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

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.

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Prostate Cancer Screening in the Workplace

AAOHN Journal ◽

10.1177/216507999804600803 ◽

1998 ◽

Vol 46 (8) ◽

pp. 379-384 ◽

Cited By ~ 6

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.

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The cost-effectiveness of prostate cancer screening using the Stockholm3 test

PLoS ONE ◽

10.1371/journal.pone.0246674 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246674 ◽

Cited By ~ 1

Author(s):

Andreas A. Karlsson ◽

Shuang Hao ◽

Alexandra Jauhiainen ◽

K. Miriam Elfström ◽

Lars Egevad ◽

...

Keyword(s):

Prostate Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Gleason Score ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Cost Effective ◽

Psa Test ◽

Life Years ◽

The Cost

Objectives The European Randomized Study of Screening for Prostate Cancer found that prostate-specific antigen (PSA) screening reduced prostate cancer mortality, however the costs and harms from screening may outweigh any mortality reduction. Compared with screening using the PSA test alone, using the Stockholm3 Model (S3M) as a reflex test for PSA ≥ 1 ng/mL has the same sensitivity for Gleason score ≥ 7 cancers while the relative positive fractions for Gleason score 6 cancers and no cancer were 0.83 and 0.56, respectively. The cost-effectiveness of the S3M test has not previously been assessed. Methods We undertook a cost-effectiveness analysis from a lifetime societal perspective. Using a microsimulation model, we simulated for: (i) no prostate cancer screening; (ii) screening using the PSA test; and (iii) screening using the S3M test as a reflex test for PSA values ≥ 1, 1.5 and 2 ng/mL. Screening strategies included quadrennial re-testing for ages 55–69 years performed by a general practitioner. Discounted costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Results Comparing S3M with a reflex threshold of 2 ng/mL with screening using the PSA test, S3M had increased effectiveness, reduced lifetime biopsies by 30%, and increased societal costs by 0.4%. Relative to the PSA test, the S3M reflex thresholds of 1, 1.5 and 2 ng/mL had ICERs of 170,000, 60,000 and 6,000 EUR/QALY, respectively. The S3M test was more cost-effective at higher biopsy costs. Conclusions Prostate cancer screening using the S3M test for men with an initial PSA ≥ 2.0 ng/mL was cost-effective compared with screening using the PSA test alone.

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

BMC Urology ◽

10.1186/s12894-021-00903-7 ◽

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.

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Patient–Provider Communication About Prostate Cancer Screening and Treatment

American Journal of Men s Health ◽

10.1177/1557988315614082 ◽

2016 ◽

Vol 11 (1) ◽

pp. 134-146 ◽

Cited By ~ 7

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.

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Systematic Review of cost-effectiveness models in prostate cancer: exploring new developments in testing and diagnosis

10.21203/rs.3.rs-32349/v1 ◽

2020 ◽

Author(s):

Edna Keeney ◽

Howard Thom ◽

Emma Turner ◽

Richard M Martin ◽

Josie Morley ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Cost Effectiveness ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

Cost Effective ◽

Economic Evaluations ◽

Psa Testing ◽

Mri Guided ◽

The Cost

Abstract Background There is currently no formal prostate cancer screening programme in the UK. Early detection using age-based prostate-specific antigen (PSA) testing is unlikely to be cost-effective due to limited mortality benefit and harms associated with overdetection. However, the discovery of new prostate cancer specific biomarkers and more accurate diagnostic strategies (e.g. magnetic resonance imaging (MRI)) could improve the outcomes of screening. A systematic review was conducted to assess the evidence base on cost-effectiveness of such innovations and areas for further development. Methods To identify model-based economic evaluations of screening and diagnostic tests for prostate cancer, a systematic review of the literature using the NHS Economic Evaluation Database, Medline, EMBASE, HTA databases, NICE guidelines, and UK National Screening Committee guidance was carried out, between 2009 and 2019. Relevant data were extracted on study type, model inputs, modelling methods and cost-effectiveness conclusions and the results narratively synthesized. Results Sixteen studies were included in the review. Seven studies compared the cost-effectiveness of new urinary or blood biomarkers compared to each other or the PSA test and found the biomarkers e.g. the Prostate Health Index (PHI) and SelectMDx, to be the most cost-effective. Seven studies compared newer prostate biopsy methods, including MRI-guided, to TRUS guided biopsy and found MRI-guided methods to be most cost-effective. The newer detection methods showed a reduction in unnecessary biopsies and overtreatment. However, there was uncertainty around the most cost-effective pathway of follow-up strategies (MRI/biomarkers) in men who have a negative initial biopsy. Many studies did not model stage or grade of cancer, cancer progression or the entire testing, screening and treatment pathway. Very few studies fully accounted for uncertainty in their analysis. Conclusions This review brings together the cost-effectiveness literature for novel screening and testing methods used in the diagnosis of prostate cancer. Several limitations of the published models were identified. The models generally either compared new biomarkers or new imaging techniques which highlights the importance of future work in this area, as biomarkers and imaging are likely to be used in combination.

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PSA Testing: Are Patients Aware of What Lies Ahead?

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x98685 ◽

2006 ◽

Vol 88 (3) ◽

pp. 284-288 ◽

Cited By ~ 13

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.

