion

Impact of screening and treatment on racial and ethnic differences in health service use, cost, and mortality among advanced (T3 or greater) prostate cancer patients.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 131-131
Author(s):  
S. Bruce Malkowicz ◽  
Sumedha Chhatre ◽  
Sanford Schwartz ◽  
Ravishankar Jayadevappa
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Health Service ◽  
Ethnic Differences ◽  
Service Use ◽  
Prostate Cancer Screening ◽  
Age Groups ◽  
Health Service Use ◽  
Specific Mortality ◽  
Racial Ethnic

131 Background: Limited information is available regarding the association between race/ethnicity, health service use, cost, and mortality in older patients with advanced (T3 or greater) stage prostate cancer. The objective is to analyze the race/ethnic differences in mortality, cost, and assess the mediating effect of prostate cancer screening and treatment on these differences in fee-for-service Medicare patients with advanced prostate cancer Methods: Retrospective, observational, case-control study using SEER-Medicare linked data. Cohort consisted of 15,054 elderly men diagnosed with advanced stage prostate cancer between 2001and 2004 and followed retrospectively for up to 2009. Cancer-free controls from Medicare data were used to determine the incremental cost of advanced stage prostate cancer. Racial/ethnic variation in health service use, cost, and mortality were analyzed using Poisson, GLM log-link, and Cox regression models. Results: For the age 66 to 75 and 76 to 85, age groups, racial/ethnic differences in health service use, cost, and all cause mortality were observed. Blacks were less likely to have received prostate cancer screening in the year prior to diagnosis of advanced prostate cancer, less likely to have received any treatment after diagnosis and had higher disease specific mortality. After adjusting for prostate cancer screening and treatment across age groups however, odds of prostate cancer-specific mortality were comparable between racial/ethnic groups suggesting that screening may have some mitigating effect on outcomes in the AA population HR 1.23 (1.07-1.41) versus HR 1.12(0.98-1.29). Conclusions: The pattern of racial/ethnic disparity varies by age group with higher mortality among black men. This may be attributable to disparity in prostate cancer screening or treatment. This suggests that the lack of consideration for racial considerations in the U.S. Preventive Services Task Force PSA recommendations could have disparate racial impact.

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