Clinical implications of the 2012 US Preventive Services Task Force (USPSTF) PSA screening recommendation in prostate cancer diagnoses and 5-year survival at a Minnesota safety net health care system.

Abstract

5051 Background: Prostate specific antigen (PSA) screening for prostate cancer has declined following the USPSTF 2012 recommendation. How screening rates and prostate cancer diagnoses have subsequently changed in a racially diverse patient population is not well defined. In this study, we aim to determine the impact of the USPSTF screening recommendation in the Hennepin Healthcare System (HHS) in the state of Minnesota. Methods: A single-institution retrospective analysis of data from our electronic health record, to identify the characteristics of PSA screening and new prostate cancer diagnoses for men ≥50 years between 2008 and 2015. Data before and after May 2012 were compared. P-values were calculated using binominal and generalized linear models. Results: Nearly 22,000 patients underwent PSA screening from 2008 to 2015. PSA screening rates decreased after May 2012 for the four largest demographics represented (p < 0.001). Hispanics and Blacks were more likely to be screened when compared to Whites and Asians (p < 0.05). 319 cases of prostate cancer were diagnosed from 2008 to 2015 with 87 cases (27.3%) diagnosed by PSA-screening. The number needed to screen to diagnose one patient with prostate cancer at HHS was 137.5, and 9.5% of patients (1146 patients) had a false positive PSA that led to further testing or a biopsy. $56,090 was spent in screening costs per diagnosis of early stage prostate cancer via screening. Patients diagnosed from screening were less likely to present with high Gleason scores (8-10) compared to non-screening diagnosis (8% vs 23.3%, p < 0.01). The 5-year survival percentage (prostate cancer mortality) was improved for those patients diagnosed by PSA screening vs the non-screened group (100% vs 89.3%, p < 0.05). Conclusions: PSA screening has declined at HHS since the USPSTF recommendation against prostate cancer screening. Implementation of PSA screening in our healthcare system is expensive and leads to a high number of false positives. Despite this, the 5-year survival from prostate cancer is significantly higher when patients are diagnosed by PSA screening.

Modelling the value of risk‐stratified skin cancer screening of asymptomatic patients by dermatologists

“…This screening threshold would incur costs per skin cancer detected of $1821 if US adults aged 50 years and older with SPT I–IV who present to dermatology for a focused visit were screened and would require an additional 2·1 h of provider face‐to‐face time per skin cancer detected. These results are comparable with those of established prostate, breast and colon cancer screening programmes, which exhibit NNEs to detect one cancer ranging from 127 to 154, although these studies did not examine the time costs of their screening interventions . Established cancer screening programmes also exhibit significantly higher costs per cancer detected, although the consequences of delayed detection on morbidity and mortality obviously vary significantly by type of malignancy …”

“…These results are comparable with those of established prostate, breast and colon cancer screening programmes, which exhibit NNEs to detect one cancer ranging from 127 to 154, although these studies did not examine the time costs of their screening interventions. [25][26][27] Established Figure 2 Additional cost of skin cancer screening in patients presenting for a focused complaint (2018 US dollars). Scatter plot showing the cost per skin cancer detected by dermatologists using age and skin phototype (SPT) screening thresholds.…”

PSA nadir and time to PSA nadir during initial androgen deprivation therapy as prognostic factors in metastatic castration‐resistance prostate cancer patients treated with docetaxel

“…Recently, numerous researches have demonstrated several factors that are associated with patients' prognosis, such as prostate‐specific antigen (PSA) levels at the time of diagnosis of PCa (Gale et al., 2017), neutrophil‐to‐lymphocyte ratio (Pei et al., 2017), PSA doubling time (Howard et al., 2017). PSA nadir (nPSA) means the lowest serum PSA level during treatment, and some scholars have pointed out that higher levels of nPSA after treatment acts as a predictive factor for shorter progression‐free survival (PFS) and poorer overall survival (OS) in metastatic prostate cancer (mPCa) patients (Teoh, Tsu, Yuen, Chiu, et al., 2017).…”