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MP21-05 TEMPORAL TRENDS IN PROSTATE CANCER RISK GROUP STRATIFICATION FOLLOWING THE 2008 UNITED STATES PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS
THE JOURNAL OF UROLOGYâ
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ESBL in 2.2%. 15% of patients who were not swabbed received i.v antibiotics. 6/808 (0.7%) screened patients developed sepsis, as opposed to 4/124 (3.2%) in patients not screened (p¼0.03 Fischer’s exact test). Allowing for all costs incurred by screening, including intravenous antibiotics, screening for FRE saved $10/patient biopsied. CONCLUSIONS: Screening for fluoroquinolone resistant E. coli prior to TRUS guided prostate biopsy with subsequent targeted antibiotics is a cost effective strategy to significantly reduce the risk of post biopsy sepsis. Source of Funding: Urology research waikato limited
MP21-05 TEMPORAL TRENDS IN PROSTATE CANCER RISK GROUP STRATIFICATION FOLLOWING THE 2008 UNITED STATES PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS Firas Abdollah*, Royal Oak, MI; Deepansh Dalela, Akshay Sood, Jesse Sammon, Patrick Karabon, Detroit, MI; Christian Meyer, Maxine Sun, Toni Choueiri, Boston, MA; Mani Menon, Detroit, MI; Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: In 2008, the United States Preventive Services Task Force (USPSTF) recommended against prostate specific antigen (PSA) screening for prostate cancer (PCa) in men aged >¼75 years. We examined temporal trends in PCa risk profile before and after the 2008 USPSTF recommendations in a nationwide dataset. METHODS: Men newly diagnosed with PCa within the National Cancer Data Base (NCDB) 2005-07 and 2009-11 were risk-stratified according to the National Comprehensive Cancer Network guidelines (low: T1c-T2a, biopsy Gleason <¼6 and PSA<10 ng/ml; intermediate: T2b-T2c, biopsy Gleason¼7 or PSA 10-20 ng/ml; high: T3a and above, biopsy Gleason 8-10 or PSA >20 ng/ml, and metastatic [anyT/anyN/ M1]). A difference-in-differences (DID) model was used to ascertain the independent effect of the 2008 recommendation in older men (aged >¼75), using younger men (aged <75) that were not subject to the USPSTF statement as a control population to account for baseline secular trends in risk stratification, and adjusting for all available demographic and socio-economic variables. RESULTS: Overall, 195,495 (29.7%) low-risk, 298,386 (45.3%) intermediate-risk, 155,933 (23.7%) high-risk localized PCa, as well as as 8,721 (1.3%) metastatic PCa cases were diagnosed in the NCDB over the study period. Amongst older men, the proportion of high-risk and metastatic PCa increased (from 36.7% to 41.7% and 3.1% to 6.1%, respectively) and low-risk PCa decreased (19.6% to 14.4%) from 2005 to 2011, while the opposite trend was noted in younger men (CochranArmitage trend test p<0.001 for all). Older men had higher mean PSA (20.7 vs. 17.1 ng/ml) and biopsy Gleason 8-10 (30.9 vs. 24.9%) at diagnosis in NCDB 2009-11 vs. 2005-07. DID multivariate regression confirmed the results (DID odds ratio [OR] for high-risk PCa 1.20 [95% CI 1.16-1.25] and metastatic PCa 1.34 [95% CI 1.21-1.48] in older vs. younger men). Older men with Charlson comorbidity index (CCI) score 0 or life expectancy >10 years were 24% and 20% more likely to be diagnosed with high-risk PCa than men aged <75 respectively (p<0.01), but not men with CCI >2. CONCLUSIONS: Our study highlights the increased likelihood of high- risk and metastatic PCa diagnoses for a man aged 75 and above following the USPSTF 2008 recommendations against PSA screening. This was especially true for older men with no comorbidities and good life expectancy. These results might serve as a herald for the changes in risk profile that have taken place in US after the 2011 USPSTF update, which recommended against PSA screening in all patients. Source of Funding: Vattikuti Urology Institute
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
