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MP21-11 AGE DEPENDENT VARIATION IN THE EFFECT OF PHYSICIAN RECOMMENDATIONS TO UNDERGO PROSTATE SPECIFIC ANTIGEN (PSA) SCREENING FOLLOWING THE UNITED STATES PREVENTIVE SERVICES TASK FORCE 2012 STATEMENT AGAINST PSA SCREENING.
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THE JOURNAL OF UROLOGYâ
MP21-09 INFORMED DECISION MAKING PRIOR TO PSA SCREENING: INITIAL RESULTS USING THE AMERICAN CANCER SOCIETY (ACS) DECSION AID (DA) AMONG A MEDICALLY UNDERSERVED COHORT
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
Source of Funding: Texas Us Too Prostate Cancer Support Group
MP21-10
Mehmet Gokce*, Jacqueline Frost, Pamela Roberson, Robert Volk, Curtis Pettaway, HOUSTON, TX
THE IMPACT OF MEDICARE ELIGIBILITY ON PROSTATE CANCER SCREENING BEHAVIORS
INTRODUCTION AND OBJECTIVES: Many organizations recommend an informed decision making (IDM) approach prior to testing for prostate cancer (Pca) utilizing prostate specific antigen (PSA) given recent controversy. We determined the feasibility and efficacy of the ACS DA in a cohort of indigent medically underserved males (MUM). METHODS: Subjects (n¼285) were either referred by their physicians or solicited via flyer in an outpatient clinic that serves a MUM population. Baseline demographic data and Pca knowledge were collected and subjects were then provided the DA consisting of a 20 slide power-point presentation adapted verbatum from the ACS instrument. Post-test assessment of knowledge was performed using the same 11 question instrument used for baseline assessment. In addition, intention to screen as well as actual screening was determined. Informed consent was obtained prior to PSA testing. Answering 8 of eleven questions correctly was termed adequate knowledge of Pca. Surveys were completed to determine participant’s opinion about the information provided to make a decision regarding testing and the DA. RESULTS: The mean age was 577 years with baseline demographic data depicting a MUM African American and Hispanic population (see Table). At baseline, 79 patients (33.1%) exhibited adequate Pca knowledge. Post DA, 174 patients (77%) were shown to have adequate knowledge (p¼ 0.001). Post DA, 206 (94.5%), 8 (3.7%), and 4 (1.8%) patients, respectively, stated they either wanted to be tested, were unsure, or did not want to be tested for Pca. The DA was found to present clear information to make a decision regarding screening for Pca in 77.395.6% of subjects. Most patients rated the DA favorably in terms of amount, length, clarity, and balance of information and would recommend to others. Two hundred eighty one men (98.5%) had a PSA test performed. Median PSA was 0.9ng/ml (0.1-10.7). DRE was performed in 180 men with 29 (16.1%) abnormal. Either an abnormal DRE or serum PSA was noted in 51 patients. Six of 16 biopsied patients (37.5%) exhibited Pca. CONCLUSIONS: Use of the ACS DA was feasible among MUM in a clinic setting and lead to increased Pca knowledge, and was associated with high rates of PSA screening among this cohort
Christian Meyer*, Boston, MA; Jesse Sammon, Detroit, MI; € rn Lo € ppenberg, Jeffrey Leow, Nawar Hanna, Julian Hanske, Bjo Alexander Cole, Boston, MA; Firas Abdollah, Mani Menon, Detroit, MI; Maxine Sun, Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: Lack of health insurance limits access to preventive services, including cancer screening. We examined effects of Medicare eligibility on the appropriate use of prostate cancer screening in the United States. METHODS: We performed a cross-sectional analysis of the 2012 Behavioral Risk Factor and Surveillance System (analyzed in 2014). Univariable and logistic regression analyses were performed for participants aged 60-64 and 66-70 to examine effects of Medicare eligibility on the prevalence of self-reported screening for prostate cancer. Sub-analyses were performed among low-income (<$25,000 annual/household) and among insured and uninsured individuals. RESULTS: Medicare-eligible individuals were significantly more likely to undergo prostate cancer screening OR: 1.29; 95%CI 1.17-1.43; and the effect was most pronounced among low-income individuals OR: 1.39; 95%CI 1.12-1.72. Access to a health care provider was the strongest independent predictor of undergoing screening in the entire cohort (OR 4.0; 95% CI 3.35-4.80) and the low income bracket (OR 3.71; 95%CI 2.58-5.33). The difference in screening was more pronounced when comparing Medicare-eligible participants to uninsured Medicare-ineligible participants (+33.2%), than to insured Medicareineligible participants (+4.9%). CONCLUSIONS: Medicare eligibility impacts prostate cancer screening rates, likely as a result of increased access to primary care providers. Low-income individuals benefit most from Medicare eligibility. Expanded public insurance coverage to these individuals may improve access to preventive services. Source of Funding: none
