scholarly journals Prostate Cancer Screening Recommendations for General and Specific Populations in the Western Nations

2020 ◽  
Author(s):  
Maurice L. King ◽  
Mary R. Nittala ◽  
Xiaoshan Z. Gordy ◽  
Paul Roberts ◽  
Seth T. Lirette ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Precision Medicine ◽  
Prostate Cancer Screening ◽  
Genomic Medicine ◽  
Cost Benefit ◽  
The Elderly ◽  
History Of ◽  
Unnecessary Procedures ◽  
The Cost ◽  
Near Future

There is a chaotic scenario that exists in the field of prostate cancer (PCa) screening. To balance goals, such as decreasing mortality, avoiding unnecessary procedures, and decreasing the cost of medical care, the pendulum seems to have swung to the side of more restricted screening. The decrease in PCa screening has led to a slowly creeping decline in the favourable outcomes that existed among patients with PCa. If a potential patient or a family member is trying to get clear guidance about PCa screening by searching the internet, they will end up confused by several recommendations from many organisations. It is even more challenging to obtain any clarity about PCa screening for special populations, such as those with a family history of PCa, those of African descent/African Americans, and the elderly. The advent of genomic medicine and precision medicine is an opportunity to identify those at a very high risk of developing aggressive PCa, so that PCa screening can be more actively undertaken among them. In this paper, the authors review the current recommendations by different entities and summarise emerging molecular markers that may help bring clarity to PCa screening. The authors predict that concrete, consensual guidelines will emerge in less than one decade. Meanwhile, this article suggests intermediary steps that will help save lives from PCa mortality, especially for under-represented populations. This paper is a catalyst to stimulate further discussion and serves as a guide to noncancer-specialists for the near future as precision medicine progresses to better understand risk–benefit and cost–benefit ratios in PCa screening.

scholarly journals CHEK2∗1100delC Mutation and Risk of Prostate Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Victoria Hale ◽  
Maren Weischer ◽  
Jong Y. Park
Keyword(s):  
Prostate Cancer ◽  
Current Knowledge ◽  
Prostate Cancer Screening ◽  
Critical Role ◽  
Prostate Cancer Risk ◽  
Conclusive Evidence ◽  
Increased Risk ◽  
History Of ◽  
Cancer Studies

Although the causes of prostate cancer are largely unknown, previous studies support the role of genetic factors in the development of prostate cancer.CHEK2plays a critical role in DNA replication by responding to double-stranded breaks. In this review, we provide an overview of the current knowledge of the role of a genetic variant, 1100delC, ofCHEK2on prostate cancer risk and discuss the implication for potential translation of this knowledge into clinical practice. Currently, twelve articles that discussedCHEK2∗1100delC and its association with prostate cancer were identified. Of the twelve prostate cancer studies, five studies had independent data to draw conclusive evidence from. The pooled results of OR and 95% CI were 1.98 (1.23–3.18) for unselected cases and 3.39 (1.78–6.47) for familial cases, indicating thatCHEK2∗1100delC mutation is associated with increased risk of prostate cancer. Screening for CHEK2∗1100delC should be considered in men with a familial history of prostate cancer.

scholarly journals Prostate cancer screening characteristics in men with BRCA1/2 mutations attending a high-risk prevention clinic

2014 ◽  
Vol 8 (11-12) ◽  
pp. 783 ◽  
Author(s):  
Richard Walker ◽  
Alyssa Louis ◽  
Alejandro Berlin ◽  
Sheri Horsburgh ◽  
Robert G. Bristow ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Family History ◽  
High Risk ◽  
Prostate Cancer Screening ◽  
Brca2 Mutation ◽  
Aggressive Disease ◽  
Mutation Carriers ◽  
The Family ◽  
History Of ◽  
Prevention Clinic

Introduction: The prostate-specific antigen (PSA) era and resultant early detection of prostate cancer has presented clinicians with the challenge of distinguishing indolent from aggressive tumours. Mutations in the BRCA1/2 genes have been associated with prostate cancer risk and prognosis. We describe the prostate cancer screening characteristics of BRCA1/2 mutation carriers, who may be classified as genetically-defined high risk, as compared to another high-risk cohort of men with a family history of prostate cancer to evaluate the utility of a targeted screening approach for these men.Methods: We reviewed patient demographics, clinical screening characteristics, pathological features, and treatment outcomes between a group of BRCA1 or BRCA2 mutation carriers and age-matched men with a family history of prostate cancer followed at our institutional Prostate Cancer Prevention Clinic from 1995 to 2012.Results: Screening characteristics were similar between the mutation carriers (n = 53) and the family history group (n = 53). Some cancers would be missed in both groups by using a PSA cut-off of >4 ug/L. While cancer detection was higher in the family history group (21% vs. 15%), the mutation carrier group was more likely to have intermediate- or high-risk disease (88% vs. 36%). BRCA2 mutation carriers were more likely to have aggressive disease, biological recurrence, and distant metastasis.Conclusions: In our cohort, regular screening appears justified for detecting prostate cancer in BRCA1 and BRCA2 carriers and other high-risk populations. Lowering PSA cut-offs and defining monitoring of PSA velocity as part of the screening protocol may be useful. BRCA2 is associated with more aggressive disease, while the outcome for BRCA1 mutation carriers requires further study. Large multinational studies will be important to define screening techniques for this unique high-risk population.

scholarly journals The landscape of fear conceptual framework: definition and review of current applications and misuses

