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Disparities found in PSA testing, prostate cancer care
Recent studies reveal sociodemographic, geographical differences, and the need to consider BMI when performing PSA tests.
PSA screening and certain aspects of prostate cancer care are in need of attention and quality improvement, according to data from three recent studies.
In the first study, published in Cancer, Chuck Scales, MD, resident in the division of urologic surgery at Duke University Medicine Center, and colleagues assessed the use of PSA screening using the 2002 Behavioral Risk Factor Surveillance System. The study included 58,511 men aged 40 years and older.
They found that “prostate cancer screening remains potentially suboptimal among high-risk men,” Scales told HemOnc Today.
“Among young men aged 40 to 49 years, approximately one in five reported a PSA test in the previous year,” he said. Of men aged ≥50 years, 53.7% reported having a PSA test in the previous year (P<.001).
The researchers also reported discrepancies in sociodemographic characteristics. “Though young black, non-Hispanic males were more likely than young white, non-Hispanic males to report a PSA test, only one in three black, non-Hispanic men reported a PSA test in the previous year,” Scales said.
Young men who had a continuous relationship with a physician were more likely to report PSA testing (OR=2.52; P<.001). Those with an annual household income of ≥$35,000 were more likely to have had a PSA test within the previous year, compared to men with an annual household income of <$35,000 (OR=1.50; P<.001).
Obesity and PSA screening
Another study, conducted by researchers at the Duke Prostate Center and the Shared Equal Access Regional Cancer Hospital, highlighted that current PSA-based screening is less effective for obese men.
“Data have shown that obese men have lower PSA values. Our hypothesis was that this is caused by hemodilution and that these lower PSA levels would lead to a delay in diagnosis resulting in later stage at diagnosis, more aggressive disease and a worse outcome, and that is exactly what we found,” Stephen Freedland, MD, associate professor at the Duke Prostate Center at Duke University, told HemOnc Today.
Freedland and colleagues used both SEARCH and Duke databases to conduct a retrospective cohort study to determine the association between BMI and the outcome of radical prostatectomy separately for men with PSA-detected cancers or those with abnormal digital rectal examinations.
The study included two cohorts consisting of 1,380 and 2,014 men treated by radical prostatectomy between 1988 and 2008.
In both cohorts, increased BMI was associated with younger age (P<.001), more recent treatment (P≤.001) and lower PSA level (P≤.008). Higher BMI was also associated with high-grade pathological disease (P≤.02) and positive surgical margins (P<.001).
Men with T1c cancers presented with a strong correlation between BMI and disease progression (P≤.004). However, this link was not apparent in men treated before 2000 or those with an abnormal rectal examination, according to the researchers.
“When screening men for prostate cancer, whatever number you use to define abnormal should be lower in obese men,” Freedland said. “Obesity is associated with aggressive cancer for two reasons: One, there is biology there; obesity creates a bad prostate cancer. And, two, we’re not screening these men as well. But that’s something we can change in our practice and improve upon.”
Quality of prostate cancer care
In a third study, researchers from Columbia University in New York and other sites in the United States found that quality of care for prostate cancer varied by region of the country and type of health care facility. However, in this study, they found no racial differences, which the researchers said suggested equity of care once treatment is initiated.
The study, published in the Journal of Clinical Oncology, included data from the American College of Surgeons National Cancer Data Base on 2,775 men with early-stage prostate cancer. Patients had been treated with radical prostatectomy or external beam radiation therapy.
Compared with community cancer centers, comprehensive cancer centers and teaching or research hospitals had higher compliance rates on structure indicators and pretherapy assignment indicators including documentation of clinical stage, family history of prostate cancer, urinary, sexual and bowel function (P<.05). However, community cancer centers had a higher compliance rate for rectal protection (P<.05). – by Stacey L. Adams
For more information:
- Br J Urol. 2008;doi:10.1111/j.1464-410X.2008.07934.x.
- Cancer. 2008;doi:10.1002/cncr.23667.
- J Clin Oncol. 2008;26:3735-3742.