ML

Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012

1920 PROSTATE CANCER SCREENING: ATTITUDES AND PRACTICES OF FAMILY PHYSICIANS IN ONTARIO Christopher Allard*, Shawn Dason, Anil Kapoor, Hamilton, Canada INTRODUCTION AND OBJECTIVES: The utility of prostate cancer (PCa) screening is controversial. We investigated whether family physicians in Ontario, Canada, believe PCa screening is beneficial and to characterize their screening protocols. METHODS: A survey was developed with input from urologists, family physicians, and the Ontario Medical Association’s Section on General and Family Practice. Questions covered three domains: demographics, beliefs about screening utility and screening practices. All 7,302 family physicians in Ontario were invited by email to complete the online survey. RESULTS: A total of 969 physicians completed the survey. Of 955 (52.0% male, 48.0% female) respondents who met inclusion criteria, 91.7% offer PCa screening. Most (81.0%) use PSA and DRE for screening; 9.4% use DRE alone and 7.2% PSA; 2.4% incorporate transrectal ultrasound. Most physicians begin offering screening at age 50 (72.9%) and stop at ages 70 or 80 (68.4%); 4.3% offer screening up to age 90 and 17.9% offer lifelong screening. Fifty-four percent offer the same amount of screening as they did 5 years ago, while 19.5% offer more and 13.8% less. Physician beliefs about the utility of PCa screening are shown in Figure 1; 51.4% of respondents believe the benefits of screening outweigh the harms. CONCLUSIONS: The publications in 2009 of two large randomized controlled trials had a negligible impact on the amount of screening offered by respondents. There is significant variability between physicians’ screening beliefs and protocols. A limitation of this study is the possibility of selection bias. Nevertheless, this is the largest sample of Ontario family physicians ever surveyed about PCa screening and highlights divergent physician practices and a need for more conclusive evidence on the subject of screening utility.

THE JOURNAL OF UROLOGY姞

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primary endpoint was cancer detection rate and the secondary endpoints were differences in mean tPSA, fPSA, %fPSA and pathologic outcomes. RESULTS: A total of 524 men (127 cancer cases) were included. Mean age was 66.6 ¡3⁄4 7.7 yr. No differences in age and tPSA were found between groups A and B. Mean fPSA, %fPSA and cancer detection rate were significantly higher in group A than group B. The incidence of %fPSA ⬍25% was significantly lower in group A than in group B. Old age, GFR ⬍60, and %fPSA ⬍25% were significant predictors for being prostate cancer. For groups A and B, the probability of being prostate cancer was 35.7% vs 22.9% (p ⫽ 0.036). CONCLUSIONS: Cancer detection rates were higher in group A than in group B whose PSA levels are within 4.0 to 10.0 ng/ml. Performing prostate biopsy should be actively considered in healthylooking patients with well-controlled CKD. Table. Differences in cancer-related parameters between patients with CKD stage 3 or higher versus stages 1 and 2. Total Group A Group B p-value n (%) 524 56 (10.6%) 468 (89.4%) Age (year)

65.8

40-59, n (%)

96 (18.3%)

60-69, n (%)

242 (46.2%)

70-79, n (%)

186 (35.5%)

Body mass index

24.4 ⫾ 2.3

Diabetes, n (%)

81 (15.5%)

65.4 ⫾ 8.9 9 (16.1%)

66.3 ⫾ 7.5 87 (18.6%)

16 (28.6%) 226 (48.3%) 31 (55.4%) 155 (33.1%) 24.7 ⫾ 2.9 14 (25.0%)

24.4 ⫾ 2.2 67 (14.3%)

0.471 0.040*

42 (75.0%) 188 (40.2%) ⬍0.001*

Hypertension, n (%)

230 (43.9%)

GFR (ml/min/1.73m2)

80.6 ⫾ 36.1 40.6 ⫾ 16.8 85.4 ⫾ 34.8 ⬍0.001*

ⱖ 90 (stage 1), n (%)

