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.

Approaches to shared decision-making for PSA screening in primary care practice.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 33-33
Author(s):  
Cara B Litvin ◽  
Steven M. Ornstein ◽  
Lynne Nemeth
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Patient Education ◽  
Shared Decision Making ◽  
Prostate Cancer Screening ◽  
Shared Decision ◽  
Psa Screening ◽  
Care Practices ◽  
Primary Care Practices

33 Background: In April 2017, the United States Preventive Services Task Force published a draft statement recommending that clinicians inform men ages 55 to 65 about the potential benefits and harms of prostate-specific antigen (PSA)-based screening for prostate cancer. The HIT-OVERUSE study is an ongoing 2 year group randomized study in 20 primary care practices to test a practice-based intervention to reduce overuse, including avoidance of routine PSA screening without shared decision making. The purpose of this report is to present qualitative findings about approaches participating practices have adopted to facilitate shared decision-making for PSA screening. Methods: Eleven practices in ten states randomized to the HIT-OVERUSE intervention group have hosted on-site visits for academic detailing and participatory planning and sent two practice representatives to a one day meeting to share ‘best practices.’ Detailed notes from site visits, follow-up emails, and the ‘best practice’ meeting were reviewed to identify strategies adopted by practices to facilitate shared decision-making for PSA screening for prostate cancer screening. Results: All practices adopted at least one strategy to promote shared-decision making for PSA screening. Four practices removed standing orders for routine PSA screening. Four practices educated their clinical staff about the test; three developed scripts for staff to use when asked by patients about the test. Six practices began using patient education handouts about PSA screening. One provider started showing a brief YouTube video with patients, while another practice developed a slide show to show in the waiting room. Most providers in nearly all practices reported modifying their conversation about PSA screening with patients to include some discussion about the benefits and the harms of screening. Conclusions: Primary care practices participating an intervention to reduce overuse have adopted varied approaches to facilitate shared-decision making for prostate cancer screening. While having face-to-face conversations is one approach, other strategies may employ staff or utilize patient education or videos to convey the benefits and harms of screening.

scholarly journals The association between physician trust and prostate-specific antigen screening: Implications for shared decision-making

2018 ◽  
Vol 12 (12) ◽  
Author(s):  
Zachary Klaassen ◽  
Christopher J.D. Wallis ◽  
Hanan Goldberg ◽  
Thenappan Chandrasekar ◽  
Neil E. Fleshner ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Prostate Cancer Screening ◽  
Specific Antigen ◽  
Population Based ◽  
Cancer Information ◽  
Shared Decision ◽  
Screening Guidelines ◽  
Psa Screening ◽  
Patient Reported

Introduction: Shared decision-making is widely recommended when men are considering prostate cancer screening with prostatespecific antigen (PSA). The role of patients’ trust in cancer information from their physician in such decisions is unknown. Methods: We identified male respondents ≥18 years of age from the Health Information National Trends Survey, a population-based survey of people living in the U.S. (2011–014). We assessed the association between degree of trust in cancer information from respondent’s physician with patient-reported receipt of PSA screening and patient-reported discussion of PSA screening with their physician. Results: Among 5069 eligible respondents, 3606 (71.1%) men reported trusting cancer information from their physician “a lot,” 1186 (23.4%) “somewhat,” 219 (4.3%) “a little,” and 58 (1.1%) “not at all.” A total of 2655 (52.4%) men reported receiving PSA screening. The degree of trust an individual had in his physician for cancer information was strongly associated with his likelihood of having received PSA screening (ptrend<0.0001) (54.9% “a lot” vs. 27.6% “not at all”). These findings persisted after multivariable regression. Similarly, men who had high levels of trust in their physician were more likely to have discussed PSA screening with a strong trend across strata (ptrend<0.0001). Conclusions: The level of trust an individual has in cancer information from his physician is strongly associated with his likelihood of discussing and undergoing PSA screening. As rationale, implementation of PSA screening requires shared decision-making, and the level of trust an individual has in his physician has important implications for dissemination of PSA screening guidelines.

Shared decision making for prostate cancer screening: Reality or farce?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 107-107 ◽  
Author(s):  
Daniel Pucheril ◽  
Sean A. Fletcher ◽  
Dimitar V. Zlatev ◽  
Matthew Mossanen ◽  
Matthew D. Ingham ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Prostate Cancer Screening ◽  
Weighted Estimate ◽  
Shared Decision ◽  
Physician Recommendation ◽  
Cancer Society ◽  
Advantages And Disadvantages

107 Background: A core tenant of major cancer society guidelines regarding prostate cancer screening (PSAS) is that providers discuss both the advantages and disadvantages of screening with eligible patients in a shared decision making (SDM) process. We sought to determine contemporary trends of SDM in regards to PSAS. Methods: Consistent with the AUA guidelines for PSAS, data was abstracted from the 2012-2016 Behavioral Risk Factor Surveillance System for men 55-69, without a personal history of prostate cancer, and having answered all questions within the PSAS module. PSAS occurred if a man had a PSA test within the last two years for reasons other than "a prostate problem” or “prostate cancer”. SDM occurred if the respondent was informed about both advantages and disadvantages of PSAS by a health professional. Descriptive statistics were generated for demographic covariates by year. The Chi-Square test was used to compare the distribution of covariate proportions amongst years. Separate multivariable regression models were built to identify independent predictors of both receipt of PSA screening and SDM. Results: A weighted estimate of 56.7 million men (n = 138,492) met inclusion criteria. Reported rates of PSAS decreased each year (56.7% in 2012 to 52.6% in 2014 to 49.1% in 2016, p < 000.1). There were no significant changes in rates of SDM (p = 0.82); in all three years, less than one-third of respondents reported SDM. After controlling for known confounders, possession of a personal physician (OR 2.24,95%CI 2.02-2.48), receipt of information regarding the advantages of PSAS (OR 3.93, 95%CI 3.63-4.26), and receiving a physician recommendation to undergo PSAS (OR 7.78, 95%CI 7.25-8.35) were most strongly associated with odds of undergoing PSAS. Odds of reporting participation in SDM were strongest amongst black respondents (2.09 95%CI 1.92-2.28) and those who received a physician recommendation to undergo PSAS (OR 4.64, 95%CI 4.32-4.99). Conclusions: Despite recommendations that physicians engage patients in a SDM process, our findings suggest that less than a third of patients are advised of both the advantages and disadvantages of PSAS. With the likely revision of the USPSTF PSAS recommendation to Grade C, a renewed effort towards SDM is needed.

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.

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