prostate-specific antigen

Association of Treatment With 5α-Reductase Inhibitors and Prostate Cancer Mortality Among Older Adults

Author/s: 
Kumar, A, Nalawade, V, Riviere, P, Sarkar, RR, Parsons, JK, Murphy, JD, Rose, BS

5α-reductase inhibitors (5-ARIs) are used to treat benign prostatic enlargement, a common condition causing urinary outflow obstruction. They also reduce prostate-specific antigen (PSA) by approximately 50%. Our group has recently published that among US military veterans, 5-ARIs are associated with delays in prostate cancer (PC) diagnoses, higher grade and stage at presentation, and worse PC-specific mortality (PCSM), presumably because of misinterpreted PSA values. We hypothesized that these results are generalizable to the broader US population.

Testing of a Tool for Prostate Cancer Screening Discussions in Primary Care

Author/s: 
Misra-Hebert, AD, Hom, G, Klein, EA, Bauman, JA, Gupta, N, Ji, X, Stephenson, AJ, Jones, JS, Kattan, Kattan, MW

The link to the study is available here: https://www.ncbi.nlm.nih.gov/pubmed/30003062

BACKGROUND:

As prostate cancer (PCa) screening decisions often occur in outpatient primary care, a brief tool to help the PCa screening conversation in busy clinic settings is needed.

METHODS:

A previously created 9-item tool to aid PCa screening discussions was tested in five diverse primary care clinics. Fifteen providers were recruited to use the tool for 4 weeks, and the tool was revised based upon feedback. The providers then used the tool with a convenience sample of patients during routine clinic visits. Pre- and post-visit surveys were administered to assess patients' knowledge of the option to be screened for PCa and of specific factors to consider in the decision. McNemar's and Stuart-Maxwell tests were used to compare pre-and post-survey responses.

RESULTS:

14 of 15 providers completed feedback surveys and had positive responses to the tool. All 15 providers then tested the tool on 95 men aged 40-69 at the five clinics with 2-10 patients each. The proportion of patients who strongly agreed that they had the option to choose to screen for PCa increased from 57 to 72% (p = 0.018) from the pre- to post-survey, that there are factors in the personal or family history that may affect PCa risk from 34 to 47% (p = 0.012), and that their opinions about possible side effects of treatment for PCa should be considered in the decision from 47 to 61% (p = 0.009).

CONCLUSION:

A brief conversation tool for the PCa screening discussion was well received in busy primary-care settings and improved patients' knowledge about the screening decision.

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