scholarly journals Implications of Regionalizing Care in the Developing World: Impact of Distance to Referral Center on Compliance to Biopsy Recommendations in a Brazilian Prostate Cancer Screening Cohort

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Alexis R. Freedland ◽  
Roberto L. Muller ◽  
Cathrine Hoyo ◽  
Elizabeth L. Turner ◽  
Patricia G. Moorman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Screening Program ◽  
Prostate Cancer Screening ◽  
Multivariable Logistic Regression Analysis ◽  
Optimal Care ◽  
Cancer Hospital ◽  
Multivariable Analyses ◽  
Large Prostate ◽  
Screening Site

Given growing specialization in medical care, optimal care may require regionalization, which may create access barriers. We tested this within a large prostate cancer (PC) screening program in Brazil. In 2004–2007, Barretos Cancer Hospital prospectively screened men for PC throughout rural Brazil. Men with abnormal screen were referred for follow-up and possible biopsy. We tested the link between distance from screening site to Barretos Cancer Hospital and risk of noncompliance with showing up for biopsy, PC on biopsy and, among those with PC, PC grade using crude and multivariable logistic regression analysis. Among 10,467 men undergoing initial screen, median distance was 257 km (IQR: 135–718 km). On crude and multivariable analyses, farther distance was significantly linked with biopsy noncompliance (OR/100 km: 0.83, P < 0.001 ). Among men who lived within 150 km of Barretos Cancer Hospital, distance was unrelated to compliance (OR/100 km: 1.09, P = 0.87 ). There was no association between distance and PC risk or PC grade (all P > 0.25 ). In Brazil, where distances to referral centers can be large, greater distance was related to reduced biopsy compliance in a PC screening cohort. Among men who lived within 150 km, distance was unrelated to compliance. Care regionalization may reduce access when distances are large.

PD40-05 DETERMINANTS OF DEFAULT FROM FOLLOW-UP CARE IN A PROSTATE CANCER SCREENING PROGRAM

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Mark Ferretti ◽  
Michael Goltzman ◽  
Akhil Saji ◽  
Neel Patel ◽  
Denton Allman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Prostate Cancer Screening ◽  
Cancer Screening Program ◽  
Follow Up Care

scholarly journals Bi- or multiparametric MRI in a sequential screening program for prostate cancer with PSA followed by MRI? Results from the Göteborg prostate cancer screening 2 trial

2021 ◽  
Author(s):  
Jonas Wallström ◽  
Kjell Geterud ◽  
Kimia Kohestani ◽  
Stephan E. Maier ◽  
Marianne Månsson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Detection ◽  
Screening Program ◽  
Prostate Cancer Screening ◽  
High Sensitivity ◽  
Multiparametric Mri ◽  
False Positives ◽  
Quality Data ◽  
Gadolinium Contrast ◽  
Sequential Screening

Abstract Objectives The PIRADS Steering Committee has called for “higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up,” however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa). Methods Within the ongoing Göteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3–5 with bpMRI and/or mpMRI. Results Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4–18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3–18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84–0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01–1.10. Conclusions In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives. Key Points • In screening for prostate cancer with PSA followed by MRI, biparametric MRI allows radiologists to detect an almost similar number of prostate cancers and score fewer false positive lesions compared to multiparametric MRI. • In a screening program, high sensitivity should be weighed against cost and risks for healthy men; a large number of men can be saved the exposure of gadolinium contrast medium by adopting biparametric MRI and at the same time allowing for a higher turnover in the MRI room.

Costs and effects of prostate cancer screening in SwedenA 15-year follow-up of a randomized trial

2004 ◽  
Vol 38 (4) ◽  
pp. 291-298 ◽  
Author(s):  
Karin Sennfält ◽  
Gabriel Sandblom ◽  
Per Carlsson ◽  
Eberhard Varenhorst
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Randomized Trial ◽  
Prostate Cancer Screening

15-YEAR FOLLOW-UP OF A RANDOMISED PROSTATE-CANCER SCREENING STUDY

2008 ◽  
Vol 179 (4S) ◽  
pp. 687-687
Author(s):  
Anders Kjellman ◽  
Olof Akre ◽  
Ulf Norming ◽  
Magnus Tornblom ◽  
Ove Gustafsson
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Screening Study
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