Prostate cancer screening: Canadian guidelines 2011

Izawa, Jonathan I.; Klotz, Laurence; Siemens, D. Robert; Kassouf, Wassim; So, Alan; Jordan, John; Chetner, Michael; Iansavichene, Alla

doi:10.5489/cuaj.11134

Cited by 44 publications

(46 citation statements)

References 73 publications

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“…There is an obvious need among family physicians for conclusive evidence on the balance of screening benefits and harms. The modern use of adjuncts to a single PSA cut-off, in addition to active surveillance of low-risk cancers, 11 exceeds the scope of conclusions drawn from recent randomized trials. It is unlikely that a consensus on the utility of prostate cancer screening will be achieved until randomized studies with long durations of follow-up evaluate modern screening practices.…”

Section: Resultsmentioning

confidence: 97%

“…Unfortunately, the results of these trials published in 2009 are conflicting, with the PLCO failing to demonstrate a survival benefit and the ERSPC demonstrating a 20% mortality reduction attributable to screening men aged 55 to 69. Although methodological differences may account for the discordant results, 11,12 the question of screening utility is as contentious as ever.…”

Section: Introductionmentioning

confidence: 99%

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1920 Prostate Cancer Screening Attitudes and Practices of Family Physicians in Ontario

Allard¹,

Dason²,

Kapoor³

2012

Journal of Urology

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Introduction: The utility of prostate cancer screening is controversial. We sought to determine whether Ontario's family physicians believe it is beneficial and to characterize their screening protocols. Methods: A survey was developed with input from urologists, family physicians and the Ontario Medical Association's Section on General and Family Practice. Questions covered three domains: (1) demographics, (2) beliefs about screening utility and (3) screening practices. All 7302 family physicians in Ontario were invited by email to complete the online survey. Results: A total of 969 physicians completed the survey; 955 (52.0% male, 48.0% female) were included. Most (80.97%) use prostate-specific antigen (PSA) and digital rectal examination (DRE) for screening; 9.4% use DRE alone and 7.15% PSA. Of the respondents, 8.3% do not offer prostate cancer screening. Most physicians begin offering screening at age 50 (72.9%) and stop at ages 70 or 80 (68.4%); 17.9% offer lifelong screening. In response to the statement "screening with DRE provides a survival benefit," 37.6% and 32.6 agreed and disagreed, respectively. For "screening with PSA provides a survival benefit," 43.3% agreed and 31.0% disagreed. For the statement "the benefits of prostate cancer screening outweigh the risks," 51.4% agreed and 22.0% disagreed. Discussion: Although 91.7% of respondents offer prostate cancer screening, they are divided over its utility. Only 51.4% were convinced that the benefits outweighed the harms. There is significant variability between physicians' screening protocols. A limitation of this study is the possibility of selection bias. Nevertheless, this is the largest sample of Ontario family physicians ever surveyed about prostate cancer screening and highlights divergent physician practices and a need for more conclusive evidence on screening utility.

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Section: Resultsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

1920 Prostate Cancer Screening Attitudes and Practices of Family Physicians in Ontario

Allard¹,

Dason²,

Kapoor³

2012

Journal of Urology

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“…Searching PubMed, Medline, and Embase yielded 348 papers, 30 of which met the inclusion criteria for study selection (two systematic reviews, 8,9 two meta-analyses, 6,10 five literature reviews, 2,4,5,11,12 and 21 single-study papers 3,13-32 ) (Fig. 1).…”

Section: Literature Search Resultsmentioning

confidence: 99%

Epidemiology of prostate and kidney cancer in the Aboriginal population of Canada: A systematic review

