Racial differences in a prostate cancer screening study
ABSTRACT We attempted to determine whether black men have a higher prostate cancer prevalence and more advanced disease.
We screened 17,157 white and 804 black men 50 years old or older by serum prostate specific antigen measurement and digital rectal examination. We recommended biopsy when either test was suspicious.
Black men had a higher prevalence of elevated prostate specific antigen (13.1 versus 8.9%) and cancer (5.1 versus 3.2%) than white men, and a higher prevalence of clinically but not pathologically advanced cancer. Fewer black men in lower income zip codes complied with recommendations for biopsy.
In our screening study black men had a higher prevalence of detectable cancer. However, unlike in clinical studies there was no striking racial difference in advanced cancer stage at diagnosis.
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ABSTRACT: In the U.S., the number of prostate biopsies increases annually. This is partly due to elevated prostate specific antigen (PSA) values identified during PC screening. This study's goal was improving prostate cancer (PC) detection through developing a clinical decision rule (CDR), based on an elevated PSA and laboratory biomarkers. This decision rule could be used after an elevated PSA, providing the patient and clinician information to consider prior to biopsy. This cross-sectional study evaluated men from the Tampa, Florida, James A. Haley (JH) VA (N=1,378), from January 1, 1998, through April 15, 2005. The study hypothesized that specific lab biomarkers among JH VA PC cases would differ significantly from JH VA patients without PC. The following biomarkers were related to PC: hemoglobin (HGB) (OR=1.42 95%CI 1.27, 1.59); red blood cell count (RBC) (OR=2.52 95%CI 1.67, 3.78); PSA (OR=1.04 95%CI 1.03, 1.05); and, creatinine (OR=1.55 95%CI 1.12, 2.15). This study attempted to determine whether including specific biomarkers (that are related to systemic diseases associated with advancing PC) could improve PC prediction (versus PSA alone). Comparing all PC stages versus non-cancerous conditions, the Receiver Operator Characteristic (ROC) curve area under the curve (AUC) expanded (increasing the probability of correctly classifying PC): PSA (alone) 0.59 (95% CI 0.55, 0.61); CDR model 0.68 (95%CI 0.65, 0.71), and the positive predictive value (PPV) increased: PSA 44.7%; CDR model 61.8%. Comparing PC (stages B, C, D) vs. other, the ROC AUC increased: PSA (alone) 0.63 (95% CI 0.58, 0.66); CDR model 0.68 (95% CI 0.68, 0.75), and the PPV increased: 20.6% (PSA); CDR model 55.3%. These results suggest evaluating certain biomarkers might improve PC prediction prior to biopsy. Moreover, the biomarkers may be more helpful in detecting clinically relevant PC. Follow-up studies should begin with replicating the study on different U.S. VA data-sets involving multiple practices.
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ABSTRACT: BACKGROUND It is not yet known whether screening for the detection of early prostate carcinoma will reduce mortality rates. However, data are available to assess intermediate outcomes from screening, including the performance characteristics of the screening tests and shifts in disease stage.METHODS Approximately 30,000 community volunteers (mean age 60 years; <5% nonwhite) were enrolled in 1 of 3 screening studies. Volunteers were screened with PSA or PSA in combination with digital rectal examination at 6-month intervals, and prostatic biopsy was recommended for those with results suspicious for cancer. Based on a first-time screen, the current study reports screening test results, the proportion of men recommended to undergo biopsy, the proportion who actually underwent biopsy, and the carcinoma detection rates for each study, stratified by initial PSA level. The authors also report the pathologic features of screen-detected carcinomas for a subset of men who underwent radical prostatectomy and for whom complete embedding and microscopic examination of the surgical specimen was performed.RESULTSApproximately 10% of the volunteers had PSA levels >4.0 ng/mL and 3-10% had digital rectal examination results suspicious for cancer. Overall, 9-20% of volunteers were recommended to undergo biopsy and 8-13% actually underwent the procedure. The positive predictive value for carcinoma detection ranged from 25-33% across studies. In the subset of men for whom surgical specimens were completely embedded, the majority of tumors detected had the clinicopathologic features of significant carcinoma (<10% possibly harmless).CONCLUSIONS The intermediate outcomes for screening with PSA and/or PSA in combination with digital rectal examination are encouraging. In community volunteers these screening tests demonstrated reasonable positive predictive value and detected carcinomas at an earlier stage. The majority of screen-detected tumors had the pathologic characteristics of medically significant carcinoma. Cancer 1997; 80:1852-6. © 1997 American Cancer Society.Cancer 01/1997; 80(9):1852 - 1856. DOI:10.1002/(SICI)1097-0142(19971101)80:9<1852::AID-CNCR25>3.0.CO;2-3 · 4.90 Impact Factor
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ABSTRACT: Benign prostatic hyperplasia (BPH) is an ever present threat to aging men. The gradual demographic shift of the population of the western world appears to be towards the elderly. The increasing burden on both individuals and the healthcare system, therefore, is going to increase in the foreseeable future. Although BPH is not a life-threatening condition, it can have serious consequences on the normal function of the lower urinary tracts. The overlap in terms of presentation exists with malignant prostatic disease and this needs to be considered when investigating these patients. The morbidity caused by BPH should not be underestimated for the sufferer, especially where there are ready treatments available and the opportunity to exclude other even more serious conditions. This article reviews the latest publications and papers looking at diagnosis and, in particular, identifying those at risk, the assessment of severity using symptom scores and discussing the methods and effectiveness of the various investigative tools. Controversy exists over the role of prostate-specific antigen (PSA) in detecting prostate cancer and the role of urodynamics versus symptom scores in the treatment and assessment of BPH patients with lower urinary tract symptoms. Investigations include the blood test for PSA to pick up those with carcinoma of the prostate, in addition, urodynamic studies, in particular flow rate and post-void residual volume, can diagnose and assess the severity of bladder outflow obstruction, assess and help exclude causes other than BPH.Disease Management and Health Outcomes 01/1997; 2(4):178-188. DOI:10.2165/00115677-199702040-00002 · 0.35 Impact Factor