scholarly journals Patient–Provider Communication About Prostate Cancer Screening and Treatment

2016 ◽  
Vol 11 (1) ◽  
pp. 134-146 ◽  
Author(s):  
Soumitra S. Bhuyan ◽  
Aastha Chandak ◽  
Niodita Gupta ◽  
Sudhir Isharwal ◽  
Chad LaGrange ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Patient Characteristics ◽  
Patient Specific ◽  
Provider Communication ◽  
Shared Decision ◽  
Psa Test ◽  
Psa Testing ◽  
Patient Provider Communication

The American Urological Association, American Cancer Society, and American College of Physicians recommend that patients and providers make a shared decision with respect to prostate-specific antigen (PSA) testing for prostate cancer (PCa). The goal of this study is to determine the extent of patient–provider communication for PSA testing and treatment of PCa and to examine the patient specific factors associated with this communication. Using recent data from the Health Information National Trends Survey, this study examined the association of patient characteristics with four domains of patient–provider communication regarding PSA test and PCa treatment: (1) expert opinion of PSA test, (2) accuracy of PSA test, (3) side effects of PCa treatment, and (4) treatment need of PCa. The current results suggested low level of communication for PSA testing and treatment of PCa across four domains. Less than 10% of the respondents report having communication about all four domains. Patient characteristics like recent medical check-up, regular healthcare provider, global health status, age group, marital status, race, annual household income, and already having undergone a PSA test are associated with patient–provider communication. There are few discussions about PSA testing and PCa treatment options between healthcare providers and their patients, which limits the shared decision-making process for PCa screening and treatment as recommended by the current best practice guidelines. This study helps identify implications for changes in physician practice to adhere with the PSA screening guidelines.

scholarly journals Does the reflexive measurement of free PSA have a role in a tertiary cancer centre?

2013 ◽  
Vol 4 (5) ◽  
pp. 317
Author(s):  
Christopher Allard ◽  
Paul Yip ◽  
Ivan Blasutig ◽  
Karen Hersey ◽  
Neil Fleshner
Keyword(s):  
Prostate Cancer ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Diagnostic Précoce ◽  
Psa Test ◽  
Total Cost ◽  
Cancer Centre ◽  
Free Psa ◽  
Psa Testing ◽  
The Cost

Purpose: The percent free prostate-specific antigen (PSA) may complementtotal PSA for prostate cancer screening, but is of no benefitfor monitoring patients with previous prostate cancer diagnoses. Atthe Princess Margaret Hospital, a tertiary cancer centre in Toronto,Ontario, Canada, PSA values in the range 4 to 10 ng/mL promptreflexive measurements of free PSA. We hypothesize that reflexivefree PSA testing at tertiary cancer centres generates unnecessarycosts as the test is often conducted on patients with previous diagnosesof prostate cancer.Materials and Methods: We reviewed all reflexive free PSA measurementsconducted on a random sample of 250 men in a 10-yearperiod at our institution. We determined the clinical indicationsfor the PSA tests which triggered reflexive free PSA measurementsto estimate the proportion of free PSA tests that are not clinicallyindicated.Results: We reviewed the 1099 reflexive free PSA measurementsfor the 250 subjects. Of these tests, 562 (51%) were triggered byPSA tests ordered for screening/early detection, and 537 (49%)for monitoring.Conclusions: Of all reflexive free PSA tests, 49% were unnecessary.We conducted 3022 free PSA tests, at a cost of $5.84 pertest (Can$); the tests were performed in 2009 at this institution fora total cost of $17 648.48, about 49% of which ($8647.76) likelyrepresents unnecessary annual costs. We suggest a trial of userselectableorder sets allowing physicians to choose whether toinclude reflexive free PSA measurements on a case-by-case basis.This policy might improve the cost-effectiveness of the PSA test attertiary cancer centres.Objectif : Le pourcentage d’antigène prostatique spécifique (APS)libre peut compléter la mesure de l’APS total dans le dépistagedu cancer de la prostate, mais il n’est d’aucune utilité pour lasurveillance de patients ayant déjà reçu un diagnostic de cancerde la prostate. À l’hôpital Princess Margaret, un centre de soinsoncologiques tertiaires de Toronto, en Ontario (Canada), un tauxd’APS se situant entre 4 et 10 ng/mL entraîne systématiquementune évaluation des taux d’APS libre. Nous avançons l’hypothèseque la mesure de l’APS libre dans les centres de soins oncologiquestertiaires entraîne des dépenses inutiles car ce test est souventmené chez des patients ayant déjà reçu un diagnostic de cancerde la prostate.Matériel et méthodes : Nous avons examiné tous les cas de mesurede l’APS libre effectuée dans un échantillon aléatoire de 250 hommessur une période de 10 ans à notre établissement. Nous avonsvérifié les indications cliniques liées aux mesures de l’APS ayantentraîné une mesure de l’APS libre afin d’évaluer la proportionde ces mesures de l’APS libre qui n’étaient pas justifiées sur leplan clinique.Résultats : Chez les 250 sujets, 1099 mesures de l’APS libre ont étéeffectuées. Sur ces tests, 562 (51 %) ont fait suite à des mesuresde l’APS prescrites à des fins de dépistage/diagnostic précoce, et537 (49 %) à des fins de surveillance.Conclusions : De toutes les mesures de l’APS libre, 49 % n’étaientpas nécessaires; 3022 tests de mesure de l’APS libre, au coût de5,84 $ par test, ont été effectués en 2009 à notre établissement,pour un coût total de 17 648,48 $, dont environ 49 % – pour unmontant de 8647,76 $ – représente selon toute apparence desdépenses inutiles. Nous suggérons d’établir une règle basée sur lejugement clinique et permettant aux médecins de choisir d’inclureou non la mesure de l’APS libre au cas par cas. Une telle politiquepourrait améliorer la rentabilité des mesures de l’APS dans lescentres de soins oncologiques tertiaires.

