Screening for Prostate Cancer: A Review of the Evidence for the U.S. Preventive Services Task Force

Chou, Roger; Croswell, Jennifer M.; Dana, Tracy; Bougatsos, Christina; Blazina, Ian; Fu, Rongwei; Gleitsmann, Ken; Koenig, Helen; Lam, Chi‐Ming; Maltz, Ashley; Rugge, J Bruin; Lin, Kenneth W.

doi:10.7326/0003-4819-155-11-201112060-00375

Cited by 493 publications

(358 citation statements)

References 74 publications

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“…Prostate cancer treatment decisions for men reporting intermediate levels of health, though, have become more complicated due to increasing recognition of overdiagnosis and overtreatment. 42 The choices are no longer just immediate active treatment vs. watchful waiting. Active surveillance, a strategy of closely monitoring low-risk cancers with PSA testing, digital rectal examination, and serial prostate biopsies, has emerged as a viable option that allows men the opportunity to avoid active treatment in the absence of cancer progression.…”

Section: Discussionmentioning

confidence: 99%

Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

et al. 2015

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BACKGROUND: Guidelines recommend against treating localized prostate cancer (PCa) in men with a greater than10-year life expectancy. However, physicians have difficulty accurately estimating life expectancy. OBJECTIVE: We used data from a population-based observational study to develop a nomogram to estimate long-term other-cause mortality based on self-reported health status (SRHS), race/ethnicity, and age at diagnosis. DESIGN: This was an observational study. SUBJECTS: Men diagnosed with localized PCa from October 1994 through October 1995 participated in the study. MAIN MEASURES: Initial measures obtained 6 months after diagnosis included sociodemographic and tumor characteristics, treatment, and a single item on the SRHS, with response options ranging from excellent to poor. We used Surveillance, Epidemiology, and End-Results program data to determine date and cause of death through December 2010. We estimated other-cause mortality with proportional hazards survival analyses, accounting for competing risks. KEY RESULTS: We evaluated 2,695 men, of whom 74 % underwent aggressive therapy (surgery or radiotherapy). At the initial survey, 18 % reported excellent (E), 36 % very good (VG), 31 % good (G), and 15 % fair/poor (F/P) health. Healthier men were younger, and more likely to be white, better educated, and to undergo surgery. At follow-up, 44 % of the cohort had died; 78 % of deaths were from causes other than PCa. SRHS predicted other-cause mortality; for men reporting E, VG, G, F/P health, the cumulative incidences of other-cause mortality were 20 %, 29 %, 40 %, and 53 %, respectively, p<0.001. Compared to a reference of excellent SRHS, multivariable hazard ratios (95 % CI) for other-cause mortality for men reporting VG, G, and F/P health were 1.22 (0

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Section: Discussionmentioning

confidence: 99%

Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

et al. 2015

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“…17,18 Information derived from genetic testing could also shift the balance of harms and benefits for some individuals such that screening tests like the PSA test, which is not recommended for the general population, may have utility in those with greatest genetic risk for prostate cancer. [19][20][21] Those at higher genetic risk may also be candidates for more sensitive screening approaches (e.g., breast MRI).…”

Section: Introductionmentioning

confidence: 99%

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

et al. 2016

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BACKGROUND: Primary care providers (PCPs) can play a critical role in helping patients receive the preventive health benefits of cancer genetic risk information. Thus, the objective of this systematic review was to identify studies of US PCPs' knowledge, attitudes, and communication-related behaviors regarding genetic tests that could inform risk-stratification approaches for breast, colorectal, and prostate cancer screening in order to describe current findings and research gaps. METHODS: We conducted a systematic search of six electronic databases to identify peer-reviewed empirical articles relating to US PCPs and genetic testing for breast, colorectal, or prostate cancer published in English from 2008 to 2016. We reviewed these data and used narrative synthesis methods to integrate findings into a descriptive summary and identify research needs. RESULTS: We identified 27 relevant articles. Most focused on genetic testing for breast cancer (23/27) and colorectal cancer risk (12/27); only one study examined testing for prostate cancer risk. Most articles addressed descriptive research questions (24/27). Many studies (24/27) documented PCPs' knowledge, often concluding that providers' knowledge was incomplete. Studies commonly (11/27) examined PCPs' attitudes. Across studies, PCPs expressed some concerns about ethical, legal, and social implications of testing. Attitudes about the utility of clinical genetic testing, including for targeted cancer screening, were generally favorable; PCPs were more skeptical of direct-to-consumer testing. Relatively fewer studies (9/27) examined PCPs' communication practices regarding cancer genetic testing. DISCUSSION: This review indicates a need for investigators to move beyond descriptive research questions related to PCPs' knowledge and attitudes about cancer genetic testing. Research is needed to address important gaps regarding the development, testing, and implementation of innovative interventions and educational programs that can improve PCPs' genetic testing knowledge, assuage concerns about the appropriateness of cancer genetic testing, and promote open and effective patientprovider communication about genetic risk and genetic testing.

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“…A more recent review that included large academic series as well as Medicare patients reported still lower rates, 0.04-0.1 % [30]. The USPSTF likewise selected for consideration papers presenting high rates of quality-of-life impairment after treatment, ignoring multiple series and metaanalyses reporting more favorable outcomes [6].…”

Section: Who Is Screened? Who Is Treated?mentioning

confidence: 99%

Implications of the New AUA Guidelines on Prostate Cancer Detection in the U.S.

Cooperberg

2014

Curr Urol Rep

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In 2012, the U.S. Preventive Services Task Force (USPSTF) issued a blanket "D" recommendation against all prostate-specific antigen (PSA)-based early detection efforts for prostate cancer, reflecting critical misinterpretations of the major evidence regarding benefits and harms of such testing. Against the backdrop of the ensuing controversy, in 2013 the American Urological Association (AUA) published a new, methodologically rigorous guideline. This guideline recommended that men aged 55-69 be offered biennial screening in the setting of shared decision-making, that men under 40 or over 69 years of age should not be screened routinely, and that evidence was insufficient to recommend screening for men aged 40-54 years. While it has received criticism with regard to the age-based recommendations, the AUA guideline reflects a far better and more balanced presentation of the available evidence than the USPSTF statement. However, because the USPSTF is far more influential than the AUA among primary care providers, the ultimate impact of the new AUA guideline on practice patterns may be limited. Optimizing early detection practices should involve consensusbuilding incorporating both primary care and specialist input, with the goals of minimizing overtreatment of low-risk disease while continuing to reduce prostate cancer mortality rates through early detection and aggressive management of highrisk disease.

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Screening for Prostate Cancer: A Review of the Evidence for the U.S. Preventive Services Task Force

Abstract: Agency for Healthcare Research and Quality.

Cited by 493 publications

References 74 publications

Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

Self-Reported Health Status Predicts Other-Cause Mortality in Men with Localized Prostate Cancer: Results from the Prostate Cancer Outcomes Study

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

Implications of the New AUA Guidelines on Prostate Cancer Detection in the U.S.

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