Prostate cancer screening—when to start and how to screen?

Kohestani, Kimia; Chilov, Marina; Carlsson, Sigrid

doi:10.21037/tau.2017.12.25

Cited by 18 publications

(14 citation statements)

References 115 publications

(142 reference statements)

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“…The AUA additionally recommends an individualized approach to PSA screening after age 40 years for higher risk men, such as Black patients, who have been reported to be diagnosed with prostate cancer at younger ages than patients of other races or ethnicities, and recommends against routine PSA screening in men younger than 40 years. 24 Following the AUA guideline, the study cohort was restricted to patients aged 40 years or older for this analysis. Our sample was additionally restricted to plan members undergoing a single annual PSA test (Prostate Specific Ag, serum; Current Procedural Terminology [ CPT ] code, 84153), with no PSA test or prostate MRI claims in previous years and no subsequent PSA test within the study period.…”

Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test

et al. 2021

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IMPORTANCE Prostate cancer screening and diagnosis exhibit known racial and ethnic disparities.Whether these disparities persist in prostate magnetic resonance imaging (MRI) utilization after elevated prostate-specific antigen (PSA) results is poorly understood. OBJECTIVETo assess potential racial and ethnic disparities in prostate MRI utilization following elevated PSA results. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 794 809 insured US men was drawn from deidentified medical claims between January 2011 and December 2017 obtained from a commercial claims database. Eligible participants were aged 40 years and older and received a single PSA result and no prior PSA screening or prostate MRI claims. Analysis was performed in January 2021. MAIN OUTCOMES AND MEASURES Multivariable logistic regression was used to examineassociations between elevated PSA results and follow-up prostate MRI. For patients receiving prostate MRI, multivariable regressions were estimated for the time between PSA and subsequent prostate MRI. PSA thresholds explored included PSA levels above 2.5 ng/mL, 4 ng/mL, and 10 ng/mL.Analyses were stratified by race, ethnicity, and age. RESULTSOf 794 809 participants, 51 500 (6.5%) had PSA levels above 4 ng/mL; of these, 1524 (3.0%) underwent prostate MRI within 180 days. In this sample, mean (SD) age was 59.8 (11.3) years (range 40-89 years); 31 350 (3.9%) were Asian, 75 935 (9.6%) were Black, 107 956 (13.6%) were Hispanic, and 455 214 (57.3%) were White. Compared with White patients, Black patients with PSA levels above 4 ng/mL and 10 ng/mL were 24.1% (odds ratio [OR], 0.78; 95% CI, 0.65-0.89) and 35.0% (OR, 0.65; 95% CI, 0.50-0.85) less likely to undergo subsequent prostate MRI, respectively. Asian patients with PSA levels higher than 4 ng/mL (OR, 0.76; 95% CI, 0.58-0.99) and Hispanic patients with PSA levels above 10 ng/mL (OR, 0.77; 95% CI, 0.59-0.99) were also less likely to undergo subsequent prostate MRI compared with White patients. Black patients between ages 65 and 74 years with PSA above 4 ng/mL and 10 ng/mL were 23.6% (OR, 0.76; 95% CI, 0.64-0.91) and 43.9% (OR, 0.56; 95% CI, 0.35-0.91) less likely to undergo MRI, respectively. Race and ethnicity were not significantly associated with mean time between PSA and MRI.CONCLUSIONS AND RELEVANCE Among men with elevated PSA results, racial and ethnic disparities were evident in subsequent prostate MRI utilization and were more pronounced at higher PSA thresholds. Further research is needed to better understand and mitigate physician decisionmaking biases and other potential sources of disparities in prostate cancer diagnosis and management.

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Section: Methodsmentioning

confidence: 99%

Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test

et al. 2021

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“…Diagnosis of localized or locally advanced disease is typically made based on PSA test, agebased screening or by patient request in men with a strong family history 11,12 . Before a decision is made regarding radical treatment particularly in high-intermediate risk patients, whole-body imaging is required to determine whether any nodal or distant metastases are present.…”

Section: [H2]newly Diagnosed High-risk Diseasementioning

confidence: 99%

The future of PSMA PET and WB MRI as next-generation imaging tools in prostate cancer

et al. 2022

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Radiolabelled prostate-specific membrane antigen (PSMA)-based Positron emission tomography-computed tomography (PET-CT) has been shown in numerous studies to be superior to conventional imaging in the detection of nodal or distant metastatic lesions. 68Ga-PSMA PET-CT is now recommended by many guidelines for the detection of biochemically relapsed disease after radical local therapy. PSMA radioligands can also function as radiotheranostics, namely Lu-PSMA has been shown to be a potential new line of treatment for metastatic castrate resistant prostate cancer. W hole-body MRI (WB-MRI) has been shown to have a high diagnostic performance in the detection and monitoring of metastatic bone disease. Prospective, randomized, multi-centre studies comparing 68 Ga-PSMA PET-CT and WB-MRI for pelvic nodal and metastatic disease detection are yet to be performed. Challenges for interpretation of PSMA include tracer trapping in non-target tissues and urinary excretion of tracers confounding image interpretation at the vesicoureteral junction. Additionally , studies have described how long-term androgen deprivation therapy (ADT) affects PSMA expression and could, therefore, reduce tracer uptake and visibility of PSMA-positive lesions . Furthermore, ADT of short duration might increase PSMA expression, leading to the PSMA flare phenomenon, which makes it challenging to accurately monitor treatment response to ADT with PSMA-PET. Scan duration, detection of incidentalomas and presence of metallic implants are some of the major challenges with WB-MRI. Emerging data supports the wider adoption of PSMA-PET and WB-MRI for diagnosis, staging, disease burden evaluation and response monitoring, though their relative roles in the standard of care management of patents is yet to be fully defined.. Key points• Next-generation imaging techniques have been found to affect prostate cancer disease state classifications as their increased sensitivity can result in stage migration.

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“…Screening via PSA results in 1 fewer PCa death for every 1000 screened men every 10 years. [ 10 ] This increases over time, with 9 fewer deaths per 1000 screened men when followed for the duration of their lives. [ 10 ] The observed differences in incidence and mortality rates between nations are attributed to the intensity of PSA screening.…”

Section: Introductionmentioning

confidence: 99%

Prostate cancer screening: Continued controversies and novel biomarker advancements

Tidd-Johnson¹,

Sebastian²,

Co³

et al. 2022

Curr Urol

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Prostate cancer (PCa) screening remains one of the most controversial topics in clinical and public health. Despite being the second most common cancer in men worldwide, recommendations for screening using prostate-specific antigen (PSA) are unclear. Early detection and the resulting postscreening treatment lead to overdiagnosis and overtreatment of otherwise indolent cases. In addition, several unwanted harms are associated with PCa screening process. This literature review focuses on the limitations of PSA-specific PCa screening, reasons behind the screening controversy, and the novel biomarkers and advanced innovative methodologies that improve the limitations of traditional screening using PSA. With the verdict of whether or not to screen not yet unanimous, we hope to aid in resolution of the long-standing debate.

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Prostate cancer screening—when to start and how to screen?

Cited by 18 publications

References 115 publications

Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test

Racial and Ethnic Disparities in the Use of Prostate Magnetic Resonance Imaging Following an Elevated Prostate-Specific Antigen Test

The future of PSMA PET and WB MRI as next-generation imaging tools in prostate cancer

Prostate cancer screening: Continued controversies and novel biomarker advancements

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