MP21-06 STATE-BY-STATE RACIAL VARIATIONS IN PROSTATE SPECIFIC ANTIGEN SCREENING PATTERNS: A NATIONWIDE ANALYSIS. €rn Lo € ppenberg, Akshay Sood, Jesse Sammon, Deepansh Dalela*, Bjo Detroit, MI; Maxine Sun, Quoc-Dien Trinh, Boston, MA; Wooju Jeong, Craig Rogers, James Peabody, Mani Menon, Detroit, MI; Firas Abdollah, Royal Oak, MI INTRODUCTION AND OBJECTIVES: Prior literature has documented the geographical heterogeneity in prostate specific antigen (PSA) screening practices in the US. However, it is unknown if some states have a differential PSA screening pattern for non-Hispanic Black (NHB) vs. non-Hispanic Whites (NHWs). METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest continuously conducted health survey, weighted to represent the entire US population. 259,505 male respondents aged 40-99 (representing 50.03 million NHW and 7.5 million NHB) were identified from the BRFSS 2012 and 2014 surveys. Those who underwent PSA testing within the last 12 months as a part of routine exam (i.e., no personal/family history of prostate cancer and/or ’prostate problem’) were considered to have undergone screening. Differences in PSA screening prevalence across the 51 states of the US were assessed, and complex sample logistic regression analyses were used to test the relationship between race and receipt of PSA screening, stratified by individual states and adjusting for all available covariates. RESULTS: Overall, 32.3% (95% CI 32.0-32.7%) reported PSA screening for survey years 2012 and 2014, varying from 21.6% in Vermont to 40.1% in Florida (p<0.001). Overall, NHW were more often screened than NHB (32.7% vs. 30.1%, p<0.01). In adjusted analyses predicting PSA screening, the interaction term between race and state was significant (p¼0.04) but not for race and survey year. There were wide variations in screening rates for NHW vs. NHB across states (figure), ranging from 22.5% higher NHW screening in South Dakota to 13.8% higher NHB screening in Utah (median difference between NHW vs. NHB 5.8%). Overall, at multivariable analyses, NHB had higher odds of receiving a PSA screening (OR 1.18, p<0.01). At a state-bystate level, NHB men in Florida, Missouri, Maryland and Michigan had higher odds of PSA screening than NHW (OR 2.12, 1.77, 1.63 and 1.42 respectively, all p<0.05), but not in the other states. No state had significantly higher odds of screening NHW, when compared to NHB. CONCLUSIONS: Despite being perceived as a high-risk group for PCa, PSA screening practices for NHB men varies widely across states within the US, with only some states more likely to screen NHB men compared to their NHW counterparts.
Source of Funding: None
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ESBL in 2.2%. 15% of patients who were not swabbed received i.v antibiotics. 6/808 (0.7%) screened patients developed sepsis, as opposed to 4/124 (3.2%) in patients not screened (p¼0.03 Fischer’s exact test). Allowing for all costs incurred by screening, including intravenous antibiotics, screening for FRE saved $10/patient biopsied. CONCLUSIONS: Screening for fluoroquinolone resistant E. coli prior to TRUS guided prostate biopsy with subsequent targeted antibiotics is a cost effective strategy to significantly reduce the risk of post biopsy sepsis. Source of Funding: Urology research waikato limited
MP21-05 TEMPORAL TRENDS IN PROSTATE CANCER RISK GROUP STRATIFICATION FOLLOWING THE 2008 UNITED STATES PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS Firas Abdollah*, Royal Oak, MI; Deepansh Dalela, Akshay Sood, Jesse Sammon, Patrick Karabon, Detroit, MI; Christian Meyer, Maxine Sun, Toni Choueiri, Boston, MA; Mani Menon, Detroit, MI; Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: In 2008, the United States Preventive Services Task Force (USPSTF) recommended against prostate specific antigen (PSA) screening for prostate cancer (PCa) in men aged >¼75 years. We examined temporal trends in PCa risk profile before and after the 2008 USPSTF recommendations in a nationwide dataset. METHODS: Men newly diagnosed with PCa within the National Cancer Data Base (NCDB) 2005-07 and 2009-11 were risk-stratified according to the National Comprehensive Cancer Network guidelines (low: T1c-T2a, biopsy Gleason <¼6 and PSA<10 ng/ml; intermediate: T2b-T2c, biopsy Gleason¼7 or PSA 10-20 ng/ml; high: T3a and above, biopsy Gleason 8-10 or PSA >20 ng/ml, and metastatic [anyT/anyN/ M1]). A difference-in-differences (DID) model was used to ascertain the independent effect of the 2008 recommendation in older men (aged >¼75), using younger men (aged <75) that were not subject to the USPSTF statement as a control population to account for baseline secular trends in risk stratification, and