Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen

Autor: Zoe D. Michael, Srinath Kotamarti, Rohith Arcot, Kostantinos Morris, Anand Shah, John Anderson, Andrew J. Armstrong, Rajan T. Gupta, Steven Patierno, Nadine J. Barrett, Daniel J. George, Glenn M. Preminger, Judd W. Moul, Kevin C. Oeffinger, Kevin Shah, Thomas J. Polascik
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: The World Journal of Men's Health, Vol 41, Iss 3, Pp 631-639 (2023)
Druh dokumentu: article
ISSN: 2287-4208
2287-4690
DOI: 10.5534/wjmh.220068
Popis: Purpose: Prostate cancer (PCa) screening can lead to potential over-diagnosis/over-treatment of indolent cancers. There is a need to optimize practices to better risk-stratify patients. We examined initial longitudinal outcomes of mid-life men with an elevated baseline prostate-specific antigen (PSA) following initiation of a novel screening program within a system-wide network. Materials and Methods: We assessed our primary care network patients ages 40 to 49 years with a PSA measured following implementation of an electronic health record screening algorithm from 2/2/2017–2/21/2018. The multidisciplinary algorithm was developed taking factors including age, race, family history, and PSA into consideration to provide a personalized approach to urology referral to be used with shared decision-making. Outcomes of men with PSA ≥1.5 ng/mL were evaluated through 7/2021. Statistical analyses identified factors associated with PCa detection. Clinically significant PCa (csPCa) was defined as Gleason Grade Group (GGG) ≥2 or GGG1 with PSA ≥10 ng/mL. Results: The study cohort contained 564 patients, with 330 (58.5%) referred to urology for elevated PSA. Forty-nine (8.7%) underwent biopsy; of these, 20 (40.8%) returned with PCa. Eleven (2.0% of total cohort and 55% of PCa diagnoses) had csPCa. Early referral timing (odds ratio [OR], 4.58) and higher PSA (OR, 1.07) were significantly associated with PCa at biopsy on multivariable analysis (both p
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