1934 PROSTATE SPECIFIC ANTIGEN (PSA)-PYRAMID IN MEN WITH LOW RANGE PSA: PROSTATE CANCER INCIDENCE AND MORTALITY - A PLEA FOR RISK-BASED PROSTATE CANCER SCREENING STRATEGY IN THE EUROPEAN RANDOMIZED STUDY OF SCREENING FOR PROSTATE CANCER (ERSPC), AARAU

183 Background: Prostate cancer has long been considered as a disease of older men. However, age at diagnosis with prostate cancer has continued to decline. Since the introduction of prostate-specific antigen (PSA) test in 1986, the prostate cancer incidence rate has steadily and dramatically increased in men under age 50. This study aims to better understand demographic variations in prostate cancer screening and incidence, and clinical characteristics of prostate cancers in men under age 50. Methods: We examined prostate cancer testing data from the Behavioral Risk Factor Surveillance System (2002, 2004, 2006, and 2008) and prostate cancer incidence data from the CDC's National Program of Cancer Registries and the NCI's Surveillance, Epidemiology, and End Results programs (2001-2006). We estimated the weighted percentage of self-reported cancer testing using SUDAAN and age-adjusted cancer incidence rates and trends using SEER-STAT. Statistical significance for trends was determined by the annual percentage change (APC) differing form zero. Results: A total of 29,176 prostate cancer cases were identified from 2001-2006 among men under age 50. Of these, 551 (1.9%) were among men under age 40. Incidence rates remained stable from 2001-2006; however the incidence of well-differentiated tumors decreased significantly (APC=−24.7) during this time period. About 44% of men aged 40-49 years old reported having a prostate cancer test in the past two years. Prostate cancer testing and incidence rates were highest among men who were black, non-Hispanic, or lived in the northeast. Black men had more than a 2-fold increase in cancer incidence than white men. Conclusions: The magnitude of prostate cancer testing and incidence in men under age 50 reveals significant health/public health problems in this younger population. This study demonstrates substantial regional differences in prostate cancer testing and incidence in men under age 50. It also confirms that prostate cancer testing and incidence varies by race and ethnicity. We observed a large disparity in prostate cancer incidence between blacks and whites. The incidence rate remained stable over time; the dramatic decrease occurred in well-differentiated cancers. No significant financial relationships to disclose.

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Metastatic Prostate Cancer Incidence and Prostate-specific Antigen Testing: New Insights from the European Randomized Study of Screening for Prostate Cancer

European Urology ◽

10.1016/j.eururo.2015.02.042 ◽

2015 ◽

Vol 68 (5) ◽

pp. 885-890 ◽

Cited By ~ 67

Author(s):

Carlotta Buzzoni ◽

Anssi Auvinen ◽

Monique J. Roobol ◽

Sigrid Carlsson ◽

Sue M. Moss ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Cancer Incidence ◽

Metastatic Prostate Cancer ◽

Randomized Study ◽

Specific Antigen ◽

Prostate Cancer Incidence ◽

Prostate Specific Antigen Testing ◽

Antigen Testing

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Screening for Prostate Cancer with Prostate-Specific Antigen: What's the Evidence?

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.216 ◽

2012 ◽

pp. 96-100 ◽

Cited By ~ 4

Author(s):

Pamela M. Marcus ◽

Barnett S. Kramer

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Specific Antigen ◽

Task Force ◽

Prostate Cancer Screening ◽

Randomized Study ◽

Specific Antigen ◽

Preventive Services ◽

Preventive Health Care ◽

Ovarian Cancer Screening

Overview: In October 2011, the U.S. Preventive Services Task Force (USPSTF, or “Task Force”) released draft recommendations on prostate cancer screening with prostate-specific antigen (PSA), concluding that “PSA-based screening results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.” This statement was accompanied by a grade “D” recommendation, which indicates that in the Task Force's judgment there “is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” The Task Force, an independent panel of nonfederal (U.S.) experts in prevention and evidence-based medicine, conducts systematic evidence reviews of preventive health care services and makes recommendations about preventive services in primary care. Task Force recommendations do not set U.S. federal policy but can and do influence reimbursement and clinical practice. In this article, we will present evidence the Task Force considered when making its decision, including two highly influential randomized controlled trials (RCTs) of prostate cancer screening, the European Randomized Study of Prostate Cancer (ERSPC) and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The two trials arrived at different conclusions about the efficacy of routine prostate cancer screening, but similar conclusions about the accompaniment of clinically relevant harms with prostate cancer screening, including overdiagnosis (screen detection of cancers that never would be diagnosed in the absence of screening). We also will present other available evidence on benefits and harms of PSA-based screening and consider that evidence and the findings of ERSPC and PLCO in conjunction with one another.