MP21-11 AGE DEPENDENT VARIATION IN THE EFFECT OF PHYSICIAN RECOMMENDATIONS TO UNDERGO PROSTATE SPECIFIC ANTIGEN (PSA) SCREENING FOLLOWING THE UNITED STATES PREVENTIVE SERVICES TASK FORCE 2012 STATEMENT AGAINST PSA SCREENING. Jesse Sammon*, Deepansh Dalela, Detroit, MI; Firas Abdollah, Royal Oak, MI; Akshay Sood, Detroit, MI; Paul Han, Moritz Hansen, Portland, €rn Lo € ppenberg, Patrick Karabon, Mani Menon, Detroit, MI; ME; Bjo Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: Men’s acceptance of prostate specific antigen (PSA) screening has been strongly linked to their physician’s recommendation for the same. However, the impact of the United States Preventive Services Task Force (USPSTF) 2012 statement against PSA screening in mediating this association is unknown. METHODS: Data from 2010 and 2013 National Health Interview Survey (NHIS) were extracted. The study cohort consisted of male respondents >¼50 years old, who visited a physician within the last 12 months and reported receiving PSA screening recommendation. Logistic regression model (adjusted for all available socio-demographic variables) with an interaction term between age group and survey year was then used to identify the independent effect of survey year on receipt of PSA screening across different age strata among men who were recommended to undergo screening. RESULTS: Among men recommended PSA screening (46.8% of the male population), fewer reported undergoing screening in survey year 2013 vs. 2010 overall (41.3 vs. 46.5% respectively, p<0.001) (Figure). Over the study period, the proportion of men aged 50-64 who
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
underwent PSA screening decreased from 52.2% to 46.9% (p¼0.01). Survey year 2013 vs. 2010 was associated with decreased odds of screening (OR 0.74, 95% CI 0.66-0.83); the interaction term for age and survey year was not significant. Men with higher self reported health status were no more likely to undergo screening than their less healthy counterparts. CONCLUSIONS: Our results suggest a nationwide impact of the 2012 USPSTF statement on discouraging PSA screening despite their physician’s recommendation for screening, although this was restricted to men aged 50-64. Widespread media coverage and greater awareness of the implications of PSA screening may underlie this phenomenon.
Source of Funding: Vattikuti Urology Institute
MP21-12 PCA3 AND T2:ERG ADD FURTHER PREDICTIVE AND CLINICAL BENEFIT TO THE DETECTION OF PROSTATE CANCER IN MEN OF VARIOUS AGES IN THE EARLY DETECTION RESEARCH NETWORK (EDRN) Padraic O’Malley*, David M. Golombos, Patrick Lewicki, Bashir Al Hussein Al Awamlh, Paul J. Christos, New York, NY; Ian M. Thompson, San Antonio, TX; Martin G. Sanda, Atlanta, GA; John T. Wei, Livonia, MI; Mark A. Rubin, Christopher E. Barbieri, Douglas S. Scherr, New York, NY INTRODUCTION AND OBJECTIVES: Prostate-specific antigen lacks specificity to accurately detect prostate cancer (PCa). Biomarkers
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such as Prostate Cancer Antigen 3 (PCA3) and transmembrane protease, serine 2 and v-ets erythroblastosis virus E26 oncogene homolog gene fusion (T2:ERG) have been utilized to improve prediction models such as the Prostate Cancer Prevention Trial Risk Calculator (PCPT RC). However, the utility of such biomarkers in men < 55 years of age (Younger) vs men >55 years of age (Older) is unknown. This study assess the value added by PCA3 and/or T2:ERG to the PCPT RC for detection of PCa amongst Younger and Older men. METHODS: Prospective post-digital rectal exam urine was collected with informed consent from 718 men presenting for transrectal