Medical Malpractice Implications of PSA Testing for Early Detection of Prostate Cancer

Prostate cancer has become a major health concern of male Americans. It is now the most common nondermatologic cancer and the second leading cause of cancer death among men. The incidence of detected prostate cancer rose rapidly in recent years, partly because of prostate-specific antigen (PSA) testing; it is only now tapering off. Screening for prostate cancer with PSA is widespread in the United States, yet controversial: the American Urological Association recommends PSA screening and the American Cancer Society recommends offering screening; however, the United States Preventive Services Task Force (USPSTF) and the American College of Physicians (ACP) recommend against routine screening; and the American Academy of Family Physicians believes that the decision to screen should be left to the patient.

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Prostate-specific antigen testing among primary care physicians and urologists: Patterns of care and impact of professional society guidelines.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.40 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 40-40

Author(s):

Sandip M. Prasad ◽

G. Caleb Alexander ◽

Scott E. Eggener

Keyword(s):

Prostate Cancer ◽

United States ◽

Prostate Specific Antigen ◽

Primary Care Physicians ◽

Medical Condition ◽

Specific Antigen ◽

The United States ◽

Chronic Medical Condition ◽

The Past ◽

Psa Testing

40 Background: During the past decade, the incidence of prostate cancer in the United States has declined. We hypothesized this was related to lower rates of prostate-specific antigen (PSA) testing and sought to evaluate PSA testing rates nationally. Methods: Using the National Ambulatory Medical Care Survey, a nationally representative sample of outpatient visits in the United States, we analyzed rates of PSA testing in men age 40 years or older who visited PCPs or urologists from 1997 to 2008. Results: An estimated 26.6 million (95% CI: 24.8-28.4 million) PSA tests were ordered during 94.5 million (95% CI: 90.9-98.1 million) office visits to urologists and 95 million (95% CI: 87.5-102.8 million) tests were ordered during 1.17 billion (95% CI: 1.15-1.18 billion) visits to PCPs, with an annual increase of 3.4% and 6.0%, respectively (P=0.055 and P<0.001 for trend). After adjusting for year, race, ethnicity, region, insurance and provider type, testing by PCPs was more likely among older men and highest among men aged 60 to 69 years (reference: 40-49 years; OR 2.32, 95% CI: 1.88-2.85). Compared to men without a chronic medical condition, those with one chronic condition had greater odds of receiving a PSA test (OR 1.28, 95% CI: 1.08-1.52). Conclusions: Prostate cancer incidence has declined over the past decade despite increasing rates of office-based PSA testing by PCPs and urologists during the period. Increasing rates of PSA testing merit scrutiny, especially in men with limited life expectancies who are unlikely to benefit from screening.

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News Media Analysis of the United States Preventive Services Task Force and American Urological Association Prostate Cancer Screening Guidelines

Urology Practice ◽

10.1016/j.urpr.2016.12.001 ◽

2018 ◽

Vol 5 (1) ◽

pp. 24-30 ◽

Cited By ~ 2

Author(s):

Kevin Koo ◽

Kevin Shee ◽

Ronald L. Yap

Keyword(s):

Prostate Cancer ◽

United States ◽

Cancer Screening ◽

News Media ◽

Task Force ◽

Prostate Cancer Screening ◽

The United States ◽

Media Analysis ◽

Screening Guidelines ◽

American Urological Association

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Overdiagnosis and Overtreatment of Prostate Cancer

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.98 ◽

2012 ◽

pp. e35-e39 ◽

Cited By ~ 4

Author(s):

