PSA request analysis: how should this be interpreted? What may be overlooked / PSA istem analizi: Nasıl yorumlanmalı? Gözden kaçanlar nelerdir?

AbstractObjective: Prostate specific antigen is widely used for the diagnosis, treatment, and follow-up of prostate cancer. However, despite being organ-specific, PSA is not specific to cancer. As some patients with elevated PSA level have normal biopsy results and some others with low PSA levels have cancer diagnosed in biopsy examination, PSA creates diagnostic uncertainty both for clinicians and patients. Moreover, different PSA results received for the same subject at separate time points as well as smalllarge fluctuations in PSA levels perturb both sides. In a setting where there are so many unknowns we have PSA in our hands without any restrictions for ordering it. This study analyzed PSA orders, patient traffic, and economic burden within a 6-year period.Methods: The number of PSA tests and patient outcomes at a training and research hospital between October 2006 and May 2013 were evaluated.Results: Of 12107 tPSA orders, 73.6% were ordered by the urology clinic and 26.4% orders were made from other outpatient clinics. When patients at follow-up for prostate cancer are excluded because their tPSAs have to be more commonly checked, we detected that 28.22% of tests were ordered at intervals of less than 1 year. The average tPSA testing frequency was 91.84±1.21 days (0-330). The number of patients younger than 40 years who were tested for tPSA was 287. Of these, 25.43% were ordered by the urology clinic and the remaining by other medical branches.Conclusion: A state of chaos surrounds PSA order and interpretation. Neither patients nor physicians are aware of PSA-related outcomes. Therefore, each hospital should hold sessions on PSA testing and inform physicians about them. Furthermore, a detailed public education should be provided and seminars should be organized at the national level.

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Prostate Cancer Burden at the Uganda Cancer Institute

Journal of Global Oncology ◽

10.1200/jgo.2015.001040 ◽

2016 ◽

Vol 2 (4) ◽

pp. 181-185 ◽

Cited By ~ 4

Author(s):

Fred Okuku ◽

Jackson Orem ◽

George Holoya ◽

Chris De Boer ◽

Cheryl L. Thompson ◽

...

Keyword(s):

Prostate Cancer ◽

Specific Antigen ◽

Stage Iv ◽

Cord Compression ◽

Hormonal Manipulation ◽

Number Of Patients ◽

Stage Iv Disease ◽

Metastatic Sites ◽

Lost To Follow Up

Purpose In Uganda, the incidence of prostate cancer is increasing at a rate of 5.2% annually. Data describing presentation and outcomes for patients with prostate cancer are lacking. Methods A retrospective review of medical records for men with histologically confirmed prostate cancer at the Uganda Cancer Institute (UCI) from January 1 to December 17, 2012, was performed. Results Our sample included 182 men whose mean age was 69.5 years (standard deviation, 9.0 years). Patients who presented to the UCI had lower urinary tract symptoms (73%; n = 131), bone pain (18%; n = 32), increased prostate-specific antigen (PSA; 3%; n = 5), and other symptoms (6%; n = 11). Median baseline PSA was 91.3 ng/mL (interquartile range, 19.5-311.3 ng/mL), and 51.1% of the patients (n = 92) had a PSA value above 100 ng/mL. Gleason score was 9 or 10 in 66.7% of the patients (n = 120). Ninety percent (n = 136) had stage IV disease, and metastatic sites included bone (73%; n = 102), viscera (21%; n = 29), and lymph nodes (4%; n = 5). Spinal cord compression occurred in 30.9% (n = 55), and 5.6% (n = 10) experienced a fracture. A total of 14.9% (n = 27) underwent prostatectomy, and 17.7% (n = 32) received radiotherapy. Gonadotropin-releasing hormone agonist was given to 45.3% (n = 82), 29.2% (n = 53) received diethylstilbestrol, and 26% (n = 47) underwent orchiectomy. Chemotherapy was administered to 21.6% (n = 39), and 52.5% (n = 95) received bisphosphonates. During the 12 months of study, 23.8% of the men (n = 43) died, and 54.4% (n = 98) were lost to follow-up. Conclusion UCI patients commonly present with high PSA, aggressive Gleason scores, and stage IV disease. The primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation, and a large number of patients are lost to follow-up.