ultrasound (TRUS) guided biopsy at three academic sites as part of the Early Detection Research Network (EDRN) study. Outcome was defined as presence of PCa on TRUS biopsy. Receiver operating characteristic (ROC) curves were performed for the two age groups to evaluate predictive utility of PCA3 and T2:ERG via logistic regression models. The area under the curve (AUC) was compared to the base model of PCPT RC to delineate the added benefit of PCA3 and/or T2:ERG in the two cohorts. Decision curve analysis (DCA) was then employed to evaluate whether this predictive utility added clinical benefit. RESULTS: Of 718 men, 143 (19.92%) were Younger. 324 (45%) men were found to have PCa on biopsy; of these 54 of 143 (37.1%) were seen in Younger men. The AUCs for PCPT RC for the Younger and Older groups for the various models is summarized in Table 1. Models involving PCA3, T2:ERG, and both biomarkers were found to have a significantly higher predictive ability on ROC analysis in Younger men (p¼0.01, 0.03, and 0.002, respectively). Similarly, improved utility was also seen in Older men for the respective biomarkers (p<0.001). Decision curve analysis demonstrated clinical benefit to use of the biomarkers over a wide set of thresholds from 20-80% in both Younger and Older men (Fig 1). CONCLUSIONS: The addition of PCA3 and T2:ERG adds predictive value to the PCPT RC for diagnosing PCa in younger patients. Furthermore, it is clear there is clinical benefit to utilization of these biomarkers over a broad set of clinical thresholds.
THE JOURNAL OF UROLOGYâ
MP21-09 INFORMED DECISION MAKING PRIOR TO PSA SCREENING: INITIAL RESULTS USING THE AMERICAN CANCER SOCIETY (ACS) DECSION AID (DA) AMONG A MEDICALLY UNDERSERVED COHORT
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
Source of Funding: Texas Us Too Prostate Cancer Support Group
MP21-10
Mehmet Gokce*, Jacqueline Frost, Pamela Roberson, Robert Volk, Curtis Pettaway, HOUSTON, TX
THE IMPACT OF MEDICARE ELIGIBILITY ON PROSTATE CANCER SCREENING BEHAVIORS
INTRODUCTION AND OBJECTIVES: Many organizations recommend an informed decision making (IDM) approach prior to testing for prostate cancer (Pca) utilizing prostate specific antigen (PSA) given recent controversy. We determined the feasibility and efficacy of the ACS DA in a cohort of indigent medically underserved males (MUM). METHODS: Subjects (n¼285) were either referred by their physicians or solicited via flyer in an outpatient clinic that serves a MUM population. Baseline demographic data and Pca knowledge were collected and subjects were then provided the DA consisting of a 20 slide power-point presentation adapted verbatum from the ACS instrument. Post-test assessment of knowledge was performed using the same 11 question instrument used for baseline assessment. In addition, intention to screen as well as actual screening was determined. Informed consent was obtained prior to PSA testing. Answering 8 of eleven questions correctly was termed adequate knowledge of Pca. Surveys were completed to determine participant’s opinion about the information provided to make a decision regarding testing and the DA. RESULTS: The mean age was 577 years with baseline demographic data depicting a MUM African American and Hispanic population (see Table). At baseline, 79 patients (33.1%) exhibited adequate Pca knowledge. Post DA, 174 patients (77%) were shown to have adequate knowledge (p¼ 0.001). Post DA, 206 (94.5%), 8 (3.7%), and 4 (1.8%) patients, respectively, stated they either wanted to be tested, were unsure, or did not want to be tested for Pca. The DA was found to present clear information to make a decision regarding screening for Pca in 77.395.6% of subjects. Most patients rated the DA favorably in terms of amount, length, clarity, and balance of information and would recommend to others. Two hundred eighty one men (98.5%) had a PSA test performed. Median PSA was 0.9ng/ml (0.1-10.7). DRE was performed in 180 men with 29 (16.1%) abnormal. Either an abnormal DRE or serum PSA was noted in 51 patients. Six of 16 biopsied patients (37.5%) exhibited Pca. CONCLUSIONS: Use of the ACS DA was feasible among MUM in a clinic setting and lead to increased Pca knowledge, and was associated with high rates of PSA screening among this cohort
