PSA screening—a matter of debate?

Heidegger, Isabel

doi:10.1007/s12254-019-00524-9

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…The benefits and harms of population screening for prostate cancer continue to be debated [ 1 , 2 ]. A simple blood test can measure blood levels of prostate specific antigen (PSA), a protein that when raised in the circulation indicates an increased risk of prostate cancer, and warrants further diagnostic investigations.…”

Section: Introductionmentioning

confidence: 99%

Impact of PSA testing on secondary care costs in England and Wales: estimates from the Cluster randomised triAl of PSA testing for Prostate cancer (CAP)

Thorn

Turner

Walsh

et al. 2023

BMC Health Serv Res

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Background Screening men for prostate cancer using prostate-specific antigen (PSA) testing remains controversial. We aimed to estimate the likely budgetary impact on secondary care in England and Wales to inform screening decision makers. Methods The Cluster randomised triAl of PSA testing for Prostate cancer study (CAP) compared a single invitation to men aged 50–69 for a PSA test with usual care (no screening). Routinely collected hospital care data were obtained for all men in CAP, and NHS reference costs were mapped to each event via Healthcare Resource Group (HRG) codes. Secondary-care costs per man per year were calculated, and cost differences (and population-level estimates) between arms were derived annually for the first five years following randomisation. Results In the first year post-randomisation, secondary-care costs averaged across all men (irrespective of a prostate cancer diagnosis) in the intervention arm (n = 189279) were £44.80 (95% confidence interval: £18.30-£71.30) higher than for men in the control arm (n = 219357). Extrapolated to a population level, the introduction of a single PSA screening invitation could lead to additional secondary care costs of £314 million. Conclusions Introducing a single PSA screening test for men aged 50–69 across England and Wales could lead to very high initial secondary-care costs.

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Section: Introductionmentioning

confidence: 99%

Impact of PSA testing on secondary care costs in England and Wales: estimates from the Cluster randomised triAl of PSA testing for Prostate cancer (CAP)

Thorn

Turner

Walsh

et al. 2023

BMC Health Serv Res

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“…Apart from diagnosing PCa, the PSA assay is useful in tracking the progression of the disease and its response to treatment. 5,6 Two studies found that 55% of males aged 46-84 years and diagnosed histologically with BPH had PSA values greater than 4 ng/mL. 7,8 It also emerged from their studies that 33% of patients with PCa showed low levels of PSA.…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Malignancy Index in Tumour Staging in Prostate Cancer

2022

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Background: A fine balance exists between the early treatment of a potentially lethal prostate disease and possible complications from the early treatment of a potentially indolent disease. Prostate-specific antigen (PSA) is an indicator of disease progression and is used in the clinical staging of prostate cancer (PCa). Given the arsenal of staging methods available, some intrusive, some not, is there a future for biochemical staging? As the presence and stage of disease are influenced by multiple factors, it is conceivable that an effective biomarker for determining pathology and stage could require a convolution of more than one biochemical entity. In this study, the authors introduce a malignancy index capable of staging PCa and discriminating pathology from non–pathology, in three unmatched sample types. Methods: Total protein measurement was by means of the Pierce Bicinchoninic acid protein assay. The total PSA concentrations were measured using a microparticle enzyme immune assay, and ELISAs confirmed the urokinase plasminogen activator and plasminogen activator inhibitor–1 concentrations. The three markers (PSA, urokinase plasminogen activator, and plasminogen activator inhibitor-1 as well as patient age) were used in the formulation of a malignancy index (the degree of a person’s vulnerability to disease). Results: The authors examined the robustness of their malignancy index in transurethral resection and biopsy tissue and plasma samples and proved that it discriminated PCa from non–PCa and was able to predict tumour stage. Conclusions: The malignancy index in this preliminary research increases with disease stage (T1 through T4) and deserves some attention as a credible marker.

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“…The heterogeneity of manifest prostate cancer is also considerable. A majority of tumors are slow growing and confined to the prostate gland while 10–15% of tumors are metastasized already at diagnosis [ 7 ]. Given that prostate cancer may develop silently for many years [ 8 ], early life risk factors and accumulation of risk across the life course are plausible to be of importance.…”

Section: Introductionmentioning

confidence: 99%

Timing of the Pubertal Growth Spurt and Prostate Cancer

Célind

Bygdell

Martikainen

et al. 2021

Cancers

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Previous studies of pubertal timing and the risk of prostate cancer have used self-reported markers of pubertal development, recalled in mid-life, and the results have been inconclusive. Our aim was to evaluate the age at the pubertal growth spurt, an objective marker of pubertal timing, and the risk of prostate cancer and high-risk prostate cancer. This population-based cohort study included 31,971 men with sufficient height measurements to calculate age at peak height velocity (PHV). Outcomes were accessed through national registers. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox regressions with follow up starting at 20 years of age. In total, 1759 cases of prostate cancer including 449 high-risk were diagnosed during follow up. Mean follow up was 42 years (standard deviation 10.0). Compared to quintiles 2–4 (Q2–4), men in the highest age at PHV quintile (Q5) had lower risk of prostate cancer (HR 0.83, 95% CI 0.73–0.94), and of high-risk prostate cancer (0.73; 0.56–0.94). In an exploratory analysis with follow up starting at age at PHV, late pubertal timing was no longer associated with reduced risk of prostate cancer. Later pubertal timing was associated with reduced risk of prostate cancer and especially high-risk prostate cancer. We propose that the risk of prostate cancer might be influenced by the number of years with exposure to adult levels of sex steroids.

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PSA screening—a matter of debate?

Cited by 9 publications

References 27 publications

Impact of PSA testing on secondary care costs in England and Wales: estimates from the Cluster randomised triAl of PSA testing for Prostate cancer (CAP)

Impact of PSA testing on secondary care costs in England and Wales: estimates from the Cluster randomised triAl of PSA testing for Prostate cancer (CAP)

Predictive Value of Malignancy Index in Tumour Staging in Prostate Cancer

Timing of the Pubertal Growth Spurt and Prostate Cancer

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