Quantifying the role of PSA screening in the US prostate cancer mortality decline

Etzioni, Ruth; Tsodikov, Alex; Mariotto, Angela B.; Szabó, Anikó; Falcon, Seth; Wegelin, Jake; diTommaso, Dante; Karnofski, Kent; Gulati, Roman; Penson, David F.; Feuer, Eric J.

doi:10.1007/s10552-007-9083-8

Cited by 358 publications

(262 citation statements)

References 39 publications

(38 reference statements)

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“…4,32,33 Using a first-order Taylor Series expansion, the racial difference in stage-specific mortality may be approximated as a weighted average of the differences in stage-specific incidence and mortality conditional on diagnosis. 34 The racial gap in incidence affects mortality to the extent that people die of each stage tumor, and the racial gap in mortality conditional on diagnosis affects mortality based on the share of people diagnosed at each stage.…”

Section: Discussionmentioning

confidence: 99%

Explaining racial differences in prostate cancer mortality

Taksler

Keating

Cutler

2012

Cancer

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BACKGROUND:In the United States, black males have an annual death rate from prostate cancer that is 2.4 times that of white males. The reasons for this are poorly understood. METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare database, 77,038 black and white males aged >65 years were identified with a first primary diagnosis of prostate cancer between 1995 and 2005, as well as 49,769 controls. The racial gap in mortality was decomposed to differential incidence and stage-specific prostate cancer mortality. The importance of various clinical and socioeconomic factors to each of these components was then examined. RESULTS: The estimated mortality gap for prostate cancer-specific mortality was 1320 more cases per 100,000 males among black than white men. This gap was due to higher prostate cancer incidence among black males (76%) and higher stage-specific mortality once diagnosed (24%). Differences in prostate-specific antigen testing, comorbidities, and income explained 29% of the difference in metastatic cancer incidence but none of the racial gap for local/regional incidence. Conditional on diagnosis, tumor characteristics explained 50% of the racial gap, comorbidities an additional 4%, choice of treatment and physician 17%, and socioeconomic factors 15%. Overall, approximately 25% of the racial gap in mortality and 86% of the gap in mortality conditional on diagnosis could be explained. CONCLUSIONS: More frequent prostate-specific antigen testing for black and low-income males could potentially reduce the prostate cancer mortality gap through earlier diagnosis of tumors that otherwise may become metastatic. More aggressive treat-

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Section: Discussionmentioning

confidence: 99%

Explaining racial differences in prostate cancer mortality

Taksler

Keating

Cutler

2012

Cancer

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“…prostate specific antigen (PSA) screening and treatment modalities such as surgery (e.g. radical prostatectomy), androgen deprivation therapy (ADT) and radiation therapy [5][6][7] . Regardless of the treatment option, prostate cancer survivors (patients) often experience a very high rate of morbidity caused by the cancer and treatments, particularly ADT.…”

Section: Introductionmentioning

confidence: 99%

Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review

Keogh

MacLeod

2012

Journal of Pain and Symptom Management

181

167

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Context: Prostate cancer patients, especially those on androgen deprivation therapy (ADT) experience many symptoms that make it difficult to maintain their independence and quality of life. As ADT act via reducing testosterone production, exercise may offset many of the ADT side-effects and that of the cancer itself. Objectives: This article sought to conduct a systematic review of the literature on whether exercise could reduce symptoms and improve quality of life for prostate cancer patients. Methods: Using relevant databases and keywords, 12 training studies were found meeting the inclusion and exclusion criteria. Results: Grade A level evidence was observed for the benefits of exercise in improving muscular endurance, aerobic endurance and overall quality of life as well as reducing fatigue in prostate cancer patients. Grade B evidence also suggested that exercise may improve prostate cancer patients' muscle mass, muscular strength, functional performance (walking and sit to stand speed) as well as health-related, social and physical quality of life. These effects appeared greater for group-rather than home-based exercise; especially if these programs including resistance training. Conclusion: It is recommended that most prostate cancer patients be encouraged to exercise regularly by their clinicians and significant others. Where possible, this exercise should be group-based and include some resistance training. Future research in this area should directly compare group-and home-based as well as resistance, aerobic and combined resistance and aerobic training to better elucidate the most effective forms of exercise for this population and what factors affect initiation and adherence to such programs.

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“…Stage migration is the most striking and consistent phenomenon associated with PCa screening (1,13,24,26). Data from ERSPC show a significant stage migration with screening, with a 7-fold reduction in the risk of locally advanced disease (4).…”

Section: Discussionmentioning

confidence: 90%

Association between Literacy, Compliance with Prostate Cancer Screening, and Cancer Aggressiveness: Results from a Brazilian Screening Study

et al. 2013

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Purpose: Little is known about the effects of literacy levels on prostate cancer screening. This study evaluates the association between literacy, compliance with screening, and biopsy findings in a large Brazilian screening study. Materials and Methods:We analyzed 17,571 men screened for PCa with digital rectal examination (DRE) and total and free prostate-specific antigen (PSA) from January 2004 to December 2007. Of those, 17,558 men had information regarding literate status. Full urological evaluation in a specialized cancer center was recommended in the case of: a) suspicious DRE, b) PSA > 4.0 ng/mL, or c) PSA 2.5-3.9 ng/mL and free/total PSA (f/tPSA) ratio < 15%. Transrectal ultrasound guided prostate biopsy (14 cores) was performed upon confirmation of these findings after the patient's consent. Patients' compliance with screening recommendations and biopsy results were evaluated according to literacy levels. Results: an abnormal PSA, a suspicious DRE, or both were present in 73.2%, 19.7%, and 7.1% of those men who underwent biopsy, respectively. PCa was diagnosed in 652 men (3.7%). Previous PSAs or DREs were less common among illiterate men (p < 0.0001). Additionally, illiterate men were less prone to attend to further evaluations due to an abnormal PSA or DRE (p < 0.0001). PSA levels > 10 mg/mL (p = 0.03), clinical stage > T2a (p = 0.005), and biopsy Gleason > 7 (p = 0.02) were more common among illiterate men. Conclusions: In a screened population, literacy levels were associated with prior PCa evaluations and with compliance with screening protocols. Illiterate men were at higher risk of being diagnosed with more advanced and aggressive PCa.

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Quantifying the role of PSA screening in the US prostate cancer mortality decline

Abstract: PSA screening may account for much, but not all, of the observed drop in prostate cancer mortality. Other factors, such as changing treatment practices, may also have played a role in improving prostate cancer outcomes.

Cited by 358 publications

References 39 publications

Explaining racial differences in prostate cancer mortality

Explaining racial differences in prostate cancer mortality

Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review

Association between Literacy, Compliance with Prostate Cancer Screening, and Cancer Aggressiveness: Results from a Brazilian Screening Study

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