2017 ◽  
Author(s):  
Sonny S Bleicher
Keyword(s):  
Conceptual Framework ◽  
Predation Risk ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Future Research ◽  
Common Framework ◽  
Dimensional Distribution ◽  
History Of ◽  
Energetic State ◽  
The Cost

Landscapes of Fear (LOF), the spatially explicit distribution of perceived predation risk as seen by a population, is increasingly cited in ecological literature and has become a frequently used “buzz-word”. With the increase in popularity, it became necessary to clarify the definition for the term, suggest boundaries and propose a common framework for its use. The LOF, as a progeny of the “ecology of fear” conceptual framework, defines fear as the strategic manifest of the cost-benefit analysis of food and safety tradeoffs. In addition to direct predation risk, the LOF is affected by individuals’ energetic-state, inter- and intra-specific competition and is constrained by the evolutionary history of each species. Herein, based on current applications of the LOF conceptual framework, I suggest the future research in this framework will be directed towards: (1) finding applied management uses as a trait defining a population’s habitat-use and habitat-suitability; (2) studying multi-dimensional distribution of risk-assessment through time and space; (3) studying variability between individuals within a population; and (4) measuring eco-neurological implications of risk as a feature of environmental heterogeneity.

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.

A Concise Overview of Penology and Penal Practice in Slovenia

2011 ◽  
Vol 91 (4) ◽  
pp. 398-424 ◽  
Author(s):  
Gorazd Meško ◽  
Chuck Fields ◽  
Tomaž Smole
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Criminal Court ◽  
The European Union ◽  
Benefit Analysis ◽  
Inmate Population ◽  
Prison Overcrowding ◽  
History Of ◽  
Probation Service ◽  
Near Future

Although Slovenia has one of the lowest incarceration rates in the world, there are not enough facilities to house the current inmate population, and prison overcrowding is becoming a serious problem in the country. This article addresses this issue, beginning with an in-depth history of penology and penal practices in Slovenia and concluding with suggestions to deal with this potentially disastrous situation. If the imprisonment rate in Slovenia does not decrease in the near future, or if Slovenia cannot create more capacity, prison overcrowding will grow beyond acceptable standards. The present situation in Slovene prisons calls for a multidisciplinary research and cost/benefit analysis. The Slovenian prison administration is challenged by its budget and staff resources. However, it is argued that the problem goes beyond this capacity and requires a serious reconsideration of penal policy, criminal court practice, and parole committee practices as well. It is also necessary to emphasize that Slovenia is the only country in the European Union without a probation service system.

scholarly journals Pros and Cons of Focal Therapy for Localised Prostate Cancer

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Luigi Mearini ◽  
Massimo Porena
Keyword(s):  
Prostate Cancer ◽  
Prostate Cancer Screening ◽  
Focal Therapy ◽  
Screening Programs ◽  
High Incidence ◽  
Related Quality ◽  
Health Related ◽  
History Of ◽  
Pros And Cons

In prostate cancer, an interesting and intriguing option to overcome the risks of whole-gland treatment is focal therapy, with the aim of eradicating known cancer foci and reducing collateral damages to the structures essential for maintaining normal urinary and sexual function. Ablation of all known lesions would favorably alter the natural history of the cancer without impacting health-related quality of life and allows for safe retreatment with repeated focal therapy or whole-gland approaches if necessary. Our objective is to reassess the possibilities and criticisms of such procedure: the rationale for focal therapy and the enthusiasm come from the success of conservative approaches in treating other malignancies and in the high incidence of overtreatment introduced by prostate cancer screening programs. One of the challenges in applying such an approach to the treatment of prostate cancer is the multifocal nature of the disease and current difficulties in accurate tumor mapmaking.

scholarly journals Interpreting cost-effectiveness ratios in a cost-effectiveness analysis of risk-tailored prostate screening: A critique of Callender et al.

2020 ◽  
Vol 3 ◽  
pp. 23
Author(s):  
James F. O'Mahony
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Disease Risk ◽  
Prostate Cancer Screening ◽  
Absolute Risk ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
The Cost

Callender et al. recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible.

scholarly journals The landscape of fear conceptual framework: definition and review of current applications and misuses

2017 ◽  
Author(s):  
Sonny S Bleicher
Keyword(s):  
Conceptual Framework ◽  
Predation Risk ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Future Research ◽  
Common Framework ◽  
Dimensional Distribution ◽  
History Of ◽  
Energetic State ◽  
The Cost

Landscapes of Fear (LOF), the spatially explicit distribution of perceived predation risk as seen by a population, is increasingly cited in ecological literature and has become a frequently used “buzz-word”. With the increase in popularity, it became necessary to clarify the definition for the term, suggest boundaries and propose a common framework for its use. The LOF, as a progeny of the “ecology of fear” conceptual framework, defines fear as the strategic manifest of the cost-benefit analysis of food and safety tradeoffs. In addition to direct predation risk, the LOF is affected by individuals’ energetic-state, inter- and intra-specific competition and is constrained by the evolutionary history of each species. Herein, based on current applications of the LOF conceptual framework, I suggest the future research in this framework will be directed towards: (1) finding applied management uses as a trait defining a population’s habitat-use and habitat-suitability; (2) studying multi-dimensional distribution of risk-assessment through time and space; (3) studying variability between individuals within a population; and (4) measuring eco-neurological implications of risk as a feature of environmental heterogeneity.

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