PSA Screening: A Public Health Dilemma

Mandelson, Margaret T.; Wagner, Edward H.; Thompson, Robert S.

doi:10.1146/annurev.pu.16.050195.001435

Cited by 31 publications

(3 citation statements)

References 79 publications

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“…Between 1992 and 1999 Group Health did not recommend PSA screening for asymptomatic men of any age, although PSA was a covered benefit. 33–35 In 1999 the guideline was changed to state that “a shared decision making process between provider and patient is recommended in counseling asymptomatic men regarding screening for prostate screening.” Following this change, PSA use in Group Health became similar to national patterns: 40% of men in Group Health in 2004 received a PSA test in the past 2 years; 36 and 2006 Behavioral Risk Factor Survey reported that 42% of men aged 40 years received a PSA test in the past 2 years. 37 …”

Section: Discussionmentioning

confidence: 99%

Biopsy Follow-Up of Prostate-Specific Antigen Tests

Zeliadt

Buist

Reid

et al. 2012

American Journal of Preventive Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

Biopsy Follow-Up of Prostate-Specific Antigen Tests

Zeliadt

Buist

Reid

et al. 2012

American Journal of Preventive Medicine

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“…The percentage of pT1a/b and pT2 tumours which have the potency to develop biological aggressive potential is unknown. It is commonly believed that the fraction of clinical irrelevant tumours within the group of pT1a/b and pT2 tumours is relatively high [23]. Therefore we asked whether TRPV6 allele frequencies of extraprostatic and intra-prostatic tumours (at time of resection) are different or not.…”

Section: Resultsmentioning

confidence: 98%

TRPV6 alleles do not influence prostate cancer progression

et al. 2009

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BackgroundThe transient receptor potential, subfamily V, member 6 (TRPV6) is a Ca2+ selective cation channel. Several studies have shown that TRPV6 transcripts are expressed in locally advanced prostatic adenocarcinoma, metastatic and androgen-insensitive prostatic lesions but are undetectable in healthy prostate tissue and benign prostatic hyperplasia. Two allelic variants of the human trpv6 gene have been identified which are transcribed into two independent mRNAs, TRPV6a and TRPV6b. We now asked, whether the trpv6a allele is correlated with the onset of prostate cancer, with the Gleason score and the tumour stage.MethodsGenomic DNA of prostate cancer patients and control individuals was isolated from resections of prostatic adenocarcinomas and salivary fluid respectively. Genotyping of SNPs of the TRPV6 gene was performed by restriction length polymorphism or by sequencing analysis. RNA used for RT-PCR was isolated from prostate tissue. Data sets were analyzed by Chi-Square test.ResultsWe first characterized in detail the five polymorphisms present in the protein coding exons of the trpv6 gene and show that these polymorphisms are coupled and are underlying the TRPV6a and the TRPV6b variants. Next we analysed the frequencies of the two TRPV6 alleles using genomic DNA from saliva samples of 169 healthy individuals. The homozygous TRPV6b genotype predominated with 86%, whereas no homozygous TRPV6a carriers could be identified. The International HapMap Project identified a similar frequency for an Utah based population whereas in an African population the a-genotype prevailed. The incidence of prostate cancer is several times higher in African populations than in non-African and we then investigated the TRPV6a/b frequencies in 141 samples of prostatic adenocarcinoma. The TRPV6b allele was found in 87% of the samples without correlation with Gleason score and tumour stage.ConclusionOur results show that the frequencies of trpv6 alleles in healthy control individuals and prostate cancer patients are not significantly different. Although expression of trpv6 transcripts correlates with aggressive potential of prostate cancer, the TRPV6 genotype does not correlate with the onset of prostate cancer, with the Gleason score and the tumour stage.

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“…Stark diVerences exist among organisations and among individual commentators regarding whether PSA screening should be recommended. 15 For the purposes of this paper, I examine only published individual decisions, leaving institutional decisionmaking for another time. There is no shortage of examples.…”

Section: Ontology Ethics and Epistemologymentioning

confidence: 99%