scholarly journals Routine PSA Testing: An Analysis of the Controversy Concerning Its Use

2005 ◽  
Vol 5 ◽  
pp. 147-150 ◽  
Author(s):  
Namath S. Hussain
Keyword(s):  
Prostate Cancer ◽  
Sensitivity And Specificity ◽  
Diagnostic Tool ◽  
Psa Screening ◽  
Psa Testing ◽  
Important Diagnostic Tool

Prostate cancer is the leading cause of cancer in American males today. PSA screening has been used for over 10 years as an important diagnostic tool for the disease. Because of its lack of sensitivity and specificity, however, PSA testing should be used with caution.

scholarly journals Risk-adapted approach to prostate cancer screening

2018 ◽  
Vol 14 (2) ◽  
pp. 109-121 ◽  
Author(s):  
A. A. Kirichek ◽  
L. N. Lyubchenko ◽  
V. B. Matveev
Keyword(s):  
Prostate Cancer ◽  
Early Detection ◽  
Germline Mutation ◽  
Prostate Cancer Screening ◽  
Germline Mutations ◽  
Polygenic Inheritance ◽  
Psa Screening ◽  
Psa Testing ◽  
Mutation Carriers ◽  
Brca1 Brca2

Mass prostatic specific antigen (PSA) testing (population-based PSA screening) has remained controversial, nevertheless there are men cohorts likely to benefit from PSA screening. Heritable factors contribute to 60 % risk for developing familial prostate cancer. Despite the fact that its clinical application is challenging due to polygenic inheritance, advances in new generation sequencing technologies permit identifying highly penetrant germline mutations in genes BRCA1, BRCA2, CHEK2, HOXB13 and MMR associated with tremendous increase in risk of developing the prostate cancer. Several germline mutations are associated with clinically aggressiveness of disease and shortened survival. Targeted screening that is based on family history and genomic aberrations should be the next step towards the precision medicine. Men at elevated risk should been performed for early detection are those with familiar history of prostate cancer, or BRCA1, BRCA2, CHEK2, HOXB13 and MMR pathogenic germline mutation carriers, or first line relatives diagnosed with certain types of cancer. Systematic PSA testing in 1–2 years among germline mutation carriers men beginning at age 45 years would contribute to increase in early detection of localized prostate cancer resulting in more chance of curative treatment and improve survival rates

scholarly journals PSA screening for prostate cancer

2017 ◽  
Vol 63 (8) ◽  
pp. 722-725 ◽  
Author(s):  
Marcus V. Sadi
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Early Diagnosis ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Low Grade ◽  
Psa Screening ◽  
Psa Testing ◽  
Baseline Values

Summary Screening of prostate cancer with prostate-specific antigen (PSA) is a highly controversial issue. One part of the controversy is due to the confusion between population screening and early diagnosis, another derives from problems related to the quality of existing screening studies, the results of radical curative treatment for low grade tumors and the complications resulting from treatments that affect the patient’s quality of life. Our review aimed to critically analyze the current recommendations for PSA testing, based on new data provided by the re-evaluation of the ongoing studies and the updated USPSTF recommendation statement, and to propose a more rational and selective use of PSA compared with baseline values obtained at an approximate age of 40 to 50 years.

Sensitivity and specificity of a whole-blood RNA transcript-based diagnostic test for the diagnosis of prostate cancer (CaP) compared with prostate-specific antigen (PSA) alone

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5052-5052
Author(s):  
R. W. Ross ◽  
D. Bankaitis-Davis ◽  
L. Siconolfi ◽  
L. Katz ◽  
K. Storm ◽  
...  
Keyword(s):  
Gene Expression ◽  
Prostate Cancer ◽  
Sensitivity And Specificity ◽  
Expression Analysis ◽  
Whole Blood ◽  
Specific Antigen ◽  
Gene Model ◽  
Healthy Men ◽  
Psa Testing ◽  
Rna Transcript