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The effects of PSA kinetics on the outcome of hypofractionated salvage radiotherapy for biochemical recurrence of prostate cancer after prostatectomy

Journal of Radiation Research ◽

10.1093/jrr/rraa074 ◽

2020 ◽

Vol 61 (6) ◽

pp. 908-919

Author(s):

Hitoshi Ishikawa ◽

Keiko Higuchi ◽

Takuya Kaminuma ◽

Yutaka Takezawa ◽

Yoshitaka Saito ◽

...

Keyword(s):

Prostate Cancer ◽

Biochemical Recurrence ◽

Survival Rates ◽

Specific Antigen ◽

Surgical Margin ◽

Salvage Radiotherapy ◽

Psa Kinetics ◽

Prostate Bed ◽

Number Of Patients

Abstract The feasibility and efficacy of hypofractionated salvage radiotherapy (HS-RT) for prostate cancer (PC) with biochemical recurrence (BR) after prostatectomy, and the usefulness of prostate-specific antigen (PSA) kinetics as a predictor of BR, were evaluated in 38 patients who received HS-RT without androgen deprivation therapy between May 2009 and January 2017. Their median age, PSA level and PSA doubling time (PSA-DT) at the start of HS-RT were 68 (53–74) years, 0.28 (0.20–0.79) ng/ml and 7.7 (2.3–38.5) months, respectively. A total dose of 60 Gy in 20 fractions (three times a week) was three-dimensionally delivered to the prostate bed. After a median follow-up of 62 (30–100) months, 19 (50%) patients developed a second BR after HS-RT, but only 1 patient died before the last follow-up. The 5-year overall survival and BR-free survival rates were 97.1 and 47.4%, respectively. Late grade 2 gastrointestinal and genitourinary morbidities were observed in 0 and 5 (13%) patients, respectively. The PSA level as well as pathological T-stage and surgical margin status were regarded as significant predictive factors for a second BR by multivariate analysis. BR developed within 6 months after HS-RT in 11 (85%) of 13 patients with a PSA-DT < 10 months compared with 1 (17%) of 6 with a PSA-DT ≥ 10 months (median time to BR: 3 vs 14 months, P < 0.05). Despite the small number of patients, our HS-RT protocol seems feasible, and PSA kinetics may be useful for predicting the risk of BR and determining the appropriate follow-up schedule.

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10-Year Outcomes After Monitoring, Surgery, or Radiotherapy

50 Studies Every Urologist Should Know ◽

10.1093/med/9780190655341.003.0008 ◽

2021 ◽

pp. 43-48

Author(s):

Philipp Dahm

Keyword(s):

Prostate Cancer ◽

Randomized Controlled Trial ◽

Radiation Therapy ◽

Controlled Trial ◽

Specific Antigen ◽

Active Monitoring ◽

Risk Of Death ◽

Psa Screening ◽

Psa Testing

This chapter provides a summary of the landmark Prostate Testing for Cancer and Treatment (ProtecT) trial, a three-armed randomized controlled trial of men with clinically localized prostate cancer mostly diagnosed through prostate-specific antigen (PSA) screening comparing radical prostatectomy to radiation therapy or active monitoring. Active monitoring consisted mostly of regular PSA testing. After 10 years of follow-up, very few deaths from prostate cancer occurred, underscoring the very low risk of death from prostate cancer in patients diagnosed by PSA screening irrespective of treatment approach.

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Stereotactic body radiation therapy for clinically localized prostate cancer

Cancer Urology ◽

10.17650/1726-9776-2018-14-2-122-129 ◽

2018 ◽

Vol 14 (2) ◽

pp. 122-129

Author(s):

N. A. Vorobyov ◽

N. I. Martynova ◽

A. V. Mikhailov ◽

Yu. V. Gutsalo ◽

A. V. Kubasov

Keyword(s):

Prostate Cancer ◽

Side Effects ◽

Specific Antigen ◽

Free Survival ◽

Psa Relapse ◽

Robotic Radiosurgery ◽

Number Of Patients ◽

Psa Nadir ◽

Cyberknife Robotic Radiosurgery

Background. In the last decade, we observed a significant increase in the number of patients undergoing radiotherapy for prostate cancer (PC). It became possible with the development of new equipment that can significantly increase radiation efficiency and reduce the frequency and severity of side effects. Active investigation of new fractionation regimens led to the development of stereotactic radiotherapy (StR) technique. In this article, we describe our own experience of using StR in patients with localized PC.Material and methods. The study included 48 patients treated with CyberKnife robotic radiosurgery system. The patients received a total dose of 36.25 Gy delivered in 5 fractions.Results. At a median follow-up of 24 months, the estimated four-year prostate-specific antigen (PSA) relapse-free survival rate was 95.8 %. The median PSA nadir was 0.48 ng/mL. We observed no grade III–IV side effects (either early or late).Conclusion. Our results suggest that the use of StR allows achieving good biochemical control comparable to that achieved by other methods and demonstrates comparable and sometimes even lower toxicity.

