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.
Journal of the National Cancer Institute (Impact Factor: 12.58). 02/2011; 103(6):520-3. DOI: 10.1093/jnci/djr007
Source: PubMed


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.
    Full-text · Article · Jul 2014 · Progrès en Urologie
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    • "The follow-up interview for patients diagnosed with cancer was tailored to include additional measures about the patient’s treatment decision-making experience and adjustment to cancer. These men were asked the 10-item version of the Decisional Conflict Scale [23], and we assessed involvement in the decision process using five items from the Assessment of Patients’ Experience of Cancer Care (APECC) study [24,25]. "
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    ABSTRACT: Background A small pre-test study was conducted to ascertain potential harm and anxiety associated with distributing information about possible cancer treatment options at the time of biopsy, prior to knowledge about a definitive cancer diagnosis. Priming men about the availability of multiple options before they have a confirmed diagnosis may be an opportunity to engage patients in more informed decision-making. Methods Men with an elevated PSA test or suspicious Digital Rectal Examination (DRE) who were referred to a urology clinic for a biopsy were randomized to receive either the clinic’s usual care (UC) biopsy instruction sheet (n = 11) or a pre-biopsy educational (ED) packet containing the biopsy instruction sheet along with a booklet about the biopsy procedure and a prostate cancer treatment decision aid originally written for newly diagnosed men that described in detail possible treatment options (n = 18). Results A total of 62% of men who were approached agreed to be randomized, and 83% of the ED group confirmed they used the materials. Anxiety scores were similar for both groups while awaiting the biopsy procedure, with anxiety scores trending lower in the ED group: 41.2 on a prostate-specific anxiety instrument compared to 51.7 in the UC group (p = 0.13). ED participants reported better overall quality of life while awaiting biopsy compared to the UC group (76.4 vs. 48.5, p = 0.01). The small number of men in the ED group who went on to be diagnosed with cancer reported being better informed about the risks and side effects of each option compared to men diagnosed with cancer in the UC group (p = 0.07). In qualitative discussions, men generally reported they found the pre-biopsy materials to be helpful and indicated having information about possible treatment options reduced their anxiety. However, 2 of 18 men reported they did not want to think about treatment options until after they knew their biopsy results. Conclusions In this small sample offering pre-biopsy education about potential treatment options was generally well received by patients, appeared to be beneficial to men who went on to be diagnosed, and did not appear to increase anxiety unnecessarily among those who had a negative biopsy.
    Full-text · Article · Feb 2013 · BMC Medical Informatics and Decision Making
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    • "Despite many attempts, blood tests have a less distinguished record. For instance, prostate-specific antigen screening is widely used despite its well-publicised problems [5]. It remains controversial and generates large numbers of papers every year (2, 032 were indexed in PubMed through 2010 using the search terms 'screening', 'prostate specific antigen' and 'cancer'). "
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    ABSTRACT: Diagnosis of cancer at an early stage leads to improved survival. However, most current blood tests detect single biomarkers that are of limited suitability for screening, and existing screening programmes look only for cancers of one particular type. A new approach is needed. Recent developments suggest the possibility of blood-based screening for multiple tumour types. It may be feasible to develop a high-sensitivity general screen for cancer using multiple proteins and nucleic acids present in the blood of cancer patients, based on the biological characteristics of cancer. Positive samples in the general screen would be submitted automatically for secondary screening using tests to help define the likelihood of cancer and provide some indication of its type. Only those at high risk would be referred for further clinical assessment to permit early treatment and mitigate potential overdiagnosis. While the assays required for each step exist, they have not been used in this way. Recent experience of screening for breast, cervical and ovarian cancers suggest that there is likely to be widespread acceptance of such a strategy.
    Full-text · Article · Nov 2011 · BMC Cancer
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