Prostate Cancer Screening

2021 ◽  
pp. 74-77
Author(s):  
Michael A. Diefenbach ◽  
Daniel Nethala ◽  
Michael Schwartz ◽  
Simon J. Hall
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Shared Decision ◽  
Psa Test ◽  
Prostate Cancers ◽  
Asymptomatic Men

This chapter introduces the controversy of prostate cancer screening that has emerged over the past two decades, starting with the widespread use of the prostate-specific antigen (PSA) test in 1994. The PSA test revolutionized prostate cancer detection as it is the first biomarker available to physicians to identify prostate cancers that could not be detected by a digital rectal exam. However, unrestricted utilization of the PSA test in asymptomatic men led to an increase in overdiagnosis and treatment-related morbidity. When reviewing evidence relating prostate cancer screening to prostate cancer–related morbidity and mortality, the US Preventative Services Task Force (USPSTF) issued a recommendation in 2012 that screening among asymptomatic men for prostate cancer produces more harm than benefit. These recommendations were updated in 2018 to offer screening selectively for men between the ages of 55 and 69 years. Both recommendations called for physicians to engage patients in shared decision making regarding screening. Consequences of these recommendations on shared decision making, health communication, and efforts to address disparities in screening among underserved and at-risk populations are discussed.

scholarly journals A discussion on controversies and ethical dilemmas in prostate cancer screening

2020 ◽  
pp. medethics-2019-105979
Author(s):  
Satish Chandra Mishra
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Task Force ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Current Evidence ◽  
Shared Decision ◽  
Psa Test ◽  
Level 1

Prostate cancer (PCa) is one of the the most common cancers in men. A blood test called prostate-specific antigen (PSA) has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of overdiagnosis and overtreatment as part of the screening. The US Preventive Services Task Force (USPSTF) in 2012 recommended that PSA-based PCa screening should not to be offered at any age. However, considering the current evidence, USPSTF recently revised its recommendation to offer the PSA test to men aged 55–69 years with shared decision-making, in line with earlier guidelines from the American Cancer Society and the American Urological Association. A shared decision making is necessary since the PSA test could potentially harm an individual. However, the literature suggests that clinicians often neglect a discussion on this issue before ordering the test. This narrative discusses the main controversies regarding PCa screening including the PSA threshold for biopsy, the concept of overdiagnosis and overtreatment, the practical difficulties of active surveillance, the current level 1 evidence on the mortality benefit of screening, and the associated pitfalls. It offers a detailed discussion on the ethics involved in the PSA test and highlights the barriers to shared decision-making and possible solutions.

scholarly journals Does shared decision making increase prostate screening uptake in countries with a low prevalence of prostate cancer?

2020 ◽  
Vol 20 (4) ◽  
pp. 1870-4
Author(s):  
Hussein Saad Amin ◽  
Mostafafa Ahmed Arafa ◽  
Karim Hamda Farhat ◽  
Danny Munther Rabah ◽  
Abdulaziz Abdullah Altaweel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Shared Decision ◽  
Advantages And Disadvantages ◽  
Psa Testing ◽  
Low Prevalence

Background: Men over 50 should discuss the benefits and harms of prostate-specific antigen (PSA) testing with their doctors. Objectives: To investigate whether shared decision making (SDM) increases the uptake of prostate cancer screening prac- tices among Saudi men. Methods: This community-based study recruited men aged ≥ 50 years between January and April 2019. Sociodemographic characteristics, history, and current medical condition information were collected. SDM information with regards to prostate cancer screening was discussed. Results: In total, 2034 Saudi men, aged between 50 and 88 years, agreed to participate in the current study. Prostate exam- ination for early detection of cancer was recommended for 35.4% (720) of subjects. Of the subjects, 23.3% (473) reported that the physicians discussed the advantages and benefits of PSA testing, whereas only 5.6% (114) stated that the physicians explained the disadvantages and drawbacks of PSA testing. Conclusion: Our findings suggest that less than one fourth discussed the advantages and disadvantages of PSA testing with their physicians; of these, less than one third underwent PSA blood tests. Improvements are needed in SDM for and against PSA screening. SDM does not affect the intensity of PSA testing. Primary health care physicians should be actively involved in the SDM process. Keywords: Decision making; prostate cancer screening; low prevalence countries.

Prostate cancer screening patterns among LGBT populations.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19077-e19077
Author(s):  
Sung Jun Ma ◽  
Oluwadamilola Temilade Oladeru ◽  
Joseph Miccio ◽  
Katy Wang ◽  
Kristopher Attwood ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Weighted Estimate ◽  
Shared Decision ◽  
Psa Screening ◽  
Lgbt Populations ◽  
Do So

e19077 Background: More than 10 million Americans identify themselves as lesbian, gay, bisexual, and transgender (LGBT), and the majority of male-to-female (MTF) transgender individuals still have prostates even after surgical transitions. Guidelines on prostate specific antigen (PSA) screening for LGBT populations are limited, and informed and shared decision making are encouraged by various organizations. However, patterns of care for PSA screening in LGBT populations remains unclear. To address this knowledge gap, we conducted a cross sectional study to evaluate self-reported PSA screening and decision making among LGBT populations. Methods: The Behavioral Risk Factor Surveillance System database was queried for LGBT adults from 2014-2016 and 2018. Those with prior prostate cancer were excluded. Multivariable logistic regression was performed to evaluate the association of LGBT status with PSA screening, informed and shared decision making, after adjusting for demographic characteristics and survey weights. Results: A total of 164,370 participants were eligible for PSA screening (n = 156,548 for cisgender [CG]+straight, n = 156 for MTF+straight, n = 33 for MTF+gay, n = 52 for MTF+bisexual, n = 51 for MTF+other sexual orientation [SO], n = 3354 for CG+gay, n = 1641 for CG+bisexual, n = 2535 for CG+other SO), representing a weighted estimate of 1.2 million LGBT populations. When compared to CG+straight, CG+gay/bisexual cohorts were more likely to undergo PSA screening within the past 2 years (CG+gay: OR 1.08, p < 0.001; CG+bisexual: OR 1.06, p < 0.001), have ever received PSA screening (CG+gay: OR 1.30, p < 0.001; CG+bisexual: OR 1.12, p < 0.001), and be recommended for PSA screening by their physicians (CG+gay and bisexual: OR 1.16, p < 0.001). All other cohorts were less likely to do so (all OR < 1, p < 0.05). MTF+gay and CG+gay participants were more likely to make informed decision (MTF+gay: OR 3.13, p < 0.001; CG+gay: OR 1.09, p < 0.001), while all other cohorts were less likely to do so (all OR < 1, p < 0.05). CG+gay participants were also more likely to share decision (OR 2.51, p < 0.001), while there were no associations for all other cohorts (all p > 0.05). Conclusions: Select gay populations were more likely to undertake PSA screening recommended by their physicians and participate in informed and shared decision making. However, other LGBT populations were less likely to make informed decisions, and transgender participants were less likely to undergo PSA screening. Further research efforts are needed to improve informed and shared decision making for PSA screening in such underserved population.

Prostate cancer screening and shared decision-making preferences among African-American members of the Prince Hall Masons

2008 ◽  
Vol 17 (10) ◽  
pp. 1006-1013 ◽  
Author(s):  
Randi M. Williams ◽  
Nicole L. Zincke ◽  
Ralph O. Turner ◽  
Jackson L. Davis ◽  
Kimberly M. Davis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
African American ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Prostate Cancer Screening ◽  
Shared Decision
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