Use of prostate‐specific antigen testing as a disease surveillance tool following radical prostatectomy

Trantham, L; Nielsen, Matthew E.; Mobley, Lee; Wheeler, Stephanie B.; Carpenter, William R.; Biddle, Andrea K.

doi:10.1002/cncr.28238

Cited by 22 publications

(29 citation statements)

References 26 publications

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“…Hispanic men actually had higher guideline concordance in this study than other populations, contrary to what has been demonstrated in the Medicare population. 10 Additionally, unmarried patients fare worse with respect to many health and prostate cancer-specific outcomes 31 including cancer surveillance in this study, suggesting that this population might also benefit from tailored interventions to ensure quality prostate cancer surveillance.…”

Section: Discussionmentioning

confidence: 81%

Association between PSA values and surveillance quality after prostate cancer surgery

et al. 2019

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Background Although prostate‐specific antigen (PSA) testing is used for prostate cancer detection and posttreatment surveillance, thresholds in these settings differ. The screening cutoff of 4.0 ng/mL may be inappropriately used during postsurgery surveillance, where 0.2 ng/mL is typically used, creating missed opportunities for effective salvage radiation treatment. We performed a study to determine whether guideline concordance with annual postoperative PSA surveillance increases when PSA values exceed 4 ng/mL, which represents a screening threshold that is not relevant after surgery. Methods We used US Veterans Health Administration data to perform a retrospective longitudinal cohort study of men diagnosed with nonmetastatic prostate cancer from 2005 to 2008 who underwent radical prostatectomy. We used logistic regression to examine the association between postoperative PSA levels and receipt of an annual PSA test. Results Among 10 400 men and 38 901 person‐years of follow‐up, annual guideline concordance decreased from 95% in year 1 to 79% in year 7. After adjustment, guideline concordance was lower for the youngest and oldest men, Black, and unmarried men. Guideline concordance significantly increased as PSA exceeded 4 ng/mL (adjusted odds ratio 2.20 PSA > 4‐6 ng/mL vs PSA > 1‐4 ng/mL, 95% confidence interval 1.20‐4.03; P = .01). Conclusions Guideline concordance with prostate cancer surveillance increased when PSA values exceeded 4 ng/mL, suggesting a screening threshold not relevant after prostate cancer surgery, where 0.2 ng/mL is considered treatment failure, is impacting cancer surveillance quality. Clarification of PSA thresholds for early detection vs cancer surveillance, as well as emphasizing adherence for younger and Black men, appears warranted.

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Section: Discussionmentioning

confidence: 81%

Association between PSA values and surveillance quality after prostate cancer surgery

et al. 2019

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“…Access to care was measured with at least one visit to a primary care provider during the baseline period (14). Receipt of active treatment was identified using inpatient, outpatient and carrier files with appropriate ICD-9 CM diagnostic and procedure codes, CPT or HCPCS codes or Revenue Center code during the six months after the index date (Appendix 1)(15, 16), (17). We classified the cancer treatment into four groups based on a hierarchy: 1) Radical Prostatectomy (RP); 2) Radiation Therapy (RT); 3) Hormone Therapy; and 4) None of the RP, RT or hormone therapy.…”

Section: Methodsmentioning

confidence: 99%

Impact of Prostate Cancer Diagnosis on Noncancer Hospitalizations Among Elderly Medicare Beneficiaries With Incident Prostate Cancer

Raval¹,

Madhavan²,

Mattes³

et al. 2016

J Natl Compr Canc Netw

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OBJECTIVES To analyze the impact of cancer diagnosis on non-cancer hospitalizations (NCHs) by comparing these hospitalizations between the pre- and post-cancer period in a cohort of fee-for-service Medicare beneficiaries with incident prostate cancer. METHODS A population-based retrospective cohort study was conducted using the Surveillance, Epidemiology and End-Results (SEER) -Medicare linked database for the years 2000 to 2010. The study cohort consisted of 57,489 elderly men (≥ 67 years) with incident prostate cancer. NCHs were identified in six time periods (t1–t6) before and after the incidence of prostate cancer. Each time period consisted of 120 days. For each time period, NCHs were defined as inpatient admissions with primary diagnosis codes not related to prostate cancer, prostate cancer-related procedures or bowel, sexual and urinary dysfunction. Bivariate and multivariate comparisons on rates of NCHs between the pre- and post-cancer period accounted for the repeated measures design. RESULTS The rate of NCHs during the post-cancer period (5.1%) was higher as compared to the pre-cancer period (3.2%). In both unadjusted and adjusted models, elderly men were 37% (Odds Ratio, OR: 1.37, 95% Confidence Interval, CI: 1.32, 1.41) and 38% (Adjusted OR: 1.38, 95% CI: 1.33, 1.46) more likely to have any NCH during the post-cancer period as compared to the pre-cancer period. CONCLUSIONS Elderly men with prostate cancer had a significant increase in the risk of NCHs after the diagnosis of prostate cancer. The study highlights the need to design interventions for reducing the excess NCHs after diagnosis of prostate cancer among elderly men.

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“…Trantham et al [10] reported that nearly 25% of African Americans did not have a PSA test for at least 12 months in the first 5 years after initial PCa. Non-Hispanic white men were more likely to receive at least one annual test during the first 5 years after PCa treatment than men of other ethnic groups based on SEER data.…”

Section: Diagnosismentioning

confidence: 99%

Racial Differences in the Diagnosis and Treatment of Prostate Cancer

et al. 2016

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Disparities between African American and Caucasian men in prostate cancer (PCa) diagnosis and treatment in the United States have been well established, with significant racial disparities documented at all stages of PCa management, from differences in the type of treatment offered to progression-free survival or death. These disparities appear to be complex in nature, involving biological determinants as well as socioeconomic and cultural aspects. We present a review of the literature on racial disparities in the diagnosis of PCa, treatment, survival, and genetic susceptibility. Significant differences were found among African Americans and whites in the incidence and mortality rates; namely, African Americans are diagnosed with PCa at younger ages than whites and usually with more advanced stages of the disease, and also undergo prostate-specific antigen testing less frequently. However, the determinants of the high rate of incidence and aggressiveness of PCa in African Americans remain unresolved. This pattern can be attributed to socioeconomic status, detection occurring at advanced stages of the disease, biological aggressiveness, family history, and differences in genetic susceptibility. Another risk factor for PCa is obesity. We found many discrepancies regarding treatment, including a tendency for more African American patients to be in watchful waiting than whites. Many factors are responsible for the higher incidence and mortality rates in African Americans. Better screening, improved access to health insurance and clinics, and more homogeneous forms of treatment will contribute to the reduction of disparities between African Americans and white men in PCa incidence and mortality.

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Use of prostate‐specific antigen testing as a disease surveillance tool following radical prostatectomy

Cited by 22 publications

References 26 publications

Association between PSA values and surveillance quality after prostate cancer surgery

Association between PSA values and surveillance quality after prostate cancer surgery

Impact of Prostate Cancer Diagnosis on Noncancer Hospitalizations Among Elderly Medicare Beneficiaries With Incident Prostate Cancer

Racial Differences in the Diagnosis and Treatment of Prostate Cancer

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