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Screening for Prostate Cancer With Prostate-Specific Antigen Testing: American Society of Clinical Oncology Provisional Clinical Opinion

Journal of Clinical Oncology ◽

10.1200/jco.2012.43.3441 ◽

2012 ◽

Vol 30 (24) ◽

pp. 3020-3025 ◽

Cited By ~ 100

Author(s):

Ethan Basch ◽

Thomas K. Oliver ◽

Andrew Vickers ◽

Ian Thompson ◽

Philip Kantoff ◽

...

Keyword(s):

Prostate Cancer ◽

Life Expectancy ◽

Specific Antigen ◽

Risk Of Bias ◽

Evidence Based ◽

Limited Data ◽

Strength Of Evidence ◽

Psa Testing ◽

American Society

Purpose An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offers timely clinical direction to the ASCO membership after publication or presentation of potentially practice-changing data from major studies. This PCO addresses the role of prostate-specific antigen (PSA) testing in the screening of men for prostate cancer. Clinical Context Prostate cancer is the second leading cause of cancer deaths among men in the United States. The rationale for screening men for prostate cancer is the potential to reduce the risk of death through early detection. Recent Data Evidence from a 2011 Agency for Healthcare Research and Quality systematic review primarily informs this PCO on the benefits and harms of PSA-based screening. An update search was conducted to March 16, 2012, for additional evidence related to the topic. Results In one randomized trial, PSA testing in men who would not otherwise have been screened resulted in reduced death rates from prostate cancer, but it is uncertain whether the size of the effect was worth the harms associated with screening and subsequent unnecessary treatment. Although there are limitations to the existing data, there is evidence to suggest that men with longer life expectancy may benefit from PSA testing. Adverse events associated with prostate biopsy are low for the majority of men; however, several population-based studies have shown increasing rates of infectious complications after prostate biopsy, which is a concern. Provisional Clinical Opinion On the basis of identified evidence and the expert opinion of the panel ( Table 1 provides a description of how recommendations and evidence are rated): In men with a life expectancy ≤ 10 years,* it is recommended that general screening for prostate cancer with total PSA be discouraged, because harms seem to outweigh potential benefits. Type and strength of recommendation. Evidence based: strong. Strength of evidence. Moderate: based on five randomized clinical trials (RCTs) with intermediate to high risk of bias, moderate follow-up, and limited data on subgroup populations. In men with a life expectancy > 10 years,* it is recommended that physicians discuss with their patients whether PSA testing for prostate cancer screening is appropriate for them. PSA testing may save lives but is associated with harms, including complications, from unnecessary biopsy, surgery, or radiation treatment. Type and strength of recommendation. Evidence based: strong. Strength of evidence. For benefit, moderate; for harm, strong: based on five RCTs (and several cohort studies) with intermediate to high risk of bias, moderate follow-up, indirect data, inconsistent results, and limited data on subgroup populations. It is recommended that information written in lay language be available to clinicians and their patients to facilitate the discussion of the benefits and harms associated with PSA testing before the routine ordering of a PSA test. Type and strength of recommendation. Informal consensus: strong. Strength of evidence. Indeterminate: evidence was not systematically reviewed to inform this recommendation; however, randomized trials are available on the topic. *Calculation of life expectancy is based on a variety of individual factors and circumstances. A number of life expectancy calculators (eg, http://www.socialsecurity.gov/OACT/population/longevity.html) are available in the public domain; however, ASCO does not endorse any one calculator over another. NOTE. ASCO PCOs reflect expert consensus based on clinical evidence and literature available at the time they are written and are intended to assist physicians in clinical decision making and identify questions and settings for further research. Because of the rapid flow of scientific information in oncology, new evidence may have emerged since the time a PCO was submitted for publication. PCOs are not continually updated and may not reflect the most recent evidence. PCOs cannot account for individual variation among patients and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It is the responsibility of the treating physician or other health care provider, relying on independent experience and knowledge of the patient, to determine the best course of treatment for the patient. Accordingly, adherence to any PCO is voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. ASCO PCOs describe the use of procedures and therapies in clinical practice and cannot be assumed to apply to the use of these interventions in the context of clinical trials. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of ASCO PCOs or for any errors or omissions.