scholarly journals Evaluation of a rapid one-step PSA test for primary prostate cancer screening

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shingo Ashida ◽  
Ichiro Yamasaki ◽  
Chiaki Kawada ◽  
Hideo Fukuhara ◽  
Satoshi Fukata ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Predictive Value ◽  
Prostate Cancer Screening ◽  
Large Population ◽  
Specific Antigen ◽  
Spot Test ◽  
Psa Test ◽  
Psa Testing ◽  
Test Kit ◽  
One Step

Abstract Background To enhance the convenience and reduce the cost of prostate cancer (PC) screening, a one-step prostate-specific antigen (PSA) test was evaluated in a large population. The PSA SPOT test kit enables rapid detection of human PSA in serum or plasma at or above a cutoff level of 4 ng/mL to aid in the diagnosis of PC. Methods PC screening using the PSA SPOT test was offered to male participants in educational public lectures that we conducted in various cities. Test results were reported to participants at the end of the lectures. Blood samples from 1429 men were evaluated. Two independent observers interpreted the tests at 15 and 30 min. The remaining serum samples were subsequently tested using a conventional quantitative assay. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the test were 79.9, 93.0, 65.4, 96.6, and 91.2%, respectively. The sensitivity and specificity of the test changed with variations in the reading time. Quantitative assessment of the intensity of the band was correlated with the PSA value. Conclusions PSA testing using this kit can be easily performed. The low cost and speed of the test make it a useful and convenient tool for primary PC screening.

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.

scholarly journals PSA Testing: Are Patients Aware of What Lies Ahead?

2006 ◽  
Vol 88 (3) ◽  
pp. 284-288 ◽  
Author(s):  
Marc Lamplugh ◽  
Paul Gilmore ◽  
Timothy Quinlan ◽  
Philip Cornford
Keyword(s):  
Prostate Cancer ◽  
Secondary Care ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Psa Test ◽  
Psa Testing ◽  
Urinary Tract Symptoms ◽  
Controversial Topic ◽  
The Uk ◽  
Men’S Knowledge

INTRODUCTION Screening for prostate cancer with serum prostate specific antigen (PSA) remains a controversial topic. The UK NHS Executive has issued extensive guidance stressing the importance of adequate counselling prior to performing this test. This study aims to assess men's knowledge of the PSA test at the time of their referral and their attitude towards screening. PATIENTS AND METHODS A total of 219 men referred to urology via the ‘fast track’ prostate cancer service were recruited into the study. Of these, 191 were referred from primary care and 28 from secondary care. All men completed a questionnaire regarding their knowledge and expectation of the test. RESULTS The response rate for completed questionnaires was 100%. Overall, 91 (41.5%) men were aware that their PSA had been performed prior to referral and only 79 (36%) men understood why the test was being done. Patients referred from secondary care appeared to be better informed. Despite these figures, 175 (80%) men said they would recommend PSA testing to a friend or colleague, and 196 (89%) men said the test should be broadly publicised. CONCLUSIONS Nearly two-thirds of the men referred to urology with an elevated PSA were unaware that they had even had their PSA done. Information about the limitations of PSA testing and the consequence of a positive test result had been deficient. Informed counselling for the PSA test should form part of the consultation of any physician intending to undertake this test whether for lower urinary tract symptoms or for prostate cancer screening.