5052 Background: Screening for CaP with PSA testing is limited by a high number of false postives, particularly in the setting of benign prostatic hypertrophy (BPH). The goal of this study was to develop whole blood RNA transcript-based diagnostic tests that improve the diagnosis of CaP over PSA alone. Methods: From August 2006 to October 2008, three prospective cohorts of men consented to the collection of whole blood in PAXgene Blood RNA tubes for gene expression analysis: men with newly diagnosed, localized, untreated CaP, otherwise healthy men without CaP, and otherwise healthy men with BPH. 168 inflammation and CaP-related genes (Source MDx Precision Profiles) were assayed using optimized Q-PCR technology. Logistic regression methods were used to develop models to optimize prostate cancer diagnosis. Results: 182 men underwent expression analysis (n = 76, 76 and 30 for CaP, normal, and BPH cohorts, respectively). The CaP and normal cohorts were age matched (median age 60 yrs); the BPH cohort median age was 70. Considering only the CaP and normal cohorts, PSA alone (using a cut-off of 4 ng/ml) had a specificity of 94.7%, but sensitivity of only 71.1% for diagnosis of CaP, or 90.8% and 77.6%, respectively, when using age-adjusted PSA criteria. A model consisting of the expression analysis of 6 genes and PSA had a higher specificity (96.1%) and a much improved sensitivity (97.4%) for CaP diagnosis. When the BPH cohort was added, the improvement of the 6-gene model remained (sensitivity and specificity of 97.4% and 92.0% vs 77.6% and 88.1% using the age-adjusted PSA criteria). Further model development using the CaP and BPH cohorts yielded a 5-gene model which, integrated with PSA and age, correctly predicted 96.1% of the CaP pts and 93.3% of BPH pts. Conclusions: These results suggest that specific whole blood RNA transcript levels can assess abnormal gene expression associated with CaP. Such a molecular CaP biomarker would be a powerful tool to reduce unnecessary biopsies in patients without CaP and detect CaP in patients with PSA values below the current cutoff. Validation of these results is ongoing and will be available at the time of the meeting. [Table: see text]

Prospective evaluation of a new patient decision aid to enhance prostate cancer screening decision-making.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 87-87
Author(s):  
Michael Austin Brooks ◽  
Anita Misra-Hebert ◽  
Alexander Zajichek ◽  
Sigrid V. Carlsson ◽  
Jonas Hugosson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Health Literacy ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Psa Screening ◽  
Psa Testing ◽  
Patient Decision ◽  
The Impact

87 Background: We previously developed screening nomograms to predict 15-year risk of all-cause mortality, prostate cancer diagnosis, and prostate cancer mortality, and incorporated them into a graphical patient decision aid (PtDA). Our objective was to prospectively recruit primary care patients interested in shared-decision making regarding prostate specific antigen (PSA) screening and assess the impact of individualized counseling using our new PtDA. Methods: 50 patients from one internal medicine practice were enrolled in a single-arm sequential trial design, with face-to-face clinician counseling and questionnaires. Eligibility criteria included men age 50-69 years old and life expectancy > 10 years. Patients were excluded for a personal history of prostate cancer or PSA screening within the prior year. Participants completed baseline questionnaires regarding prior PSA testing, demographic information, health literacy, and the Control Preferences Scale (CPS). They then received standardized counseling (based on large trial and epidemiologic data) regarding PSA screening, followed by individualized counseling using our new PtDA. Participants then made a screening decision, and completed a post decision questionnaire including a Decisional Conflict Scale. Results: The median age was 60 (IQR 54; 65). 41 (82%) had a prior PSA test, while 9 (18%) had not. 42 (84%) of participants received some education beyond high school, 41 (82%) demonstrated high health literacy, and 45 (90%) desired to have an active role in decision-making based on the CPS. After undergoing counseling, 34 (68%) participants chose to undergo initial or repeat PSA screening, 8 (16%) chose against future screening, and 8 (16%) remained uncertain. 45 (90%) participants found individualized counseling using the PtDA more useful than standardized counseling. Finally, patients reported reduced decisional conflict compared to historical controls (P < 0.001). Conclusions: Our process of standardized counseling followed by individualized counseling using our new PtDA was effective in reducing decisional conflict. The majority of participants found the PtDA more useful for decision making than standardized counseling. Clinical trial information: NCT03387527.