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Racial and Ethnic Variation in PSA Testing and Prostate Cancer Incidence Following the 2012 USPSTF Recommendation

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa171 ◽

2020 ◽

Author(s):

Kevin H Kensler ◽

Claire H Pernar ◽

Brandon A Mahal ◽

Paul L Nguyen ◽

Quoc-Dien Trinh ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Cancer Incidence ◽

Race And Ethnicity ◽

Task Force ◽

Prostate Cancer Screening ◽

Disease Incidence ◽

Specific Antigen ◽

Prostate Cancer Incidence ◽

Psa Testing

Abstract Background The 2012 US Preventive Services Task Force recommendation against routine prostate-specific antigen (PSA) testing led to a decrease in prostate cancer screening, but the heterogeneity of its impact by race and ethnicity remains unclear. Methods The proportion of 40- to 74-year-old men who self-reported receiving a routine PSA test in the past year was estimated in the Behavioral Risk Factor Surveillance System (2012-2018). Odds ratios (ORs) of undergoing screening by race and ethnicity were estimated, adjusting for healthcare–related factors. Prostate cancer incidence rates and rate ratios (IRRs) by race and ethnicity were estimated using Surveillance, Epidemiology, and End Results registry data (2004-2017). Results PSA testing frequencies were 32.3% (95% confidence interval [CI] = 31.7% to 32.8%) among non-Hispanic White (NHW), 30.3% (95% CI = 28.3% to 32.3%) among non-Hispanic Black (NHB), 21.8% (95% CI = 19.9% to 23.7%) among Hispanic, and 17.7% (95% CI = 14.1% to 21.3%) among Asian and Pacific Islander men in 2012. The absolute screening frequency declined by 9.5% from 2012 to 2018, with a larger decline among NHB (11.6%) than NHW men (9.3%). The relative annual decrease was greater among NHB (OR = 0.86, 95% CI = 0.84 to 0.88) than NHW men (OR = 0.89, 95% CI = 0.89 to 0.90; Pheterogeneity = .005), driven by a larger decline among NHB men ages 40-54 years. The NHB to NHW IRR for total prostate cancer increased from 1.73 (95% CI = 1.69 to 1.76) in 2011 to 1.87 (95% CI = 1.83 to 1.92) in 2012 and has remained elevated, driven by differences in localized tumor incidence. Metastatic disease incidence is rising across all racial and ethnic groups. Conclusions The frequency of prostate cancer screening varies by race and ethnicity, and there was a modestly steeper decline in PSA testing among younger NHB men relative to NHW men since 2012. The NHB to NHW IRR for localized prostate cancer modestly increased following 2012.

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A natural history model for planning prostate cancer testing: calibration and validation using Swedish registry data

10.1101/402743 ◽

2018 ◽

Author(s):

Andreas Karlsson ◽

Alexandra Jauhiainen ◽

Roman Gulati ◽

Martin Eklund ◽

Henrik Grönberg ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Natural History ◽

