Benefits And Harms Of Prostate Specific Antigen Screening For Prostate Cancer
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Benefits And Harms Of Prostate Specific Antigen Screening For Prostate Cancer
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Author : Kenneth Lin
language : en
Publisher:
Release Date : 2008
Benefits And Harms Of Prostate Specific Antigen Screening For Prostate Cancer written by Kenneth Lin and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008 with categories.
BACKGROUND: Prostate cancer is the most common nonskin cancer in men in the United States, and prostate cancer screening has increased in recent years. In 2002, the U.S. Preventive Services Task Force concluded that evidence was insufficient to recommend for or against screening for prostate cancer with prostate-specific antigen (PSA) testing. PURPOSE: To examine new evidence of benefits and harms of screening asymptomatic men for prostate cancer with PSA testing. DATA SOURCES: English-language articles identified in PubMed and the Cochrane Library (search dates, January 2002 to July 2007), reference lists of retrieved articles, and expert suggestions. STUDY SELECTION: Randomized, controlled trials and meta-analyses of PSA screening and cross-sectional and cohort studies of screening harms and of the natural history of screening-detected cancer were selected to answer the following questions: Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? What are the magnitude and nature of harms associated with prostate cancer screening, other than overtreatment? What is the natural history of PSA-detected, nonpalpable, localized prostate cancer? DATA EXTRACTION: Studies were reviewed, abstracted, and rated for quality by using predefined U.S. Preventive Services Task Force criteria. DATA SYNTHESIS: No good-quality randomized, controlled trials of screening for prostate cancer have been completed. In 1 cross-sectional and 2 prospective cohort studies of fair to good quality, false-positive PSA screening results caused psychological adverse effects for up to 1 year after the test. The natural history of PSA-detected prostate cancer is poorly understood. LIMITATIONS: Few eligible studies were identified. Long-term adverse effects of false-positive PSA screening test results are unknown. CONCLUSION: Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain. Prostate cancer is the most common nonskin cancer in U.S. men. An estimated 218,890 men received a new diagnosis of prostate cancer in 2007, and 1 in 6 men will receive a diagnosis in their lifetime. The American Cancer Society estimates that 27,350 men died of prostate cancer in 2006. After peaking in 1991 (29.4 deaths per 100,000 men), the prostate cancer mortality rate has gradually decreased. Although this positive trend may be related to increased screening for prostate cancer, other factors, including new treatment approaches, could also account for some or all of the observed decline in mortality. The serum prostate-specific antigen (PSA) test was approved by the U.S. Food and Drug Administration in 1986, and its use for prostate cancer screening has increased substantially since the mid-1990s. However, PSA testing is not specific to prostate cancer; common conditions, such as benign prostatic hyperplasia and prostatitis, also increase PSA levels. Approximately 1.5 million U.S. men age 40 to 69 years have a PSA level greater than 4.0 ơg/L, a widely used cutoff value for a positive screening result. Refinements designed to improve the PSA test's sensitivity and specificity for prostate cancer include determination of PSA density, PSA velocity, PSA doubling time, and percentage of free PSA. Potential harms from PSA screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis (the identification of prostate cancer that would never have caused symptoms in the patient's lifetime, leading to unnecessary treatment and associated adverse effects). Much uncertainty surrounds which cases of prostate cancer require treatment and whether earlier detection leads to improvements in duration or quality of life. Two recent systematic reviews of the comparative effectiveness and harms of therapies for localized prostate cancer concluded that no single therapy is superior to all others in all situations. In 2002, the U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against routine screening for prostate cancer. The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but found mixed and inconclusive evidence that screening and early detection improve health outcomes. Consequently, the USPSTF was unable to determine the balance between benefits and harms of periodic screening for prostate cancer. The analytic framework that guided the previous USPSTF evidence review (Figure) included 8 key questions about benefits and harms of prostate cancer screening and treatment. This evidence update focuses on critical gaps in the evidence that the Task Force identified in the previous review: the lack of good-quality studies linking screening to improved health outcomes; limited information about harms of screening; and a paucity of knowledge about the natural history of PSA-detected, nonpalpable, localized prostate cancer (the most common type of prostate cancer detected today). These evidence gaps produced 3 new key questions for this update: 1. Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? 2. What are the magnitude and nature of harms associated with prostate cancer screening other than overtreatment? 3. What is the natural history of PSA-detected, nonpalpable, localized prostate cancer?
