Prostate Cancer Screening Trends After United States Preventative Services Task Force Guidelines in an Underserved Population

Patel, Neel; Bloom, Jonathan; Hillelsohn, Joel; Fullerton, Sean; Allman, Denton; Matthews, Gerald J.; Eshghi, Majid; Phillips, John L.

doi:10.1089/heq.2018.0004

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…Changes in screening recommendations by the U.S. Preventive Services Task Force in 2012 against general PSA screening and later in 2018 to favor open-ended discussion on screening for most men at general risk of prostate cancer may have played a role in a disproportionate effect within Black populations, which had a 29% decrease in screening rates after the recommendation changes, despite being at higher risk. 16 Decreases in screening have previously been shown to have an effect on later presentation patterns. Indeed, in the 5 years after the initial decreased PSA screening recommendation, there was a decrease in incidence of local stage disease but increases in regional and distant metastases.…”

Section: Changing Trendsmentioning

confidence: 99%

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Cackowski

Mahal

Heath

et al. 2021

American Society of Clinical Oncology Educational Book

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Despite notable screening, diagnostic, and therapeutic advances, disparities in prostate cancer incidence and outcomes remain prevalent. Although commonly discussed in the context of men of African descent, disparities also exist based on socioeconomic level, education level, and geographic location. The factors in these disparities span systemic access issues affecting availability of care, provider awareness, and personal patient views and mistrust. In this review, we will discuss common themes that patients have noted as impediments to care. We will review how equitable access to care has helped improve outcomes among many different groups of patients, including those with local disease and those with metastatic castration-resistant prostate cancer. Even with more advanced presentation, challenges with recommended screening, and lower rates of genomic testing and trial inclusion, Black populations have benefited greatly from various modalities of therapy, achieving comparable and at times superior outcomes with certain types of immunotherapy, chemotherapy, androgen receptor–based inhibitors, and radiopharmaceuticals in advanced disease. We will also briefly discuss access to genomic testing and differences in patterns of gene expression among Black patients and other groups that are traditionally underrepresented in trials and genomic cohort studies. We propose several strategies on behalf of providers and institutions to help promote more equitable care access environments and continued decreases in prostate cancer disparities across many subgroups.

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Section: Changing Trendsmentioning

confidence: 99%

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Cackowski

Mahal

Heath

et al. 2021

American Society of Clinical Oncology Educational Book

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“…Data obtained from several sources showed that PSA testing peaked in 2008 then consecutively declined 7 . Trends in PSA testing reflected the timing of changes in USPSTF guidelines 17–19 . Early‐stage prostate cancer is an asymptomatic disease and is sensitive to screening patterns.…”

Section: Discussionmentioning

confidence: 99%

Rates and trends in stage‐specific prostate cancer incidence by age and race/ethnicity, 2000–2017

Cao

Zhang

et al. 2021

The Prostate

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Background The 2008 and 2012 United States Preventive Services Task Force (USPSTF) recommendations against prostate‐specific antigen (PSA) screening have led to changes in the incidence pattern of prostate cancer. We sought to examine rates and trends in stage‐specific prostate cancer incidence by age and race/ethnicity using the most recent data obtained from Surveillance, Epidemiology, and End Results (SEER) program. Methods SEER*Stat version 8.3.6 was used to analyze annual prostate cancer incidence rates between 2000 and 2017 according to the SEER summary stage, age group, and race/ethnicity group. Incidence rates per 100,000 men were calculated and age‐adjusted to 2000 US standard population. Annual percentage change (APC) was performed to identify the trend in prostate cancer incidence. Results Between 2008 and 2012, trends in incidence of overall and localized prostate cancer significantly declined in comparison with between 2000 and 2007 (APC, −5.4 and −6.0, respectively). However, there was an increase in the incidence rate of both overall and localized prostate cancer from 2014 to 2017 (43.3–46 and 34–34.9 per 100,000 men, respectively). The incidence of regional prostate cancer significantly increased between 2013 and 2017 (5.9–6.8 per 100,000 men; APC, 4.3). Distant disease incidence increased continually between 2008 and 2012 (2.9–3.3 per 100,000 men; APC, 2.3) and between 2013 and 2017 (3.4–4.3 per 100,000 men; APC, 6.0). In addition, these increases in incidence occurred in men of all stratified age and race/ethnicity groups, except for men aged <50 years and American Indian/Alaska Native men. Conclusion This study demonstrates that the longer‐term effects of USPSTF recommendations against PSA screening may have resulted in a reversal of downtrend in prostate cancer incidence, as incidence rates of overall and localized prostate cancer gradually increased from 2014 to 2017. Meanwhile, the trend in stage migration toward advanced disease increased incrementally.

