Prostate Cancer Screening — Polling Results

New England Journal of Medicine (Impact Factor: 55.87). 10/2012; 367(17):e25. DOI: 10.1056/NEJMclde1212034
Source: PubMed

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    ABSTRACT: OBJECTIVE: Screening asymptomatic men for prostate cancer is controversial and informed decision making is recommended. Within two prostate cancer screening programs, we evaluated the impact of a print-based decision aid (DA) on decision-making outcomes. METHODS: Men (N=543) were 54.9 (SD=8.1) years old and 61% were African-American. The 2(booklet type: DA vs. usual care (UC))×2(delivery mode: Home vs. Clinic) randomized controlled trial assessed decisional and screening outcomes at baseline, 2-months, and 13-months. RESULTS: Intention-to-treat linear regression analyses using generalized estimating equations revealed that DA participants reported improved knowledge relative to UC (B=.41, p<.05). For decisional conflict, per-protocol analyses revealed a group by time interaction (B=-.69, p<.05), indicating that DA participants were less likely to report decisional conflict at 2-months compared to UC participants (OR=.49, 95% CI: .26-.91, p<.05). CONCLUSION: This is the first randomized trial to evaluate a DA in the context of free mass screening, a challenging setting in which to make an informed decision. The DA was highly utilized by participants, improved knowledge and reduced decisional conflict. PRACTICE IMPLICATIONS: These results are valuable in understanding ways to improve the decisions of men who seek screening and can be easily implemented within many settings.
    No preview · Article · Jan 2013 · Patient Education and Counseling
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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.
    Full-text · Article · Jun 2013 · Expert Review of Pharmacoeconomics & Outcomes Research
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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.
    Preview · Article · Aug 2013 · BJU International
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