Harms Of Prostate Specific Antigen Psa Screening In Prostate Cancer
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Author : Jennifer Fergenbaum
language : en
Publisher:
Release Date : 2015
Harms Of Prostate Specific Antigen Psa Screening In Prostate Cancer written by Jennifer Fergenbaum and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2015 with Electronic books categories.
Prostate Specific Antigen Based Screening For Prostate Cancer
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Author :
language : en
Publisher:
Release Date : 2011
Prostate Specific Antigen Based Screening For Prostate Cancer written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2011 with categories.
BACKGROUND: In 2008, the U.S. Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years. The USPSTF recommended against screening for prostate cancer in men aged 75 years or older. PURPOSE: To update a previous systematic review performed for the USPSTF and evaluate new evidence on the potential benefits of prostate-specific antigen (PSA)-based screening for prostate cancer. DATA SOURCES: English-language articles identified in PubMed and the Cochrane Library (search dates January 2007 to July 2011), reference lists of retrieved articles, and expert suggestions. STUDY SELECTION: Randomized controlled trials, systematic reviews, and meta-analyses were selected to determine whether PSA-based screening decreases prostate cancer-specific or all-cause mortality. Where available, information on the potential harms of screening for prostate cancer was also extracted from included studies. DATA EXTRACTION: Studies were reviewed, abstracted, and rated for quality, using predefined USPSTF criteria. DATA SYNTHESIS: Five randomized controlled trials (two fair- and three poor-quality) and two meta-analyses evaluating the impact of PSA-based screening on prostate cancer mortality were identified. A report describing results from a single center participating in one of the fair-quality trials was also identified. Of the two highest-quality trials, the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial found no statistically significant effect of PSA-based screening on prostate cancer mortality after 10 years (rate ratio [RR], 1.11 [95% CI, 0.83-1.50]). The European Randomized Study of Screening for Prostate Cancer also found no statistically significant effect in all enrolled men (ages 50-74 years) after a median followup of 9 years (RR, 0.85 [95% CI, 0.73-1.00]), but reported a 0.07% absolute risk reduction in a prespecified subgroup of men aged 55 to 69 years (RR, 0.80 [95% CI, 0.65-0.98]). Neither meta-analysis indicated a reduction in prostate cancer mortality with the use of PSA-based screening. When a benefit was found, PSA-based screening resulted in an estimated 48 additional men being treated for each prostate cancer death that was averted. Twelve percent to 13% of screened men had false-positive results after 3 to 4 screening rounds, and clinically important infections, bleeding, or urinary retention occurred after 0.5%-1.0% of prostate biopsies. LIMITATIONS: Evidence was conflicting regarding the effect of screening on prostate cancer mortality in the highest-quality trials; they also represented interim results. We restricted the search on the potential harms of PSA-based screening to information available from randomized efficacy trials. CONCLUSIONS: After about 10 years, PSA-based screening results in the detection of more cases of prostate cancer, but small to no reduction in prostate cancer-specific mortality.
Informed Decision Making About Prostate Specific Antigen Psa Testing Findings And Implications From Formative Testing Of A Multimodal Intervention
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Author : Cindy S. Soloe
language : en
Publisher: RTI Press
Release Date : 2009-02-01
Informed Decision Making About Prostate Specific Antigen Psa Testing Findings And Implications From Formative Testing Of A Multimodal Intervention written by Cindy S. Soloe and has been published by RTI Press this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-02-01 with Mathematics categories.
We created the You Decide multimodal intervention to provide men with the information, skills, and reinforcement needed to engage in informed decision making (IDM) related to prostate cancer screening. We developed intervention materials based on three rounds of formative research conducted with 145 members of the intended recipient audience through 10 focus groups and more than 50 individual in-depth interviews. This report documents key findings from our formative research that may apply to the development of other IDM interventions, especially those related to prostate cancer. Our findings underscored (1) the difficulty of promoting IDM for cancer screening given people's high affinity for such screenings, and (2) the challenge of graphically communicating risk-related tradeoffs. We found that pretest participants had a preference for full-story narratives conveying personal experiences and interpersonal learning opportunities. Our formative research findings also supported the need to use plain language to address a range of health literacy levels. We describe our efforts to apply these formative research findings in our final intervention materials and discuss implications for future intervention research. Our findings underscore the importance of involving the intended audience in the process of developing intervention materials.
