Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease

J. J. Tosoian, R. Alam, C. Gergis, Amol Narang, N. Radwan, S. Robertson, Todd McNutt, A. E. Ross, Danny Y Song, Theodore DeWeese, Phuoc T Tran, Patrick Walsh

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Abstract

Background:To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer.Methods:Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 years or older. Patients were classified into one of four groups based on PSA-testing history: (1) no PSA testing; (2) incomplete/ineffective PSA testing; (3) PSA testing; or (4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (that is, low, intermediate or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high-risk cancer.Results:PSA-testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high-risk cancer (23.0% vs 51.6%, P<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high-risk disease at diagnosis (odds ratio 3.39, 95% confidence interval 1.96–5.87, P<0.001) as compared to the tested population.Conclusions:Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.Prostate Cancer and Prostatic Diseases advance online publication, 3 January 2017; doi:10.1038/pcan.2016.64.

Original languageEnglish (US)
JournalProstate Cancer and Prostatic Diseases
DOIs
StateAccepted/In press - Jan 3 2017

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Prostatic Neoplasms
History
Neoplasms
Prostatic Diseases
Biopsy
Publications
Radiotherapy
Logistic Models
Odds Ratio
Confidence Intervals
Population

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Cancer Research

Cite this

@article{87bcdaaf88544e18bdfc8b2968219e52,
title = "Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease",
abstract = "Background:To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer.Methods:Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 years or older. Patients were classified into one of four groups based on PSA-testing history: (1) no PSA testing; (2) incomplete/ineffective PSA testing; (3) PSA testing; or (4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (that is, low, intermediate or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high-risk cancer.Results:PSA-testing history was available in 274 (94.5{\%}) of 290 subjects meeting study criteria. In total, 148 men (54.0{\%}) underwent PSA testing with follow-up biopsy, 72 (26.3{\%}) underwent PSA testing without appropriate follow-up, and 54 men (19.7{\%}) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high-risk cancer (23.0{\%} vs 51.6{\%}, P<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high-risk disease at diagnosis (odds ratio 3.39, 95{\%} confidence interval 1.96–5.87, P<0.001) as compared to the tested population.Conclusions:Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.Prostate Cancer and Prostatic Diseases advance online publication, 3 January 2017; doi:10.1038/pcan.2016.64.",
author = "Tosoian, {J. J.} and R. Alam and C. Gergis and Amol Narang and N. Radwan and S. Robertson and Todd McNutt and Ross, {A. E.} and Song, {Danny Y} and Theodore DeWeese and Tran, {Phuoc T} and Patrick Walsh",
year = "2017",
month = "1",
day = "3",
doi = "10.1038/pcan.2016.64",
language = "English (US)",
journal = "Prostate Cancer and Prostatic Diseases",
issn = "1365-7852",
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TY - JOUR

T1 - Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease

AU - Tosoian, J. J.

AU - Alam, R.

AU - Gergis, C.

AU - Narang, Amol

AU - Radwan, N.

AU - Robertson, S.

AU - McNutt, Todd

AU - Ross, A. E.

AU - Song, Danny Y

AU - DeWeese, Theodore

AU - Tran, Phuoc T

AU - Walsh, Patrick

PY - 2017/1/3

Y1 - 2017/1/3

N2 - Background:To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer.Methods:Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 years or older. Patients were classified into one of four groups based on PSA-testing history: (1) no PSA testing; (2) incomplete/ineffective PSA testing; (3) PSA testing; or (4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (that is, low, intermediate or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high-risk cancer.Results:PSA-testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high-risk cancer (23.0% vs 51.6%, P<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high-risk disease at diagnosis (odds ratio 3.39, 95% confidence interval 1.96–5.87, P<0.001) as compared to the tested population.Conclusions:Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.Prostate Cancer and Prostatic Diseases advance online publication, 3 January 2017; doi:10.1038/pcan.2016.64.

AB - Background:To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer.Methods:Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 years or older. Patients were classified into one of four groups based on PSA-testing history: (1) no PSA testing; (2) incomplete/ineffective PSA testing; (3) PSA testing; or (4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (that is, low, intermediate or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high-risk cancer.Results:PSA-testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high-risk cancer (23.0% vs 51.6%, P<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high-risk disease at diagnosis (odds ratio 3.39, 95% confidence interval 1.96–5.87, P<0.001) as compared to the tested population.Conclusions:Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.Prostate Cancer and Prostatic Diseases advance online publication, 3 January 2017; doi:10.1038/pcan.2016.64.

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