Biopsy Follow-Up of Prostate-Specific Antigen Tests

Abstract

Background A prostate-specific antigen (PSA) level above 4 ng/mL has historically been recognized as an appropriate threshold to recommend biopsy; however the risk of high-grade disease observed among men with lower PSA levels in the Prostate Cancer Prevention Trial has led to calls to change the criteria for biopsy referral. Purpose To aid providers when discussing aggressiveness of biopsy by cataloging available community biopsy patterns and determine whether lower PSA thresholds are being used to recommend biopsy. Methods Laboratory and biopsy records were reviewed among 59,764 men in a large Washington State health plan between 1998 and 2007. Follow-up in the 12-month period after a test was categorized as biopsy, urology visit without biopsy, additional PSA testing with no urology visit, or no PSA-related follow-up. Data analysis occurred between 2010 and 2011. Results Twenty-eight percent of tests with PSA levels ≥4.0 ng/mL, 2.9% of tests with levels between 2.5 and 4.0 ng/mL, and 0.4% of tests with levels <2.5 ng/mL were followed with a biopsy within 12 months. Over 40% of elevated tests (≥4.0 ng/mL) were followed by a urologist visit without a biopsy, and over 30% of tests ≥4.0 did not have any PSA-related follow-up within 12 months. PSA velocity, defined as annualized rate of change in PSA level, was strongly associated with biopsy, especially when absolute PSA was <4.0 ng/mL. There appear to be no discernable temporal trends in biopsy thresholds or practice patterns based on PSA velocity. Conclusions Despite recent calls to more aggressively recommend biopsy at lower PSA thresholds, the practice in this large health plan has remained consistent over time.

Poor Follow-up After Elevated Prostate-specific Antigen Tests: A Population-based Cohort Study

“…The testing pattern shown in this article is not reflective of behaviour in an isolated healthcare system, but seems to mirror the activities in several countries as mentioned previously [6,[17][18][19]. Therefore, we believe that these results are likely to be generalisable to countries and settings such as Sweden, which contain a population characterised by a high PC incidence, a high PC mortality rate, and moderately high rates of PSA testing.…”

“…In 2005, Pinsky et al [6] reported that in the USA, one out of four men with a PSA of >10 ng/ml in the PLCO trial did not have a prostate biopsy within 2 yr of an elevated test. Moreover, Zeliadt et al [17] found that 28% of men with a PSA of >4 ng/ml did not undergo a prostate biopsy within 1 yr.…”

Five-Year Downstream Outcomes Following Prostate-Specific Antigen Screening in Older Men

“…In clinical practice, 33% of men age 65 years and older underwent biopsy within 5 years of a screening PSA > 4ng/ml, which is consistent with prior smaller community studies. 37 Even among the 0.9% of men with screening PSA > 10ng/ml, only 42% underwent biopsy within 5 years suggesting that many men in clinical practice do not pursue biopsy even when PSA levels are very high.…”

Influence of different domains of social capital on psychological distress among Croatian high school students

“…Social capital is defined as the instrumental and moral resources that individuals can access through their social network connections. In turn, the child is conceptualised as being embedded in social relationships that exist within their families, their neighbourhoods, and their schools [ 6 - 9 ]. Social capital theory posits that interpersonal trust, norms of reciprocity, and exchange of social support each constitutes a type of resource and that access to these resources may promote the resilience of the individuals against adversity [ 10 - 12 ].…”

“…Social capital theory posits that interpersonal trust, norms of reciprocity, and exchange of social support each constitutes a type of resource and that access to these resources may promote the resilience of the individuals against adversity [ 10 - 12 ]. Social capital has been shown to have positive effects on multiple health outcomes among young people (i.e., obesity [ 8 ], diabetes [ 9 , 10 ], cardiovascular disease [ 10 ] and infectious diseases [ 10 ]). There are many different layers of environmental influences that can affect a child’s development, starting with people and institutions immediately surrounding the child (i.e., parents and families), to school environments, to residential neighbourhoods, and eventually the societal culture [ 13 ].…”