Prostate Cancer Screening
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Author : Martin I. Resnick
language : en
Publisher: Springer Science & Business Media
Release Date : 2001-06-01
Prostate Cancer Screening written by Martin I. Resnick and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2001-06-01 with Medical categories.
More than one in six men will develop prostate cancer in their lifetime. In recent years there has been an explosion of information regarding PSA screening and biomarkers for the disease. In Prostate Cancer Screening, Second Edition, the world’s leading experts on prostate cancer detection update the first edition with the latest findings. The book incorporates a series of thoughtful and cutting-edge works from the world’s experts in prostate cancer screening, ranging from the current status quo of prostate cancer screening across the globe to consensus on optimal utilization of the traditional PSA and DRE tests, to cutting-edge research in new biomarkers, biomeasures, and extended risk algorithms for prostate cancer. An additional chapter covers family-based linkage analysis as well as possible pitfalls in prostate cancer biomarker evaluation studies. Timely and authoritative, Prostate Cancer Screening, Second Edition, is an essential text for urologists, oncologists and family physicians, as well as researchers in the biomarker industry who seek methods to better develop and support markers and measures of prostate cancer.
Early Detection Of Prostate Cancer An Issue Of Urologic Clinics
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Author : Stacy Loeb
language : en
Publisher: Elsevier Health Sciences
Release Date : 2014-05-28
Early Detection Of Prostate Cancer An Issue Of Urologic Clinics written by Stacy Loeb and has been published by Elsevier Health Sciences this book supported file pdf, txt, epub, kindle and other format this book has been release on 2014-05-28 with Medical categories.
PSA screening remains highly controversial due to several important disadvantages. More PSA is produced with prostatic enlargement and in other benign conditions such as urinary tract infections. False positive tests can then lead to unnecessary diagnostic workup with invasive prostate biopsy. Another major problem with screening programs in general is overdiagnosis of cancers that would not have caused harm during the patient's lifetime. For example, many prostate cancers have a relatively indolent behavior so may not require diagnosis or treatment in a patient with limited life expectancy. All forms of prostate cancer treatment have potential urinary and sexual side effects, so reducing overdiagnosis and overtreatment are critical public health issues. Because screening has many proven benefits but also significant harms, there are widely disparate guidelines on prostate cancer screening from major organizations worldwide. This issue of the Urologic Clinics will provide insights into the many different prostate cancer guidelines and related policy issues.
Adenocarcinoma Of The Prostate
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Author : Andrew W. Bruce
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-12-06
Adenocarcinoma Of The Prostate written by Andrew W. Bruce and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-12-06 with Medical categories.
Carcinoma of the prostate increasingly dominates the attention of urologists for both scientific and clinical reasons. The search for an explanation and the prediction of the variable behaviour of the malignant prostatic cell continues unabated. The search for more precise tumour staging and more effective treatment is equally vigorous. Editors Andrew Bruce and John Trachtenberg have assembled acknowledged leaders in prostate cancer to present those areas of direct interest to the clinician. There are a number of other topics that might have been considered but most of these, such as experimental tumour models or biochemical factors affecting cell growth, still lack immediate application for the clinician. Carcinoma of the prostate continues to have its highest incidence in the western world, and the difference in comparison with the incidence in the Far East appears to be real and not masked by diagnostic or other factors. A number of other epidemiological aspects need careful analysis: Is the incidence increasing? Is the survival improving? Is the prognosis worse in the younger patient? Epidemiological data are easily misused and misinterpreted so that a precise analysis of the known facts makes an important opening chapter to this book.
Screening For Prostate Cancer With The Prostate Specific Antigen Test United States 2006
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Author : Erwin Brown
language : en
Publisher:
Release Date : 2009
Screening For Prostate Cancer With The Prostate Specific Antigen Test United States 2006 written by Erwin Brown and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009 with Cancer categories.