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Feasibility and acceptability of follow-up for prostate cancer in primary care: a pilot study

BJGP Open ◽

10.3399/bjgpopen18x101616 ◽

2018 ◽

Vol 2 (4) ◽

pp. bjgpopen18X101616 ◽

Cited By ~ 2

Author(s):

Marianne Heins ◽

François Schellevis ◽

Mirjam Schotman ◽

Bart van Bezooijen ◽

Ismene Tchaoussoglou ◽

...

Keyword(s):

Prostate Cancer ◽

Pilot Study ◽

Clinical Pathway ◽

Specific Antigen ◽

Stable Phase ◽

Number Of Patients ◽

One Year ◽

The Cost ◽

Practice Care

BackgroundThe number of patients with prostate cancer is increasing, which puts additional pressure on health care. GP-led follow up may help reduce costs, travel time for patients, and workload for urologists and improve continuity of care.AimTo test the feasibility and acceptability of a new clinical pathway for GP-led prostate cancer follow-up.Design & settingA feasibility pilot study was performed in cooperation with six GP practices in the Dutch region of Amersfoort.MethodThe study included 20 patients with prostate cancer in a stable phase, who were aged ≥65 years and with comorbidity. Follow-up for prostate cancer was transferred to the GP for one year. Participating GPs and urologists jointly developed a protocol. Patient satisfaction was measured at 0 and 12 months with the ‘personalised care’ subscale of the Consumer Quality (CQ) index 'general practice care'. Next, patients, GPs, and urologists were interviewed about their experiences. The clinical pathway was considered successful if no patients were referred back to the urologist, except for an increase in prostate-specific antigen (PSA), and if the majority of patients and participating urologists and GPs were satisfied.ResultsOf the 20 patients included in the study, three were referred back to the urologist because of increasing PSA levels and one died (unrelated to prostate cancer). Most patients (73%) were satisfied with the transfer of care, indicated by a score of ≥3 on the ‘personalised care’ subscale. GPs and urologists had confidence in the ability of GPs to provide follow-up care and preferred to continue this.ConclusionThe new clinical pathway was successful, warranting a larger study to provide evidence for the (cost-)effectiveness of GP-led prostate cancer follow-up.

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Guy’s and St Thomas NHS Foundation active surveillance prostate cancer cohort: a characterisation of a prostate cancer active surveillance database

BMC Cancer ◽

10.1186/s12885-021-08255-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Salonee Shah ◽

Kerri Beckmann ◽

Mieke Van Hemelrijck ◽

Ben Challacombe ◽

Rick Popert ◽

...

Keyword(s):

Prostate Cancer ◽

Active Surveillance ◽

Specific Antigen ◽

Future Research ◽

Low Grade ◽

Intermediate Risk ◽

Psa Testing ◽

Diagnostic Characteristics ◽

Diagnostic Biopsy

Abstract Background The routine clinical use of serum prostatic specific antigen (PSA) testing has allowed earlier detection of low-grade prostate cancer (PCa) with more favourable characteristics, leading to increased acceptance of management by active surveillance (AS). AS aims to avoid over treatment in men with low and intermediate-risk PCa and multiple governing bodies have described several AS protocols. This study provides a descriptive profile of the Guy’s and St Thomas NHS Foundation Trust (GSTT) AS cohort as a platform for future research in AS pathways in PCa. Methods Demographic and baseline characteristics were retrospectively collected in a database for patients at the GSTT AS clinic with prospective collection of follow-up data from 2012. Seven hundred eighty-eight men being monitored at GSTT with histologically confirmed intermediate-risk PCa, at least 1 follow-up appointment and diagnostic characteristics consistent with AS criteria were included in the profile. Descriptive statistics, Kaplan-Meier survival curves and multivariable Cox proportion hazards regression models were used to characterize the cohort. Discussion A relatively large proportion of the cohort includes men of African/Afro-Caribbean descent (22%). More frequent use of magnetic resonance imaging and trans-perineal biopsies at diagnosis was observed among patients diagnosed after 2012. Those who underwent trans-rectal ultrasound diagnostic biopsy received their first surveillance biopsy 20 months earlier than those who underwent trans-perineal diagnostic biopsy. At 3 years, 76.1% men remained treatment free. Predictors of treatment progression included Gleason score 3 + 4 (Hazard ratio (HR): 2.41, 95% Confidence interval (CI): 1.79–3.26) and more than 2 positive cores taken at biopsy (HR: 2.65, CI: 1.94–3.62). A decreased risk of progressing to treatment was seen among men diagnosed after 2012 (HR: 0.72, CI: 0.53–0.98). Conclusion An organised biopsy surveillance approach, via two different AS pathways according to the patient’s diagnostic method, can be seen within the GSTT cohort. Risk of patients progressing to treatment has decreased in the period since 2012 compared with the prior period with more than half of the cohort remaining treatment free at 5 years, highlighting that the fundamental aims of AS at GSTT are being met. Thus, this cohort is a good resource to investigate the AS treatment pathway.