scholarly journals Prostate Cancer Screening in the Workplace

AAOHN Journal ◽  
1998 ◽  
Vol 46 (8) ◽  
pp. 379-384 ◽  
Author(s):  
Claire Snyder ◽  
Peggy N. Schrammel ◽  
Claudia B. Griffiths ◽  
Robert I. Griffiths
Keyword(s):  
Prostate Cancer ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Screening Tests ◽  
Test Results ◽  
Total Cost ◽  
Screening Programs ◽  
Psa Testing ◽  
The Cost

Recognition of the mortality and morbidity associated with prostate cancer has resulted in employer based screening programs. This retrospective cohort study identified the employer costs of prostate cancer screening and referrals due to abnormal test results. The subjects were 385 men enrolled in a workplace screening program at a single employer between 1993 and 1995. Screening consisted of digital rectal examination (DRE) annually for enrolled employees aged 40 years and older, plus annual prostate specific antigen (PSA) testing for those 50 and older, and those 40 and older and considered at high risk. Data related to the health care and lost productivity costs of screening and referrals for abnormal test results were collected and analyzed. The total cost of screening was $44,355, or approximately $56 per screening encounter (788 DREs; 437 PSAs). Abnormal screening tests resulted in 52 referrals. Upon further evaluation, 42% were found to have an enlargement, 29% a node, and 12% benign prostatic hyperplasia. Only one malignancy was found. The total cost of additional referrals was $31,815, or 42% of the cost of screening plus referrals. As the cost per screening encounter was low, prostate cancer screening in the workplace is an efficient alternative.

Patient preference for prostate-specific antigen testing: A population-based analysis.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 188-188
Author(s):  
S. L. Chang ◽  
J. C. Presti ◽  
J. P. Richie
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Patient Preferences ◽  
Prostate Cancer Screening ◽  
Population Based ◽  
Decision Making Process ◽  
Shared Decision ◽  
Psa Testing ◽  
History Of

188 Background: The AUA and American Cancer Society both recommend a shared decision-making process between clinicians and patients for prostate cancer screening with PSA testing. Data are limited data regarding patient preferences for PSA evaluation in the United States. We assessed the sociodemographic and clinical characteristics of men who proceeded with or opted out of PSA testing in a nationally representative population-based cohort. Methods: We analyzed male participants from the 2001 to 2008 cycles of the National Health and Nutrition Examination Survey (NHANES) who were 40 years old or older without a history of prostate cancer, recent prostate manipulation, or hormone therapy use (n = 6,032). All men underwent or refused PSA testing after a standardized explanation about prostate cancer screening by a physician. A multivariate logistic regression was conducted after adjusting for survey weights to identify independent sociodemographic and clinical predictors for opting out of PSA testing. Results: Overall, 5% of the study cohort refused PSA testing. The analysis revealed predictors for refusing PSA testing (Table). PSA testing preference was not influenced by a family history of prostate cancer, previous prostate cancer screening, education level, socioeconomic status, insurance status, or tobacco history. There were no significant time trends for PSA testing. Conclusions: Despite equal access to PSA testing in our study, there was unequal utilization. We found that Black men were more likely to refuse PSA testing. Our analysis also suggests that a perception of suboptimal health or uncertain future outlook may discourage men from undergoing PSA evaluation. These patient preferences for PSA evaluation should be factored into the shared decision-making process for prostate cancer screening. [Table: see text] No significant financial relationships to disclose.

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.

The role of prostate specific antigen measurement in the detection and management of prostate cancer.

2000 ◽  
pp. 37-51 ◽  
Author(s):  
A F Nash ◽  
I Melezinek
Keyword(s):  
Prostate Cancer ◽  
Endocrine Therapy ◽  
Prostate Specific Antigen ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Marked Change ◽  
Reference Ranges ◽  
Psa Density ◽  
Psa Testing

The introduction of prostate specific antigen (PSA) testing has revolutionised the early detection, management and follow-up of patients with prostate cancer and it is considered to be one of the best biomedical markers currently available in the field of oncology. Its use with annual digital rectal examination in prostate cancer screening programmes has led to a marked change in the distribution of stage at presentation towards earlier disease and led to a significant increase in the detection of potentially curable disease. In order to improve the specificity of PSA testing and thereby reduce the number of unnecessary prostatic biopsies, a number of refinements of PSA evaluation have been proposed. These include free to total PSA ratio, PSA density, PSA density, PSA density of the transition zone, PSA velocity and age-specific PSA reference ranges. The utility of these approaches is considered in this review. The role of PSA monitoring in the detection of recurrence following radical prostatectomy and radiotherapy is discussed, as well as its role in monitoring patients treated with endocrine therapy is discussed, as well as its role in monitoring patients treated with endocrine therapy in terms of correlating PSA response with outcome, in detecting disease progression and in guiding the use of subsequent therapies. Large continuing multicentre screening and outcome studies will provide important information enabling greater refinement of the use of this important diagnostic and monitoring tool in the future detection and management of prostate cancer.

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