Cancer Incidence ◽

Prostate Cancer Screening ◽

Prostate Cancer Incidence ◽

Disease States ◽

Natural History Model ◽

Incidence And Mortality ◽

The Us

AbstractRecent prostate cancer screening trials have given conflicting results and it is unclear how to reduce prostate cancer mortality while minimising overdiagnosis and overtreatment. Prostate cancer testing is a partially observable process, and planning for testing requires either extrapolation from randomised controlled trials or, more flexibly, modelling of the cancer natural history.An existing US prostate cancer natural history model (Gulati et al, Biostatistics 2010;11:707-719) did not model for differences in survival between Gleason 6 and 7 cancers and predicted too few Gleason 7 cancers for contemporary Sweden. We re-implemented and re-calibrated the US model to Sweden. We extended the model to more finely describe the disease states, their time to biopsy-detectable cancer and prostate cancer survival. We first calibrated the model to the incidence rate ratio observed in the European Randomised Study of Screening for Prostate Cancer (ERSPC) together with age-specific cancer staging observed in the Stockholm PSA (prostate-specific antigen) and Biopsy Register; we then calibrated age-specific survival by disease states under contemporary testing and treatment using the Swedish National Prostate Cancer Register.After calibration, we were able to closely match observed prostate cancer incidence trends in Sweden. Assuming that patients detected at an earlier stage by screening receive a commensurate survival improvement, we find that the calibrated model replicates the observed mortality reduction in a simulation of ERSPC.Using the resulting model, we predicted incidence and mortality following the introduction of regular testing. Compared with a model of the current testing pattern, organised 8 yearly testing for men aged 55–69 years was predicted to reduce prostate cancer incidence by 0.11% with no increase in the mortality rate. The model is open source and suitable for planning for effective prostate cancer screening into the future.Author summaryA naïve perspective is that cancer screening is simple: people are screened, some cancers are detected early, and cancer mortality rates decline. However, the mathematics for screening becomes difficult quickly, it is hard to infer causation from observational data, and even large randomised screening studies provide limited evidence. Simulations are therefore important for planning cancer screening.We found an older US prostate cancer natural history model to be poorly suited for contemporary Sweden. We therefore re-implemented and re-calibrated the US model using data from Swedish registries.Our revised model, the Stockholm “Prostata” model, provides predictions similar to those observed in the detailed Swedish registers on prostate cancer incidence and mortality. By modelling the mechanisms of the screening effect, we can predict the benefits and harms under a range of screening interventions.

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Prostate-specific antigen and long-term prediction of prostate cancer incidence and mortality in the general population.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.5 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 5-5

Author(s):

David D Orsted ◽

Borge G. Nordestgaard ◽

Stig E. Bojesen

Keyword(s):

Prostate Cancer ◽

General Population ◽

Prostate Specific Antigen ◽

Cancer Incidence ◽

Specific Antigen ◽

Prostate Cancer Incidence ◽

Increased Risk ◽

Incidence And Mortality

5 Background: It is largely unknown whether prostate-specific antigen at first date of testing predicts long-term risk of prostate cancer incidence and mortality in the general population. We tested the hypothesis that baseline prostate-specific antigen levels predict long-term risk of prostate cancer incidence and mortality. Methods: Using a prospective study, we examined 4383 20-94 year old men from the Danish general population followed in the Copenhagen City Heart Study from 1981 through 2009. Prostate-specific antigen was measured in plasma samples obtained in 1981-83. Results: During 28 years of follow-up, 170 men developed prostate cancer and 94 died from prostate cancer. Median follow-up was 18 years (range 0.5-28 years). For prostate cancer incidence, the subhazard ratio was 3.0 (95% confidence interval (CI) 1.9-4.6) for a prostate-specific antigen level of 1.01-2.00 ng/ml, 6.8 (4.2-11) for 2.01-3.00 ng/ml, 6.6 (3.4-13) for 3.01-4.00 ng/ml, 16 (10.4-25) for 4.01-10.00 ng/ml, and 57 (32-104) for >10.00 ng/ml versus 0.01-1.00 ng/ml.. For prostate cancer mortality, corresponding subhazard ratios were 2.2 (1.3-3.9), 5.1 (2.8-9.0), 4.2 (1.8-10), 7.0 (3.8-14), and 14 (6.0-32). For men with prostate-specific antigen levels of 0.01-1.00 ng/ml, absolute 10-year risk of prostate cancer was 0.6% for age <45 years, 0.7% for 45-49 years, 1.1% for 50-54 years, 1.2% for 55-59 years, 1.3% for 60-64 years, 1.1% for 65-69 years, 1.3% for 70-74 years, and 1.5% for age≥75 years; corresponding values for prostate-specific antigen levels >10.00 ng/ml were 35%, 41%, 63%, 71%, 77%, 69%, 75%, and 88%, respectively. Conclusions: Stepwise increases in prostate-specific antigen at first date of testing predicted a 3-57 fold increased risk of prostate cancer, a 2-16 fold increased risk of prostate cancer mortality, and a 35-88% absolute 10-year risk of prostate cancer in those with prostate-specific antigen levels >10.00 ng/ml. Equally important, absolute 10-year risk of prostate cancer in those with levels 0.01-1.00 ng/ml was only 0.6-1.5%.

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