scholarly journals Age specific trends in prostate cancer tests, incidence and mortality in Australia since the introduction of the Prostate Specific Antigen (PSA) test

2020 ◽  
Author(s):  
Thanya Pathirana ◽  
Rehan Sequeira ◽  
Chris Del Mar ◽  
James A Dickinson ◽  
Katy J L Bell ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Incidence ◽  
Specific Antigen ◽  
Age Groups ◽  
Prostate Cancer Incidence ◽  
Psa Screening ◽  
Prostate Biopsies ◽  
Psa Testing ◽  
Incidence And Mortality ◽  
Incidental Cancer

Abstract BackgroundPopulation trends in PSA screening and prostate cancer incidence do not perfectly correspond. We aimed to better understand relationships between trends in PSA screening, prostate cancer incidence and mortality in Australia.MethodsDescription of age standardised time trends in PSA tests, prostate biopsies, cancer incidence and mortality within Australia for the age groups: 45-74, 75-84, and 85+ years.ResultsPSA testing increased from its introduction in 1989 to a peak in 2008. It then declined in men aged 45-84 years. Prostate biopsies and cancer incidence declined from 1995 to 2000, in parallel with decrease in trans-urethral resections of prostate (TURP). After 2000, changes in biopsies and cancer incidence paralleled PSA screening in men 45-84 years, while in men ≥85 years, biopsies stabilised and incidence declined. More recently a reduction in TURP correlated with increased Dutasteride and Tamsulosin usage. Prostate cancer mortality in men aged 45-74 years remained low throughout. Mortality in men 75-84 years gradually increased until the mid 1990s, then gradually decreased. Mortality in men ≥85 years increased until the mid 1990s, then stabilised.ConclusionsAge specific prostate cancer incidence largely mirrors PSA screening rates. Most deviation may be explained by changes in management of benign prostatic disease and incidental cancer detection. The timing of the small mortality reduction in men 75-84 years is more consistent with benefits from advances in treatment than with early detection through PSA. The large increases in prostate cancer incidence with minimal changes in mortality suggest overdiagnosis.

10-Year Outcomes After Monitoring, Surgery, or Radiotherapy

2021 ◽  
pp. 43-48
Author(s):  
Philipp Dahm
Keyword(s):  
Prostate Cancer ◽  
Randomized Controlled Trial ◽  
Radiation Therapy ◽  
Controlled Trial ◽  
Specific Antigen ◽  
Active Monitoring ◽  
Risk Of Death ◽  
Psa Screening ◽  
Psa Testing

This chapter provides a summary of the landmark Prostate Testing for Cancer and Treatment (ProtecT) trial, a three-armed randomized controlled trial of men with clinically localized prostate cancer mostly diagnosed through prostate-specific antigen (PSA) screening comparing radical prostatectomy to radiation therapy or active monitoring. Active monitoring consisted mostly of regular PSA testing. After 10 years of follow-up, very few deaths from prostate cancer occurred, underscoring the very low risk of death from prostate cancer in patients diagnosed by PSA screening irrespective of treatment approach.

scholarly journals Prostate-specific antigen testing and opportunistic prostate cancer screening in England (1998-2017): a cohort study

2020 ◽  
pp. bjgp20X713957
Author(s):  
Ashley Kieran Clift ◽  
Carol Coupland ◽  
Julia Hippisley-Cox
Keyword(s):  
Prostate Cancer ◽  
Cohort Study ◽  
Cancer Screening ◽  
Prostate Specific Antigen ◽  
Prostate Cancer Screening ◽  
Randomised Trial ◽  
Specific Antigen ◽  
Opportunistic Screening ◽  
Psa Screening ◽  
Psa Testing

