Clinical decisions. Prostate cancer screening--polling results.

New England Journal of Medicine (Impact Factor: 54.42). 10/2012; 367(17):e25. DOI: 10.1056/NEJMclde1212034
Source: PubMed
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    ABSTRACT: Purpose: SEER recently released patient Gleason scores at biopsy/transurethral resection of the prostate. For the first time this permits accurate assessment of prostate cancer presentation and treatment according to clinical factors at diagnosis. Materials and Methods: We used the SEER database to identify men diagnosed with localized prostate cancer in 2010 who were assigned NCCN (R) risk based on clinical factors. We identified sociodemographic factors associated with high risk disease and analyzed the impact of these factors along with NCCN risk on local treatment. Results: Of the 42,403 men identified disease was high, intermediate and low risk in 38%, 40% and 22%, respectively. On multivariate analysis patients who were older, nonwhite, unmarried or living in a county with a higher poverty rate were more likely to be diagnosed with high risk disease (each p <0.05). Of the 38,634 men in whom prostate cancer was the first malignancy 23% underwent no local treatment, 40% were treated with prostatectomy, 36% received radiation therapy and 1% underwent local tumor destruction, predominantly cryotherapy. On multivariate analysis patients who were older, black, unmarried or living in a county with a higher poverty rate, or who had low risk disease were less likely to receive local treatment (each p <0.05). Conclusions: Our analysis provides information on the current clinical presentation and treatment of localized prostate cancer in the United States. Nonwhite and older men living in a county with a higher poverty rate were more likely to be diagnosed with high risk disease and less likely to receive local treatment.
    The Journal of Urology 06/2014; 192(6). DOI:10.1016/j.juro.2014.06.017 · 3.75 Impact Factor
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    ABSTRACT: To assess recommendations for prostate-specific antigen (PSA) screening in a national survey of radiation oncologists and urologists following the recent U.S. Preventive Services Task Force (USPSTF) grade D recommendation. A random sample of 1,366 radiation oncologists and urologists were identified from the American Medical Association Physician Masterfile. Through November 2011 to April 2012, a mail survey was sent to query PSA screening recommendations for men at average risk of PC for the following age groups: 40-49, 50-59, 60-69, 70-74, 75-79 and > 80 years. Multivariable logistic regression was used to test for differences in PSA-based screening recommendations by physician characteristics. Response rates were similar at 52% for radiation oncologists and urologists (p=0.92). Overall, 51.5% of respondents recommended PSA-based screening for 40-49 year old men, while nearly all endorsed it for men 50-74 years (96.1% for 50-59, 97.3% for 60-69, and 87.7% for 70-74 years). However, screening recommendations decreased to 43.9% and 12.8% for 75-79 and > 80 year old men, respectively. On multivariable analysis, urologists were more likely to recommend screening for patients aged 40-49 (OR: 3.09; p<0.001) and 50-59 (OR: 3.81; p=0.01) years, but less likely for patients 75-79 (OR: 0.66; p=0.01) and > 80 (OR: 0.45; p=0.002) years compared with radiation oncologists. While radiation oncologists and urologists recommended PSA screening for men between 50-69 years of age, there was less agreement about screening for younger (40-49 years old) and older (>70 years old) patients at average risk for prostate cancer.
    BJU International 08/2013; DOI:10.1111/bju.12422 · 3.13 Impact Factor
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    ABSTRACT: Prostate cancer is the most common non-skin cancer in American men, and prostate-specific antigen (PSA) testing is its common screening procedure. In May 2012, the US Preventive Services Task Force recommended against PSA-based screening. These recommendations contradict the current recommendations of other organizations such as the American Urological Association. The authors conducted a systematic review of PubMed, EMBASE and Cochrane to examine the published literature reporting the cost-effectiveness of PSA-based screening. The authors found ten studies each for US and non-US jurisdiction population. All reviewed studies concluded PSA-based screening to be cost effective in younger men (≤60 years of age) and at higher PSA levels (≥3 ng/ml). Further cost-effectiveness analyses reflecting latest clinical practice and current perspectives regarding adverse outcomes of potentially unnecessary treatment are required, especially from the US government perspective.
    Expert Review of Pharmacoeconomics & Outcomes Research 06/2013; 13(3):327-42. DOI:10.1586/erp.13.26 · 1.87 Impact Factor