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The Precision Medicine Approach in Oncology
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Taking all of this into account, clinical practice guidelines for prostate cancer screening are controversial because the benefits of screening may not outweigh the risks of follow-up diagnostic tests and cancer treatments. Meta-analyses have shown that a single PSA value of <1µg/L for a man in their 60s largely rules out the risk of clinically significant prostate cancer in the rest of his lifetime.
Current Active Surveillance Protocol for Prostate Cancer
Published in Ayman El-Baz, Gyan Pareek, Jasjit S. Suri, Prostate Cancer Imaging, 2018
Scott Greenberg, Jennifer Yates
The landscape of prostate cancer screening, diagnosis, and treatment is changing rapidly. The most active areas of research and development are arguably occurring in the treatment of advanced and metastatic prostate cancer. With the introduction of abiraterone and enzalutamide, the paradigm for advanced prostate cancer management has significantly changed. On the other end of the prostate cancer spectrum, screening for prostate cancer has become a controversial topic. The changes introduced by the United States Preventive Services Task Force’s (USPSTF) prostate cancer screening recommendations has had a major impact on attitudes toward screening and actual screening practices. Once recent review of studies assessing the impact of the USPSTF grade “D” recommendation found that prevalence of low-risk prostate cancer has decreased since 2012 (Lee et al. 2017). Additional studies of prostate cancer epidemiology over the next decade may continue to reveal a shift in the stage at diagnosis, a concern to urologists who will be tasked with treating more advanced prostate cancer.
Precision medicine in prostate cancer
Published in Debmalya Barh, Precision Medicine in Cancers and Non-Communicable Diseases, 2018
With the changing demographics of the world population and increasing life expectancy, prostate cancer has become the most common nonskin cancer in developed countries. In the United Kingdom, it is the most common cancer in men, representing 24% of all new cancer cases. For example, 37,051 cases were registered in 2008 with a lifetime risk of 1 in 9 (Office for National Statistics, Cancer Statistics Registrations, UK, 2008) and this figure increased to 40,331 in 2015 (Office for National Statistics, Cancer Statistics Registrations, UK, 2017). In the United States an estimated 218,890 men were newly diagnosed with prostate cancer in 2007 with a lifetime risk of 1 in 6 (National Cancer Institute Surveillance Epidemiology and End Results Program, Cancer Stat Facts: Cancer of Prostate, 2006), however in 2016 the number of new cases registered had decreased to 180,890 (National Cancer Institute Surveillance Epidemiology and End Results Program, Cancer Stat Facts: Cancer of Prostate, 2016). This decrease may be the result of the United States Preventive Services Task Force (USPSTF) recommendations of 2012, whereby it concluded that the evidence was insufficient to assess the balance of benefits and harms of prostate cancer screening using the serum prostate-specific antigen (PSA) in men younger than 75 years, and recommended against screening in men older than 75 years (Lin et al., 2011).
International Society of Urological Pathology (ISUP)-Grade Grouping in Prostatic Adenocarcinoma and its Prognostic Implications
Published in Cancer Investigation, 2022
Atif Ali Hashmi, Syeda Narisa Iftikhar, Shahzeb Munawar, Omer Ahmed, Syed Rafay Yaqeen, Ishaq Azeem Asghar, Muhammad Irfan, Javaria Ali, Muhammad M. Edhi, Shumaila Kanwal Hashmi
Screening for prostate cancer using the PSA test is still controversial and thus is not recommended unless risks and benefits are completely explained to the patients. Recently, a meta-analysis combining results of five randomized control trials, including 721,718 men, evaluated all aspects of prostate cancer screening. They showed that screening has no effect on all-cause mortality and may not even have any significant effect on the prostate cancer-specific mortality. However, sensitivity analysis of studies that were at low risk of bias demonstrated that screening seems to have a small effect on prostate-specific mortality. Therefore, the study concluded that at maximum, prostate cancer screening using PSA has a small effect on prostate cancer-specific mortality; however, there is no significant effect on overall mortality (15). Despite limitations of prostate cancer screening, many men in western countries undergo prostate cancer screening that leads to an early diagnosis of cancer in these patients. Alternatively, in Pakistan, apart from the lack of prostate cancer screening, most patients present late in the disease course leading to high cancer morbidity and mortality. The same trends were demonstrated in our study, revealing a higher frequency of grade-4 and grade-5 tumors, along with high tumor volume. These poor-prognostic features may be attributed to the late disease presentation and lack of screening programs in our population.
Addressing Disparities by Evaluating Depression as a Predictor of Prostate Screenings among Black Men in a Community Health Clinic
Published in Journal of Community Health Nursing, 2022
Eugenia Millender, Sabrina L. Dickey, Christine Ouma, Derminga Bruneau, Karen Wisdom-Chambers, Jessica R. Bagneris, Rachel M. Harris
The current study is a retrospective, exploratory analysis of factors influencing prostate cancer screening behaviors among patients in a clinical setting. We utilized clinical data from an NLCHC in South Florida to examine our hypotheses among a convenience sample of 267 male patients (age range = 37–80 years) who had received routine clinical care from the health center between 2014 and 2018. Individuals in the sample were primarily low-income, underinsured, or uninsured. The sample was representative of the nation’s diversity, with participants identifying as members of either two major subgroups within the non-Hispanic Black community, African American and Black-Caribbean; Hispanic or Latinx; or non-Hispanic White. In addition, a sizable portion of the sample spoke English as a second language and had immigrated to the U.S. from another country.
General practitioners’ reflections on using PSA for diagnosis of prostate cancer. A qualitative study
Published in Scandinavian Journal of Primary Health Care, 2022
Olav Thorsen, Eirik Viste, Torgeir Gilje Lid, Svein R. Kjosavik
Norwegian guidelines recommend specific, risk-adapted screening only for men with genetic predisposition from the age of 45 years and to breast cancer susceptibility gene (BRCA) mutation carriers who have been confirmed to be at risk of early and aggressive disease (mainly BRAC2), from around 40 years of age, as recommended by the European Association of Urology (EAU) [5]. Nordic GPs are also influenced by the Choosing Wisely Campaign (www.choosingwisely.org), which seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures. One of their recommendations relevant to primary care is: “do not recommend prostate cancer screening for men over 75 years of age without considering life expectancy and the risks of testing, overdiagnosis, and overtreatment”. Still, over-utilization of using the PSA test is quite common, often caused by patient preferences when deciding whether to order a test [6].