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“…Then, in 2012, the USPSTF recommended against PSA screening for the general population [18] because of the notable rates of overtreatment of benign prostate cancers and the lack of disease‐specific survival benefits in two large screening studies [19–22]. These changes resulted in a 29% decrease in screening rates for underserved populations [23], as well as a decrease in incidence of local stage disease, but increased rates of regional and distant metastases [1, 24–26]. Low health literacy, which disproportionately affects racial and ethnic minorities and underserved populations [27], was also correlated with lower screening rates [28].…”

Section: Disparities In Prostate Cancer Diagnosesmentioning

confidence: 99%

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

et al. 2021

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Prostate cancer remains the leading diagnosed cancer and the second leading cause of death among American men. Despite improvements in screening modalities, diagnostics, and treatment, disparities exists among Black men in this country. This primary objective of this systematic review is to describe the reported disparities in screening, diagnostics and treatments as well as efforts to alleviate these disparities though community and educational outreach efforts. Critical review took place of retrospective, prospective, and socially descriptive data of English language publications in the PubMed database. Despite more advanced presentation, lower rates of screening and diagnostic procedures, and low rates of trial inclusion, sub-analyses have shown that various modalities of therapy are quite effective in Black populations. Moreover, patients treated on prospective clinical trials and within equal access care environments have shown similar outcomes. Additional prospective studies and enhanced participation in screening, diagnostic and genetic testing, clinical trials and community-based educational endeavors are important to ensure equitable progress in prostate cancer for all patients. The Oncologist 2021;9999:• • Implications for Practice: Notable progress has been made with therapeutic advances for prostate cancer, but racial disparities continue to exist. Differing rates in screening and utility in diagnostic procedures play a role in these disparities. Black patients often present with more advanced disease, higher PSA, and other adverse factors, but outcomes can be attenuated in trials or in equal access care environments. Recent data has shown that multiple modalities of therapy are quite effective in Black populations. Novel and bold hypotheses to increase inclusion in clinical trial, enhance decentralized trial efforts and enact successful models of patient navigation and community partnership are vital to ensure continued progress in prostate cancer disparities. BACKGROUND Despite notable progress over the years, prostate cancer remains the leading cancer among men in the United States, with 191,000 cases and 33,000 deaths anticipated in 2020 1. Advances in screening rates, genomic testing, imaging, and treatment have led to an almost 98% five-year survival among affected men 2. Black men, however, have traditionally had higher incidence and decreased rates of survival in prostate cancer for all stages. Statistically, 1 in 9 men overall and 1 in 7 Black men will be affected 3. Moreover, Black men are more likely to be diagnosed at an earlier age, have advanced disease at that time of diagnosis and have significantly elevated PSA levels compared to White men 3-6. They also have a higher risk of regional and metastatic disease at presentation 7,8. Several factors could possibly account for this higher relative incidence and poorer outcomes for Black men with prostate cancer. Patients with lower socioeconomic status and less education have been shown to have worse overall survival from prostate and other ...

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Prostate Cancer Screening Trends After United States Preventative Services Task Force Guidelines in an Underserved Population

Cited by 10 publications

References 34 publications

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Evolution of Disparities in Prostate Cancer Treatment: Is This a New Normal?

Rates and trends in stage‐specific prostate cancer incidence by age and race/ethnicity, 2000–2017

Prostate Cancer: Community Education and Disparities in Diagnosis and Treatment

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