Wong

Kapoor

2017

CUAJ

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Introduction: Prostate and kidney cancer rates in the Aboriginal population of Canada is a growing issue. Methods: A systematic review of prostate and kidney cancer epidemiology in the Aboriginal population of Canada was performed with international comparison and evaluation of present epidemiological disparities. PubMed, Medline, and Embase (from January 1946 to June 2016), relevant government-published reports, and the websites of organizations contributing to prostate or kidney cancer guidelines were searched. We included studies that informed any of the three epidemiological questions this review is focused on answering. Results: Two systematic reviews, two meta-analyses, five literature reviews, and 21 single-study papers were included. The incidence and mortality rates of kidney cancer were elevated among Canadian Aboriginals when compared to the provincial or national population and to several international regions. No studies reported data on survival. Prostate cancer incidence, mortality, and survival rates were lower in Aboriginals provincially, nationally, and internationally, with incidence and survival reaching statistical significance. Elevated rate of risk factors for kidney cancer was a significant finding among Canadian Aboriginals. Aboriginals were screened for prostate cancer less than the general Canadian population, a trend also observed in the U.S. Conclusions:The elevated incidence and mortality of kidney cancer among Canadian Aboriginals is most likely attributable to the rise in lifestyle-based risk factors. Two correlations concerning prostate cancer are made. However, due to temporal and regional disparities in data, further investigation is required to elucidate these observations. IntroductionIn Canada, the term "Aboriginal" is used to describe individuals who identify as First Nations (North American Indian), Métis, or Inuk (Inuit).1 According to the 2011 National Household Survey, 1 400 685 Canadians identified as being Aboriginal, comprising 4.3% of the Canadian population.1 Provincially, Ontario has the largest population of Aboriginal people in Canada, with 301 425 Aboriginal residents.1 Prostate cancer is the most commonly diagnosed malignancy among males in Canada, while kidney cancer ranks sixth. Renal cell carcinoma (RCC) is the most common morphology of kidney cancer, accounting for 80% of cases. 2Prostate and kidney cancer among Aboriginals of Canada is of particular concern due to the lack of current data on screening, treatment, and surveillance. [3][4][5][6] There are three points of interest for comparison in this review:1. Incidence, mortality, and survival rates 2. Risk factor prevalence 3. Screening guidelines The goal of this review is to answer three epidemiological questions:1. How do Aboriginals of Canada compare provincially, nationally, and internationally with regards to prostate and kidney cancer incidence, mortality, and survival? 2. What risk factor is the most contributory to the development of prostate and kidney cancer among Aboriginals of Canad...

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“…Active surveillance (AS) has been proposed as a strategy to decrease overtreatment [4][5][6][7][8][9][10] and is now recognized as a management option by a number of evidence-based guidelines. [11][12][13] Although several prospective series have reported on its safety, 4-10 few studies have reported on the uptake of AS at a population level. [14][15][16][17][18][19][20][21][22][23] No previous population-based study has evaluated the proportion of men being managed by AS in Canada.…”

Section: Introductionmentioning

confidence: 99%

The uptake of active surveillance for the management of prostate cancer: A population-based analysis

Richard

Alibhai²,

Panzarella³

et al. 2016

CUAJ

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Introduction: Active surveillance (AS) is a strategy for the management of low-risk prostate cancer (PCa). However, few studies have assessed the uptake of AS at a population level and none of these were based on a Canadian population. Therefore, our objectives were to estimate the proportion of men being managed by AS in Ontario and to assess the factors associated with its uptake. Methods: This was a retrospective, population-based study using administrative databases from the province of Ontario to identify men ≤75 years diagnosed with localized PCa between 2002 and 2010. Descriptive statistics were used to estimate the proportion of men managed by AS, whereas mixed models were used to assess the factors associated with the uptake of AS. Results: 45 691 men met our inclusion criteria. Of these, 18% were managed by AS. Over time, the rates of AS increased significantly from 11% to 21% (p<0.001). Older age, residing in an urban centre, being diagnosed in the later years of the study period, having a neighborhood income in the highest quintile, and being managed by urologists were all associated with greater odds of receiving AS. Conclusions: There has been a steady increase in the uptake of AS between 2002 and 2010. However, only 18% of men diagnosed with localized PCa were managed by AS during the study period. The decisions to adopt AS were influenced by several individual and physician characteristics. The data suggest that there is significant opportunity for more widespread adoption of AS. IntroductionSince the introduction of prostate-specific antigen (PSA)-based screening, there has been an increase in the incidence of prostate cancer (PCa).1,2 However, this increase is mostly driven by an increase in the diagnosis of clinically insignificant cancers.3 Thus, the management of PCa has been associated with considerable overtreatment. Active surveillance (AS) has been proposed as a strategy to decrease overtreatment [4][5][6][7][8][9][10] and is now recognized as a management option by a number of evidence-based guidelines. 11-13Although several prospective series have reported on its safety, 4-10 few studies have reported on the uptake of AS at a population level. [14][15][16][17][18][19][20][21][22][23] No previous population-based study has evaluated the proportion of men being managed by AS in Canada. In other areas of PCa management, there are significant differences between Canada and other countries. Although a recent single-institution series from the University of Ottawa has examined the treatment patterns of men diagnosed with low-risk PCa, 24 there remains a need to better understand the rates of AS use and the factors related to its adoption, outside of single-institution series. We hypothesized that the rates of AS increased throughout the study period. Methods ParticipantsThis was an institutional review board-approved, population-based, retrospective study that identified, using administrative databases, men aged 18-75 years who were diagnosed with adenocarcinoma of the prostate betwe...

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Prostate cancer screening: Canadian guidelines 2011

Cited by 44 publications

References 73 publications

1920 Prostate Cancer Screening Attitudes and Practices of Family Physicians in Ontario

1920 Prostate Cancer Screening Attitudes and Practices of Family Physicians in Ontario

Epidemiology of prostate and kidney cancer in the Aboriginal population of Canada: A systematic review

The uptake of active surveillance for the management of prostate cancer: A population-based analysis

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