Ian M. Thompson

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Specific Antigen ◽

The United States ◽

Assessment Tools ◽

Low Grade ◽

High Grade ◽

Surveillance Strategy ◽

Psa Testing ◽

Prostate Cancer Prevention

Overview: Prostate cancer is a ubiquitous disease, affecting as many as two-thirds of men in their 60s. Through widespread prostate-specific antigen (PSA) testing, increasing rates of prostate biopsy, and increased sampling of the prostate, a larger fraction of low-grade, low-volume tumors have been detected, consistent with tumors often found at autopsy. These tumors have historically been treated in a manner similar to that used for higher-grade tumors but, more recently, it has become evident that with a plan of active surveillance that reserves treatment for only those patients whose tumors show evidence of progression, very high disease-specific survival can be achieved. Unfortunately, the frequency of recommendation of an active surveillance strategy in the United States is low. An alternative strategy to improve prostate cancer detection is through selected biopsy of those men who are at greater risk of harboring high-grade, potentially lethal cancer. This strategy is currently possible through the use of risk assessment tools such as the Prostate Cancer Prevention Trial Risk Calculator ( www.prostate.cancer.risk.calculator.com ) as well as others. These tools can predict with considerable accuracy a man's risk of low-grade and high-grade cancer, allowing informed decision making for the patient with a goal of detection of high-risk disease. Ultimately, other biomarkers including PCA3, TMPRSS2:ERG, and [-2]proPSA will likely aid in discriminating these two types of cancer before biopsy.

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Is Social Support From Family Associated With PSA Testing? An Exploratory Analysis Using the Health Information National Trends Survey (HINTS) 2005

American Journal of Men s Health ◽

10.1177/1557988308328541 ◽

2008 ◽

Vol 4 (1) ◽

pp. 50-59 ◽

Cited By ~ 4

Author(s):

Kamilah B. Thomas ◽

Sean L. Simpson ◽

Will L. Tarver ◽

Clement K. Gwede

Keyword(s):

Prostate Cancer ◽

Social Support ◽

Health Information ◽

Specific Antigen ◽

White Men ◽

The United States ◽

Social Contexts ◽

Psa Testing ◽

Instrumental Social Support ◽

National Trends

African American and White men have the highest rates of prostate cancer in the United States. Families represent important social contexts within which illness occurs.The purpose of this study is to explore whether prostate-specific antigen (PSA) testing is associated with instrumental and informational social support from family members among a sample of Black and White men aged 45 and older. Data from the 2005 Health Information National Trends Survey were analyzed using logistic regression. The dependent variable was having a PSA test within the past year or less. The independent variables consisted of selected demographic and family informational and instrumental social support variables. The statistically significant variables included age and having a family member with cancer. Additional studies to elucidate the mechanisms of social support from family for prostate cancer are needed.

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The Role of Targeted Focal Therapy in the Management of Low-Risk Prostate Cancer: Update on Current Challenges

Prostate Cancer ◽

10.1155/2012/587139 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Daniel W. Smith ◽

Diliana Stoimenova ◽

Khadijah Eid ◽

Al Barqawi

Keyword(s):

Prostate Cancer ◽

Side Effects ◽

Specific Antigen ◽

Three Dimensional ◽

Focal Therapy ◽

The United States ◽

Psa Testing ◽

Three Dimensional Mapping ◽

Risk Prostate Cancer ◽

Low Risk Prostate Cancer

Prostate cancer is one of the most prevalent cancers among men in the United States, second only to nonmelanomatous skin cancer. Since prostate-specific antigen (PSA) testing came into widespread use in the late 1980s, there has been a sharp increase in annual prostate cancer incidence. Cancer-specific mortality, though, is relatively low. The majority of these cancers will not progress to mortal disease, yet most men who are diagnosed opt for treatment as opposed to observation or active surveillance (AS). These men are thus burdened with the morbidities associated with aggressive treatments, commonly incontinence and erectile dysfunction, without receiving a mortality benefit. It is therefore necessary to both continue investigating outcomes associated with AS and to develop less invasive techniques for those who desire treatment but without the significant potential for quality-of-life side effects seen with aggressive modalities. The goals of this paper are to discuss the problems of overdiagnosis and overtreatment since the advent of PSA screening as well as the potential for targeted focal therapy (TFT) to bridge the gap between AS and definitive therapies. Furthermore, patient selection criteria for TFT, costs, side effects, and brachytherapy template-guided three-dimensional mapping biopsies (3DMB) for tumor localization will also be explored.

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