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

Publication ,  Journal Article
Michael, ZD; Kotamarti, S; Arcot, R; Morris, K; Shah, A; Anderson, J; Armstrong, AJ; Gupta, RT; Patierno, S; Barrett, NJ; George, DJ; Moul, JW ...
Published in: World J Mens Health
July 2023

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<0.05), while other risk factors were not. Referred patients had higher mean PSAs (2.97 vs. 1.98, p=0.001). CONCLUSIONS: Preliminary outcomes following implementation of a multidisciplinary screening algorithm identified PCa in a small, important percentage of men in their forties. These results provide insight into baseline PSA measurement to provide early risk stratification and detection of csPCa in patients with otherwise extended life expectancy. Further follow-up is needed to possibly determine the prognostic significance of such mid-life screening and optimize primary care physician-urologist coordination.

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Published In

World J Mens Health

DOI

ISSN

2287-4208

Publication Date

July 2023

Volume

41

Issue

3

Start / End Page

631 / 639

Location

Korea (South)

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
  • 3215 Reproductive medicine
 

Citation

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Michael, Z. D., Kotamarti, S., Arcot, R., Morris, K., Shah, A., Anderson, J., … Duke Cancer Institute Planning Committee for Prostate Cancer Screening. (2023). Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen. World J Mens Health, 41(3), 631–639. https://doi.org/10.5534/wjmh.220068
Michael, Zoe D., Srinath Kotamarti, Rohith Arcot, Kostantinos Morris, Anand Shah, John Anderson, Andrew J. Armstrong, et al. “Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen.World J Mens Health 41, no. 3 (July 2023): 631–39. https://doi.org/10.5534/wjmh.220068.
Michael ZD, Kotamarti S, Arcot R, Morris K, Shah A, Anderson J, et al. Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen. World J Mens Health. 2023 Jul;41(3):631–9.
Michael, Zoe D., et al. “Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen.World J Mens Health, vol. 41, no. 3, July 2023, pp. 631–39. Pubmed, doi:10.5534/wjmh.220068.
Michael ZD, Kotamarti S, Arcot R, Morris K, Shah A, Anderson J, Armstrong AJ, Gupta RT, Patierno S, Barrett NJ, George DJ, Preminger GM, Moul JW, Oeffinger KC, Shah K, Polascik TJ, Duke Cancer Institute Planning Committee for Prostate Cancer Screening. Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen. World J Mens Health. 2023 Jul;41(3):631–639.

Published In

World J Mens Health

DOI

ISSN

2287-4208

Publication Date

July 2023

Volume

41

Issue

3

Start / End Page

631 / 639

Location

Korea (South)

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
  • 3215 Reproductive medicine