Abstract Background: Prostate cancer is a leading cause of cancer-related death. Interpretation of results from trials of screening with prostate-specific antigen (PSA) are complex in terms of defining optimal prostate cancer screening policy. Aims: Assess the rates of, and factors associated with the uptake of PSA testing and opportunistic screening (PSA test in absence of symptoms) in England between 1998 and 2017. Estimate the likely rates of pre-randomisation screening and contamination (unscheduled screening in ‘control’ arm) of the UK-based Cluster Randomised Trial of PSA Testing for Prostate Cancer (“CAP”). Design and Setting: Open cohort study of men aged 40-75 years at cohort entry (1998-2017) undertaken using the QResearch database. Method: Eligible men were followed for up to 19-years. Rates of PSA testing and opportunistic PSA screening were calculated and Cox regression was used to estimate associations. Results: The cohort comprised 2,808,477 men, of whom 631,426 had a total of 1,720,855 PSA tests. We identified that 410,751 men had opportunistic PSA screening. Cumulative proportions of uptake of opportunistic screening in the cohort: 10% at 5yrs, 23% at 10yrs, and 44% at 19yrs of follow-up. The potential rate of contamination in the CAP control arm was estimated at 24.5%. Conclusions: A substantial number of men in England opt-in to opportunistic prostate cancer screening despite uncertainty regarding the efficacy and harms. The rate of opportunistic prostate cancer screening in the population is likely to have contaminated the CAP trial making it difficult to interpret the results.

Contemporary racial disparities in PSA screening in a large, integrated health care system.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 308-308
Author(s):  
James T. Kearns ◽  
Oluwaseun Adeyemi ◽  
William E. Anderson ◽  
Timothy C. Hetherington ◽  
Yhenneko J. Taylor ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Cancer Screening ◽  
Racial Disparities ◽  
African American Men ◽  
Prostate Cancer Screening ◽  
Psa Screening ◽  
Psa Testing ◽  
Caucasian Men ◽  
Clinical Records

308 Background: The USPSTF prostate cancer screening guidelines have changed significantly in the past decade, from a recommendation of do not screen in 2012 to a 2018 recommendation that focuses on shared decision making. Additionally, most guidelines further acknowledge that African American men should be screened more intensively than Caucasian men due to increased incidence of prostate cancer and increased prostate cancer mortality. Our objective was to characterize racial disparities in PSA screening in a large healthcare system with a diverse patient population to understand contemporary trends. Methods: This retrospective cohort study used data from the Atrium Health Enterprise Data Warehouse, which includes clinical records from over 900 care locations across North Carolina, South Carolina, and Georgia. Participants included all men ≥ 40 years seen in the ambulatory or outpatient setting during 2014-2018. PSA testing was determined through laboratory data. Clinical and demographic data were collected. Between-group comparisons were conducted using generalized estimating equations models to account for within-subject correlation. Statistical significance was defined as p < 0.05. Results: There were 582,846 individual men seen from 2014-2018, including 416,843 Caucasians (71.5%) and 85,773 African Americans (14.7%). Screening rates declined among all groups from 2014-2018 (see table). African American men were screened at a similar or lower rate than Caucasian men in each year (from 18.6% vs 19.0% in 2014 to 11.9% vs 12.2% in 2018, respectively). Conclusions: PSA screening declined significantly between 2014 and 2018. African American men screened at a similar or lower rate than Caucasian men each year. Given the consensus that African American men should be more intensively screened for prostate cancer, significant racial disparities remain in prostate cancer screening. Further study is warranted to understand patient, provider, and system factors that contribute to disparities in prostate cancer care and outcomes.[Table: see text]

scholarly journals PSA testing in general practice

2012 ◽  
Vol 4 (3) ◽  
pp. 199 ◽  
Author(s):  
Fraser Hodgson ◽  
Zuzana Obertová ◽  
Charis Brown ◽  
Ross Lawrenson
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Age Groups ◽  
Psa Test ◽  
Psa Screening ◽  
Psa Testing ◽  
Asymptomatic Patients ◽  
Keywords Prostate ◽  
General Practices