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

Endocrine Related Cancer ◽

10.1677/erc.0.0070037 ◽

2000 ◽

pp. 37-51 ◽

Cited By ~ 37

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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Long-Term Prediction of Prostate Cancer Up to 25 Years Before Diagnosis of Prostate Cancer Using Prostate Kallikreins Measured at Age 44 to 50 Years

Journal of Clinical Oncology ◽

10.1200/jco.2006.06.9351 ◽

2007 ◽

Vol 25 (4) ◽

pp. 431-436 ◽

Cited By ~ 138

Author(s):

Hans Lilja ◽

David Ulmert ◽

Thomas Björk ◽

Charlotte Becker ◽

Angel M. Serio ◽

...

Keyword(s):

Prostate Cancer ◽

Predictive Value ◽

Prostate Cancer Screening ◽

Conditional Logistic Regression ◽

Specific Antigen ◽

Screening Programs ◽

Free Psa ◽

Swedish Cancer Registry ◽

Total Psa

PurposeWe examined whether prostate-specific antigen (PSA) forms and human kallikrein 2 (hK2) measured at age 44 to 50 years predict long-term risk of incident prostate cancer.MethodsFrom 1974 to 1986, 21,277 men age ≤ 50 years in Malmö, Sweden, enrolled onto a cardiovascular study (74% participation). The rate of PSA screening in this population is low. According to the Swedish Cancer Registry, 498 were later diagnosed with prostate cancer. We measured hK2, free PSA, and total PSA (tPSA) in archived blood plasma from 462 participants later diagnosed with prostate cancer and from 1,222 matched controls. Conditional logistic regression was used to test for association of prostate cancer with hK2 and PSA forms measured at baseline.ResultsMedian delay between venipuncture and prostate cancer diagnosis was 18 years. hK2 and all PSA forms were strongly associated with prostate cancer (all P < .0005). None of the 90 anthropometric, lifestyle, biochemical, and medical history variables measured at baseline was importantly predictive. A tPSA increase of 1 ng/mL was associated with an increase in odds of cancer of 3.69 (95% CI, 2.99 to 4.56); addition of other PSA forms or hK2 did not add to the predictive value of tPSA. tPSA remained predictive for men diagnosed ≥ 20 years after venipuncture, and the predictive value remained unchanged in an analysis restricted to palpable disease.ConclusionA single PSA test at age 44 to 50 years predicts subsequent clinically diagnosed prostate cancer. This raises the possibility of risk stratification for prostate cancer screening programs.

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Prostate cancer screening: guidelines review and laboratory issues

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2018-1252 ◽

2019 ◽

Vol 57 (10) ◽

pp. 1474-1487 ◽

Cited By ~ 6

Author(s):

Xavier Filella ◽

María Dolores Albaladejo ◽

Juan Antonio Allué ◽

Miguel Angel Castaño ◽

Daniel Morell-Garcia ◽

...

Keyword(s):

Prostate Cancer ◽

Clinical Practice ◽

Prostate Cancer Screening ◽

Specific Antigen ◽

World Health ◽

Level Of Evidence ◽

Screening Guidelines ◽

Psa Testing ◽

Medical Institutions ◽

Health Organization

Abstract Background Prostate-specific antigen (PSA) remains as the most used biomarker in the detection of early prostate cancer (PCa). Clinical practice guidelines (CPGs) are produced to facilitate incorporation of evidence into clinical practice. This is particularly useful when PCa screening remains controversial and guidelines diverge among different medical institutions, although opportunistic screening is not recommended. Methods We performed a systematic review of guidelines about PCa screening using PSA. Guidelines published since 2008 were included in this study. The most updated version of these CPGs was used for the evaluation. Results Twenty-two guidelines were selected for review. In 59% of these guidelines, recommendations were graded according to level of evidence (n = 13), but only 18% of the guidelines provided clear algorithms (n = 4). Each CPG was assessed using a checklist of laboratory issues, including pre-analytical, analytical, and post-analytical factors. We found that laboratory medicine specialists participate in 9% of the guidelines reviewed (n = 2) and laboratory issues were frequently omitted. We remarked that information concerning the consequences of World Health Organization (WHO) standard in PSA testing was considered by only two of 22 CPGs evaluated in this study. Conclusions We concluded that the quality of PCa early detection guidelines could be improved properly considering the laboratory issues in their development.

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The Prostate Gland and PSA (Prostate Specific Antigen)

European Journal of Interdisciplinary Studies ◽

10.26417/ejis.v2i2.p74-80 ◽

2016 ◽

Vol 2 (2) ◽

pp. 74

Author(s):

Serfa Faja ◽

Amir Shoshi

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Quantitative Measurement ◽

Prostate Gland ◽

Specific Antigen ◽

Transrectal Ultrasound ◽

High Sensitivity ◽

Psa Test ◽

Psa Testing ◽

Very High

The PSA test is used primarily to screen for prostate cancer. A PSA test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced in the prostate, a small gland that sits below a man's bladder. PSA is mostly found in semen, which also is produced in the prostate. Small amounts of PSA ordinarily circulate in the blood. The PSA test can detect high levels of PSA that may indicate the presence of prostate cancer. However, many other conditions, such as an enlarged or inflamed prostate, can also increase PSA levels. We use ImmunoAssay for Quantitative Measurement of PSA in Human Blood / Serum / Plasma with i-CHROMA TM Reader System with high sensitivity and specifity. We have analysed 120 patients and only 2 of them had very high value of PSA so we can determine for a prostate cancer. Additional factors increase the accuracy of PSA testing and it is not sufficient only the PSA to determine a prostate cancer so we need a rectal examination and transrectal ultrasound.

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