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Factors Related to Prostate-Specific Antigen–Based Prostate Cancer Screening in Primary Care: Retrospective Cohort Study of 120,587 French Men Over the Age of 50 Years (Preprint)

10.2196/preprints.10352 ◽

2018 ◽

Author(s):

Cédric Rat ◽

Heloise Schmeltz ◽

Sylvain Rocher ◽

France Nanin ◽

Aurélie Gaultier ◽

...

Keyword(s):

Prostate Cancer ◽

Chronic Disease ◽

Cancer Screening ◽

Low Income ◽

Screening Test ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Psa Testing ◽

Younger Men

BACKGROUND International guidelines recommend avoiding prostate-specific antigen (PSA)-based prostate cancer screening in the elderly when life expectancy is less than 10 years. For younger men, most recommendations encourage a shared decision-making process taking into account patient comorbidities. OBJECTIVE The objective was to assess the performance of PSA-based prostate cancer screening in men older than 74 years and assess whether the presence (vs absence) of comorbidities was related to the performance of PSA testing in younger men aged 50 to 74 years who were eligible for screening. METHODS We analyzed data from the French national health care database (Loire-Atlantique geographic area). We reported the follow-up of two cohorts of men from April 1, 2014, to March 31, 2016: 22,480 men aged over 74 years and 98,107 men aged 50 to 74 years. We analyzed whether these patients underwent PSA testing after 2 years of follow-up and whether PSA testing performance was related to the following patient-related variables: age, low income, proxy measures indicative of major comorbidities (repeated ambulance transportation, having one of 30 chronic diseases, taking 5 or more drugs per day), or proxy measures indicative of specific comorbidities (cancer diseases, cardiovascular diseases, or psychiatric disorders). Statistical analysis was based on a multivariate mixed-effects logistic regression. RESULTS The proportion of patients who underwent a PSA-based screening test was 41.35% (9296/22,480) among men older than 74 years versus 41.05% (40,275/98,107) among men aged 50 to 74 years. The following factors were associated with less frequent PSA testing in men older than 74 years—age (odds ratio [OR] 0.89, 95% CI 0.88-0.89), low income (OR 0.18, 95% CI 0.05-0.69), suffering from a chronic disease (OR 0.82, 95% CI 0.76-0.88), repeated ambulance transportation (OR 0.37, 95% CI 0.31-0.44), diabetes requiring insulin (OR 0.51, 95% CI 0.43-0.60), dementia (OR 0.68, 95% CI 0.55-0.84), and antipsychotic treatment (OR 0.62, 95% CI 0.51-0.75)—whereas cardiovascular drug treatment was associated with more frequent PSA testing (OR 1.6, 95% CI 1.53-1.84). The following factors were associated with less frequent PSA testing in men aged 50 to 74 years—low income (OR 0.61, 95% CI 0.55-0.68); nonspecific conditions related to frailty: suffering from a chronic disease (OR 0.80, 95% CI 0.76-0.83), repeated ambulance transportation (OR 0.29, 95% CI 0.23-0.38), or chronic treatment with 5 or more drugs (OR 0.89, 95% CI 0.83-0.96); and various specific comorbidities: anticancer drug treatment (OR 0.67, 95% CI 0.55-0.83), diabetes requiring insulin (OR 0.55, 95% CI 0.49-0.61), and antiaggregant treatment (OR 0.91, 95% CI 0.86-0.96)—whereas older age (OR 1.07, 95% CI 1.07-1.08) and treatment with other cardiovascular drugs (OR 2.23, 95% CI 2.15-2.32) were associated with more frequent PSA testing. CONCLUSIONS In this study, 41.35% (9296/22,480) of French men older than 74 years had a PSA-based screening test. Although it depends on patient comorbidities, PSA testing remains inappropriate in certain populations.

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