INTRODUCTION: In New Zealand, prostate-specific antigen (PSA) testing has increased significantly (275 000 tests/year). Controversy exists around PSA testing as part of an unorganised screening programme. AIM: To look at the use of PSA testing in a sample of general practices and investigate the reasons GPs undertake PSA testing. METHODS: Five Waikato general practices investigated looking at PSA laboratory tests of men =40 years in 2010 compared against GP notes. Testing rates, reasons for testing, histology and referral/s were examined for different age groups. A questionnaire was sent to the GPs to determine their views on PSA testing. RESULTS: One in four men aged 40+ years had a PSA test in 2010. Of these men, 71% were asymptomatic. More than half of men tested aged 70+ years were asymptomatic. Ten percent of all PSA tests were elevated. Twenty-one of 23 prostate cancers were diagnosed following an elevated PSA test: more than 80% of these men had histories of prostate pathology or lower urinary tract symptoms. The questionnaire confirmed that GPs believe in the benefits of PSA screening and it also showed they had difficulty in providing patients with information about pros and cons of PSA testing. DISCUSSION: All GPs in this study tested asymptomatic men. GPs in this study value PSA screening and believe that it reduces mortality rates. However, although PSA tests were most frequently done on asymptomatic patients, the majority of patients subsequently diagnosed with prostate cancer had been tested because of symptoms or had previous prostate problems. KEYWORDS: Prostate specific antigen (PSA); PSA testing; screening; prostate cancer; general practitioners

scholarly journals Factors associated with PSA testing in men ≥ 50 years in Ireland

2021 ◽  
Vol 31 (Supplement_3) ◽  
Author(s):  
R O'Donovan ◽  
P Fitzpatrick
Keyword(s):  
Prostate Cancer ◽  
Screening Programme ◽  
Population Based ◽  
Older Age ◽  
Related Factors ◽  
Psa Test ◽  
Psa Screening ◽  
Psa Testing ◽  
Increased Risk ◽  
Health Related

Abstract Background Ireland has among the highest rates of prostate cancer in the EU, primarily due to widespread PSA screening. PSA screening is not recommended for asymptomatic men. Due to the potential for harm to the patient, and the economic and clinical repercussions for the healthcare system caused by inappropriate screening, this study aimed to investigate associations between PSA screening and sociodemographic, lifestyle, and health-related factors in men ≥50 years in Ireland. Methods A cross-sectional study was completed using data from Wave 4 of The Irish Longitudinal Study on Aging (TILDA), a nationally representative sample of community dwellers ≥ 50 years in Ireland. Participants self-reported having or not having a PSA test to screen for prostate cancer in the previous two years. Variables were entered into a multivariable logistic regression to estimate adjusted odds ratios (OR) for associations between PSA testing and the factors of interest. Results There were 2,426 male participants, with 68% reporting a PSA test in the previous two years. In adjusted analysis, older age (OR 1.78, 95%CI 1.32-2.31), third level education (OR 1.34, 95%CI 1.07-1.69) and a higher household net income (OR 2.14, 95% CI 1.52-3.02) increased the likelihood of PSA testing. Health-related factors positively associated with PSA testing screening were private health insurance (OR 1.89, 95%CI 1.52-2.35), blood pressure measurement in the previous year (OR 8.80, 95%CI 6.06-12.77) and a positive family history of cancer (OR 1.42, 95%CI 1.13-1.78). Conclusions High rates of prostate cancer screening are taking place in Ireland, despite the absence of a population-based screening programme. Men of older age, higher socioeconomic status and who demonstrate health-protective-behaviours have an increased risk of PSA screening. This subgroup of the population should be targeted to increase awareness of the potential benefits and harms of PSA testing. Key messages Rates of PSA screening remain high in Ireland, despite the absence of a population-based screening programme. Increased awareness of the potential harms and benefits of PSA screening is needed.

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