adjusting for all available demographic and socio-economic variables. RESULTS: Overall, 195,495 (29.7%) low-risk, 298,386 (45.3%) intermediate-risk, 155,933 (23.7%) high-risk localized PCa, as well as as 8,721 (1.3%) metastatic PCa cases were diagnosed in the NCDB over the study period. Amongst older men, the proportion of high-risk and metastatic PCa increased (from 36.7% to 41.7% and 3.1% to 6.1%, respectively) and low-risk PCa decreased (19.6% to 14.4%) from 2005 to 2011, while the opposite trend was noted in younger men (CochranArmitage trend test p<0.001 for all). Older men had higher mean PSA (20.7 vs. 17.1 ng/ml) and biopsy Gleason 8-10 (30.9 vs. 24.9%) at diagnosis in NCDB 2009-11 vs. 2005-07. DID multivariate regression confirmed the results (DID odds ratio [OR] for high-risk PCa 1.20 [95% CI 1.16-1.25] and metastatic PCa 1.34 [95% CI 1.21-1.48] in older vs. younger men). Older men with Charlson comorbidity index (CCI) score 0 or life expectancy >10 years were 24% and 20% more likely to be diagnosed with high-risk PCa than men aged <75 respectively (p<0.01), but not men with CCI >2. CONCLUSIONS: Our study highlights the increased likelihood of high- risk and metastatic PCa diagnoses for a man aged 75 and above following the USPSTF 2008 recommendations against PSA screening. This was especially true for older men with no comorbidities and good life expectancy. These results might serve as a herald for the changes in risk profile that have taken place in US after the 2011 USPSTF update, which recommended against PSA screening in all patients. Source of Funding: Vattikuti Urology Institute
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
MP21-06 STATE-BY-STATE RACIAL VARIATIONS IN PROSTATE SPECIFIC ANTIGEN SCREENING PATTERNS: A NATIONWIDE ANALYSIS. €rn Lo € ppenberg, Akshay Sood, Jesse Sammon, Deepansh Dalela*, Bjo Detroit, MI; Maxine Sun, Quoc-Dien Trinh, Boston, MA; Wooju Jeong, Craig Rogers, James Peabody, Mani Menon, Detroit, MI; Firas Abdollah, Royal Oak, MI INTRODUCTION AND OBJECTIVES: Prior literature has documented the geographical heterogeneity in prostate specific antigen (PSA) screening practices in the US. However, it is unknown if some states have a differential PSA screening pattern for non-Hispanic Black (NHB) vs. non-Hispanic Whites (NHWs). METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest continuously conducted health survey, weighted to represent the entire US population. 259,505 male respondents aged 40-99 (representing 50.03 million NHW and 7.5 million NHB) were identified from the BRFSS 2012 and 2014 surveys. Those who underwent PSA testing within the last 12 months as a part of routine exam (i.e., no personal/family history of prostate cancer and/or ’prostate problem’) were considered to have undergone screening. Differences in PSA screening prevalence across the 51 states of the US were assessed, and complex sample logistic regression analyses were used to test the relationship between race and receipt of PSA screening, stratified by individual states and adjusting for all available covariates. RESULTS: Overall, 32.3% (95% CI 32.0-32.7%) reported PSA screening for survey years 2012 and 2014, varying from 21.6% in Vermont to 40.1% in Florida (p<0.001). Overall, NHW were more often screened than NHB (32.7% vs. 30.1%, p<0.01). In adjusted analyses predicting PSA screening, the interaction term between race and state was significant (p¼0.04) but not for race and survey year. There were wide variations in screening rates for NHW vs. NHB across states (figure), ranging from 22.5% higher NHW screening in South Dakota to 13.8% higher NHB screening in Utah (median difference between NHW vs. NHB 5.8%). Overall, at multivariable analyses, NHB had higher odds of receiving a PSA screening (OR 1.18, p<0.01). At a state-bystate level, NHB men in Florida, Missouri, Maryland and Michigan had higher odds of PSA screening than NHW (OR 2.12, 1.77, 1.63 and 1.42 respectively, all p<0.05), but not in the other states. No state had significantly higher odds of screening NHW, when compared to NHB. CONCLUSIONS: Despite being perceived as a high-risk group for PCa, PSA screening practices for NHB men varies widely across states within the US, with only some states more likely to screen NHB men compared to their NHW counterparts.
Source of Funding: None