Pd09-04 Estimating the Harms and Benefits of Prostate Cancer Screening: Comparing Common Clinical Practice to Recommended Good Practice
Year: 2016
Type: article
Study design: Observational Study
Abstract: METHODS: We identified all prostate biopsies performed by a large urology group practice utilizing a centralized pathology lab.Changes in the number of total biopsies performed and the percentage of positive biopsies were examined.For those with positive biopsies, we assessed differences in patient age, PSA, and Gleason score.RESULTS: A total of 4178 biopsies were identified-2513 in 2011 and 1665 in 2014.The percentage of positive biopsies was 27% in 2011 versus 34% in 2014 (P-value<0.0001).For the 2011 cohort, the median age was 68(range¼44-95), the median PSA was 5.3(range¼0.2-978)and the median Gleason score was 6 (range 6-10).The 2014 cohort had a median age of 67 (range¼40-92), a median PSA of 5.8 (range¼0.05-1016)and a median Gleason score of 7 (range¼6-10).Among patients with positive biopsies, we found statistically significant differences between the 2 cohorts in the median ages and Gleason scores.Patients were about 1 year younger in 2014 compared to 2011 (t-test; p-value¼0.043).High Gleason scores (8-10) were diagnosed in 19% of the 2014 biopsies versus 9% in the 2011 biopsies (chi square; p-value <0.0001).The PSA values did not differ between the 2 years analyzed (chi square; p-value¼0.3515).CONCLUSIONS: After the widespread implementation of the 2011 USPTF PSA screening guidelines, 34% fewer biopsies were performed with a 29% increase in positive biopsy rates.We found a significantly higher incidence of high grade disease in 2014 compared with 2011 despite otherwise stable variables.The percentage of patients with positive biopsies having Gleason score 8-10 doubled in 2014.The higher incidence of these more aggressive cancers that will require more extensive and expensive therapy with anticipated poorer survival must be considered in policy recommendations and discussions regarding PSA screening.
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2326024624