Reevaluating PSA Testing Rates in the PLCO Trial

Shoag, Jonathan; Mittal, Sameer; Hu, Jim C.

doi:10.1056/nejmc1515131

Cited by 165 publications

(108 citation statements)

References 4 publications

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“…22 While it is correct to look to high-level evidence for guidance on cancer screening, like the randomized control trials in this field, the unfortunate contamination of these studies mean that we must be cautious when interpreting their findings. 23 To make sweeping recommendations based on the results of these few studies at face value will see us return to a time when a diagnosis of prostate cancer often had a much bleaker presentation and outcome. 24 The landscape of prostate cancer screening continues to be in flux.…”

Section: Discussionmentioning

confidence: 99%

Prostate-specific antigen testing for prostate cancer screening: A national survey of Canadian primary care physicians’ opinions and practices

Goldenberg¹,

Skeldon

Nayan

et al. 2017

CUAJ

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Introduction: In 2014, the Canadian Task Force on Preventive Health Care (CTFPHC) recommended against routine prostate cancer screening with the prostate-specific antigen (PSA) blood test.1 We surveyed Canadian primary care physicians (PCPs) to understand their opinions and attitudes towards prostate cancer screening in 2016.Methods: Twenty PCPs piloted the survey to assess its accessibility. We distributed a flyer to 19 633 PCPs as an insert in a large mailed package inviting them to attend a national meeting, and later promoted the survey at the meeting. Multinomial logistic regression models examined factors associated with agreement of key guideline statements and the overall benefit of PSA screening.Results: A total of 1254 PCPs responded (rate of 6.4%); 54.7% of physicians aware of the CTFPHC recommendations report screening less often as a result. Overall, 55.6% of PCPs feel that the risks of PSA screening outweigh the benefits. On multivariable analysis, physicians who did not read the guidelines, did not have an academic appointment, or were in practice for over 20 years were significantly more likely to disagree with the statement that men 55‒69 years old should not be screened for prostate cancer with PSA.Conclusions: Our national survey found that the prostate cancer screening practices of Canadian PCPs varies widely across physician demographic groups, with almost equal numbers for or against. This has significant ethical, medical, and legal implications. The poor response rate to highly incentivized survey request may suggest a reluctance or general apathy towards this subject because of the Task Force recommendations. Future efforts should provide physicians with objective guidance around PSA screening, incorporating input from all stakeholders, including PCPs, urologists, and patients.

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Section: Discussionmentioning

confidence: 99%

Prostate-specific antigen testing for prostate cancer screening: A national survey of Canadian primary care physicians’ opinions and practices

Goldenberg¹,

Skeldon

Nayan

et al. 2017

CUAJ

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“…10,18,19 In contrast, ERSPC showed that screening was associated Panel A shows the rate of prostate-cancer-specific survival. Prostate-cancer-specific deaths were those that were definitely or probably due to prostate cancer or its treatment, as determined by an independent causeof-death evaluation committee whose members were unaware of the treatment assignments.…”

Section: -Year Outcomes In Localized Prostate Cancermentioning

confidence: 97%

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

Hamdy

Donovan

Lane³

et al. 2016

N Engl J Med

2,294

1,725

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med nejm.org This article was published on September 14, 2016, at NEJM.org. DOI: 10.1056/NEJMoa1606220Copyright © 2016 Massachusetts Medical Society. BACKGROUNDThe comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. METHODSWe compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths. RESULTSThere were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P = 0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P = 0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P = 0.004 for the overall comparison). Higher rates of disease progression were seen in the activemonitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P<0.001 for the overall comparison). CONCLUSIONSAt a median of 10 years, prostate-cancer-specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.

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“…33 Conversely, the other major randomised screening study 34 , which showed no benefit for screening, was recently found to have major contamination of the control arm, in which 90% of men had a PSA test during the study period. 35 This makes its results less reliable, although it is important to note that there were still 22% more cancers diagnosed in the screening arm after 2 years, with no associated survival benefit.…”

Section: View From An Oncologist -By Ian Hainesmentioning

confidence: 97%