0 (0%)

125 (23.9%)

60-89 (stage 2), n (%)

0 (0%)

343 (65.5%)

30-59 (stage 3), n (%)

40 (7.6%)

0 (0%)

15-29 (stage 4), n (%)

10 (1.9%)

0 (0%)

⬍ 15 (stage 5), n (%)

6 (1.1%)

0 (0%)

PSA (ng/ml)

6.0 ⫾ 1.7

6.2 ⫾ 1.7

5.9 ⫾ 1.7

0.208

Free PSA (ng/ml)

1.3 ⫾ 0.6

1.6 ⫾ 0.6

1.3 ⫾ 0.6

⬍0.001*

Percent free PSA (%)

22.0 ⫾ 8.9

26.3 ⫾ 8.2

21.4 ⫾ 8.8

⬍0.001*

Prostate volume (ml)

43.5 ⫾ 22.4 42.2 ⫾ 14.2 44.3 ⫾ 23.1

0.208

Cancer detection rates

127 (24.2%)

0.034*

Percent free PSA (⬍ 25%) 374 (71.4%)

20 (35.7%) 107 (22.9%)

26 (46.4%) 348 (74.4%) ⬍0.001*

Biopsy Gleason sum 6

62 (48.8%)

9 (45.0%)

53 (49.5%)

7

39 (30.7%)

7 (35.0%)

32 (29.9%)

8

20 (15.7%)

3 (15.0%)

17 (15.9%)

9

4 (3.1%)

1 (5.0%)

3 (2.8%)

10

2 (1.6%)

0 (0%)

Biopsy Gleason sum (肁8) Percent positive core (%)

Source of Funding: None

26 (20.5%)

4 (20.0%)

0.931

0 (0%) 22 (20.6%)

0.955

27.4 ⫾ 15.8 29.2 ⫾ 14.5 27.1 ⫾ 16.1

0.580

Source of Funding: None

1921 DIFFERENCES IN PROSTATE CANCER DETECTION RATES ACCORDING TO THE LEVEL OF GLOMERULAR FILTRATION RATE IN PATIENTS WHOSE PSA LEVELS OF 4.0 TO 10.0 NG/ML Jae-Seung Yeon*, Seoul, Korea, Republic of; Jae Hyun Jung, s, Korea, Republic of; Sung Yong Cho, Seung Bae Lee, Hwancheol Son, Hyeon Jeong, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: To investigate differences in prostate cancer detection rates according to the level of glomerular filtration rates (GFR). METHODS: Patients with PSA levels within 4.0 to 10.0 ng/ml were analyzed. Age, serum creatinine, estimated GFR, body mass index, total PSA (tPSA), free PSA (fPSA), percent free PSA (%fPSA), comorbidities, biopsy Gleason sum, and percent positive core were retrospectively reviewed. All parameters were compared to show whether patients with GFR ⬍60 ml/min/1.73m2 (group A) have higher risk of prostate cancer than patients with GFR ¡A˜60 (group B). The

1922 FEATURES OF ATYPICAL GLANDS ON INITIAL PROSTATE BIOPSY AS POSITIVE OR NEGATIVE PREDICTORS OF MALIGNANCY ON SUBSEQUENT PROSTATE BIOPSY Sriram Venigalla*, Chen Zhao, Hiroshi Miyamoto, Rochester, NY INTRODUCTION AND OBJECTIVES: Patients whose prostate biopsy reveals the presence of atypical glands suspicious for prostatic carcinoma (AGSC) are subject to close monitoring and repeat biopsies, perhaps unnecessarily, as clinicians do not have a clear basis for understanding and stratifying the significance of these findings. The value of histologic atypia on an initial prostate biopsy in predicting the detection of prostate cancer on subsequent biopsies should thus be further studied. METHODS: In a retrospective, blinded manner, we examined the initial biopsies of 82 patients (93 foci) reported as AGSC. Five factors assessed in these biopsies include the size of the nucleoli of