Prostate cancer is one of the most common forms of cancer among men, and one of the leading causes of cancer death among men in the U.S. civilian noninstitutionalized population. However, many more men will be diagnosed with prostate cancer than will eventually die from it. The U.S. Food and Drug Administration (FDA) has approved the prostate-specific antigen (PSA) test along with a digital rectal exam (DRE) to help detect prostate cancer in men age 50 and older. Currently there is no consensus on the appropriate use of the PSA test for early detection of prostate cancer. The U.S. Preventive Services Task Force (USPSTF) recommends against screening for men age 75 and older. Furthermore the USPSTF suggests that men younger than 75 discuss the benefits and harms of the PSA test with their clinicians prior to testing. Health insurance coverage is associated with access to medical care. Studies have suggested that health insurance coverage is associated with the receipt of timely preventive care. This Statistical Brief examines data from the 2006 Household Component of the Medical Expenditure Panel Survey (MEPS-HC) on screening for prostate cancer with the PSA for men ages 50 to 74, by health insurance coverage status. All differences between estimates discussed in the text are statistically significant at the 0.05 level.
Screening For Prostate Cancer With Prostate Specific Antigen And Treatment Of Early Stage Or Screen Detected Prostate Cancer
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Author : Lesley Deanne Dunfield
language : en
Publisher:
Release Date : 2015
Screening For Prostate Cancer With Prostate Specific Antigen And Treatment Of Early Stage Or Screen Detected Prostate Cancer written by Lesley Deanne Dunfield and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2015 with Electronic books categories.
Screening For Prostate Cancer
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Author : Russel P. Harris
language : en
Publisher:
Release Date : 2002
Screening For Prostate Cancer written by Russel P. Harris and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2002 with categories.
CONTEXT: More than 31,000 men were expected to die from prostate cancer in 2001. Researchers and the public have given most attention for controlling prostate cancer to screening. No well-conducted randomized controlled trial (RCT) of screening has been completed. We are thus left with examining indirect evidence to determine the efficacy of screening for reducing prostate cancer mortality. OBJECTIVE: To examine the evidence of the benefits and harms of screening and earlier treatment in reducing prostate cancer mortality and to assist the US Preventive Services Task Force in making recommendations on this topic. DATA SOURCES: We first developed an analytic framework and 9 key questions that represent the logical chain between screening and reduced mortality. We then systematically searched MEDLINE from January 1994 to September 15, 2002, using the Medical Subject Heading prostate neoplasms and combining this term with predefined strategies to identify English language studies concerning the 9 key questions. We also searched the Cochrane Library, contacted experts, and scanned review bibliographies. STUDY SELECTION: We examined abstracts and full articles of all identified studies to determine whether they met preset inclusion and exclusion criteria for each key question. We selected studies that met the following inclusion criteria: (1) randomized controlled trials (RCTs), case-control studies, and ecologic studies that examined links between screening and reduced mortality, (2) studies that addressed the accuracy, reliability, and yield of screening tests by applying the test and a reference standard uniformly to a defined population; (3) RCTs with clinical outcomes for treatment questions; (4) studies of patient reports about their experience with screening or various treatments; and (5) studies that examined or modeled the costs and benefits of screening. For key questions about treatment, we required RCTs with clinical outcomes. We graded the quality of all included articles according to criteria established by the USPSTF. DATA EXTRACTION: Members of the study team abstracted relevant information from included studies and entered it into established abstraction forms. The first author checked all abstractions against the original papers. DATA SYNTHESIS: No conclusive direct evidence shows that screening reduces mortality from prostate cancer. Although we could not precisely determine the sensitivity and specificity of screening with prostate-specific antigen (PSA) and digital rectal examination (DRE), research is clear that these tests can detect prostate cancer at an earlier stage than clinical detection. Because of the heterogeneity in the natural history of prostate cancer, we could not determine how many screen-detected cancers would eventually become clinically important. The efficacy of treatment for clinically localized prostate cancer detected by screening with any of the currently used approaches is unknown. Each treatment is associated with several well-documented potential harms. The cost of a national screening program is potentially large. Modeling studies show that men ages 50 to 69 years could receive benefit at reasonable cost from screening under favorable assumptions about the efficacy of earlier treatment. These studies do not adjust for the potential harms of screening. Given the current strategy for screening, men with a life expectancy of less than 10 years are unlikely to benefit even under favorable assumptions. CONCLUSIONS: We are unable to determine the net benefit of screening because we cannot establish the presence and, if present, the magnitude of benefit from screening. We can establish the presence of potential harms.