Article

Influence of publication of US and European prostate cancer screening trials on PSA testing practices

Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA 98101,USA.
CancerSpectrum Knowledge Environment (Impact Factor: 15.16). 02/2011; 103(6):520-3. DOI: 10.1093/jnci/djr007
Source: PubMed

ABSTRACT In 2009, results from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial indicated no difference in mortality between the screening and the control groups (rate ratio = 1.13, 95% confidence interval = 0.75 to 1.70), whereas those from the European Randomized study of Screening for Prostate Cancer trial indicated a 20% reduction in mortality among the screening group (rate ratio = 0.80, 95% confidence interval = 0.65 to 0.98). In this study, we examined whether prostate-specific antigen (PSA) testing has changed following these publications. The primary outcome measure was the proportion of men seen at least once in a primary care or urology clinic between August 1, 2004, and March 31, 2010, who received a PSA test. Following the publications, PSA use declined slightly-by 3.0 percentage points and 2.7 percentage points among men aged 40-54 and 55-74 years, respectively. PSA testing among men older than 75 years initially declined slightly following the recommendations by the US Preventive Services Task Force in 2008 and continued to decline after the trial publications.

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    • "Entre 2008 et 2011, années de publications des deux résultats contradictoires des deux principaux essais cliniques , de recommandations comme aux États-Unis et du rappel officiel des recommandations en France, il n'est pas observé de diminution de la fréquence annuelle des hommes avec au moins un test annuel du PSA qui demeure relativement stable entre 30 % et 31 %. Aux États-Unis, la National Health Interview Survey Study Cohort ne retrouvait pas de diminution entre 2005 et 2010 et une étude sur des patients vus pour la première fois dans des centres d'urologie rapporte une légère diminution de l'ordre de 3 % entre 2008 et 2010 pour les hommes de 40—54 ans et 55—74 ans mais ils conservaient des fréquences élevées : 34 % et 47 % en 2010 [1] [12]. Néanmoins, une diminution du nombre de cancers de la prostate incidents en France a été rapportée avec une estimation à 56 841 cas en 2012 [13]. "
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    ABSTRACT: Introduction Prostate-specific antigen (PSA) testing is high in France. The aim of this study was to estimate their frequency and those of biopsy and newly diagnosed cancer (PCa) according to the presence or absence of treated benign prostatic hyperplasia (BPH). Patients and methods This study concerned men 40 years and older covered by the main French national health insurance scheme (73 % of all men of this age). Data were collected from the national health insurance information system (SNIIRAM). This database comprehensively records all of the outpatient prescriptions and healthcare services reimbursed. This information are linked to data collected during hospitalisations. Results The frequency of men without diagnosed PCa (10.9 millions) with at least one PSA test was very high in 2011 (men aged 40 years and older: 30 %, 70–74 years: 56 %, 85 years and older: 33 % and without HBP: 25 %, 41 % and 19 %). Men with treated BPH totalized 9 % of the study population, but 18 % of the men with at least one PSA test, 44 % of those with at least one prostate biopsy and 40 % of those with newly managed PCa. Over a 3-year period, excluding men with PCa, 88 % of men with BPH had at least one PSA test and 52 % had three or more PSA tests versus 52 % and 15 % for men without BPH. One year after PSA testing, men of 55–69 years with BPH more frequently underwent prostate biopsy than those without BPH (5.4 % vs 1.8 %) and presented PCa (1.9 % vs 0.9 %). Conclusions PSA testing frequencies in France are very high even after exclusion of men with BPH, who can be a group with more frequent managed PCa. Level of evidence 4.
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    ABSTRACT: To discuss the issue of screening for prostate cancer in elderly individuals. The impact of life expectancy on the choice of treatment in both patients and health care providers has been investigated as well. We identified studies published from 1990 onwards by searching the MEDLINE database of the National Library of Medicine. Initial search terms were "localized prostate cancer" and "early stage prostate cancer" combined with "elderly patients, life expectancy, palliative, curative, quality of life, watchful waiting, radical prostatectomy, brachytherapy, and external beam radiotherapy". Despite the decrease in prostate carcinoma-specific mortality, the use of prostate-specific antigen (PSA) has been shown to increase the prostate cancer detection rate with a shift to detection at earlier and less invasive pathological stages, overriding concerns about over-diagnosis and over treating. However, PSA screening is mainly offered to younger individuals, and older patients are more likely to have progressive disease and high-risk prostate cancer at diagnosis. Given that PSA screening diagnoses mainly curable, early prostate cancer, screening decision could be offered to otherwise healthy elderly patients who are likely to benefit from aggressive treatment. Prostate-specific antigen screening is not officially recommended and most scientific associations promote shared decision making. While PSA screening decision is currently based on physician's judgment, it is clear that a strict age cut-off of 75 years reduces over-screening, but also prohibits screening in healthy older men with a long life expectancy.
    Urology journal 01/2011; 8(2):83-7. · 0.71 Impact Factor
  • CancerSpectrum Knowledge Environment 02/2011; 103(6):450-1. DOI:10.1093/jnci/djr047 · 15.16 Impact Factor
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