Christian Meyer*, Boston, MA; Jesse Sammon, Detroit, MI; € rn Lo € ppenberg, Jeffrey Leow, Nawar Hanna, Julian Hanske, Bjo Alexander Cole, Boston, MA; Firas Abdollah, Mani Menon, Detroit, MI; Maxine Sun, Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: Lack of health insurance limits access to preventive services, including cancer screening. We examined effects of Medicare eligibility on the appropriate use of prostate cancer screening in the United States. METHODS: We performed a cross-sectional analysis of the 2012 Behavioral Risk Factor and Surveillance System (analyzed in 2014). Univariable and logistic regression analyses were performed for participants aged 60-64 and 66-70 to examine effects of Medicare eligibility on the prevalence of self-reported screening for prostate cancer. Sub-analyses were performed among low-income (<$25,000 annual/household) and among insured and uninsured individuals. RESULTS: Medicare-eligible individuals were significantly more likely to undergo prostate cancer screening OR: 1.29; 95%CI 1.17-1.43; and the effect was most pronounced among low-income individuals OR: 1.39; 95%CI 1.12-1.72. Access to a health care provider was the strongest independent predictor of undergoing screening in the entire cohort (OR 4.0; 95% CI 3.35-4.80) and the low income bracket (OR 3.71; 95%CI 2.58-5.33). The difference in screening was more pronounced when comparing Medicare-eligible participants to uninsured Medicare-ineligible participants (+33.2%), than to insured Medicareineligible participants (+4.9%). CONCLUSIONS: Medicare eligibility impacts prostate cancer screening rates, likely as a result of increased access to primary care providers. Low-income individuals benefit most from Medicare eligibility. Expanded public insurance coverage to these individuals may improve access to preventive services. Source of Funding: none
MP21-11 AGE DEPENDENT VARIATION IN THE EFFECT OF PHYSICIAN RECOMMENDATIONS TO UNDERGO PROSTATE SPECIFIC ANTIGEN (PSA) SCREENING FOLLOWING THE UNITED STATES PREVENTIVE SERVICES TASK FORCE 2012 STATEMENT AGAINST PSA SCREENING. Jesse Sammon*, Deepansh Dalela, Detroit, MI; Firas Abdollah, Royal Oak, MI; Akshay Sood, Detroit, MI; Paul Han, Moritz Hansen, Portland, €rn Lo € ppenberg, Patrick Karabon, Mani Menon, Detroit, MI; ME; Bjo Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: Men’s acceptance of prostate specific antigen (PSA) screening has been strongly linked to their physician’s recommendation for the same. However, the impact of the United States Preventive Services Task Force (USPSTF) 2012 statement against PSA screening in mediating this association is unknown. METHODS: Data from 2010 and 2013 National Health Interview Survey (NHIS) were extracted. The study cohort consisted of male respondents >¼50 years old, who visited a physician within the last 12 months and reported receiving PSA screening recommendation. Logistic regression model (adjusted for all available socio-demographic variables) with an interaction term between age group and survey year was then used to identify the independent effect of survey year on receipt of PSA screening across different age strata among men who were recommended to undergo screening. RESULTS: Among men recommended PSA screening (46.8% of the male population), fewer reported undergoing screening in survey year 2013 vs. 2010 overall (41.3 vs. 46.5% respectively, p<0.001) (Figure). Over the study period, the proportion of men aged 50-64 who
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
underwent PSA screening decreased from 52.2% to 46.9% (p¼0.01). Survey year 2013 vs. 2010 was associated with decreased odds of screening (OR 0.74, 95% CI 0.66-0.83); the interaction term for age and survey year was not significant. Men with higher self reported health status were no more likely to undergo screening than their less healthy counterparts. CONCLUSIONS: Our results suggest a nationwide impact of the 2012 USPSTF statement on discouraging PSA screening despite their physician’s recommendation for screening, although this was restricted to men aged 50-64. Widespread media coverage and greater awareness of the implications of PSA screening may underlie this phenomenon.
Source of Funding: Vattikuti Urology Institute
MP21-12 PCA3 AND T2:ERG ADD FURTHER PREDICTIVE AND CLINICAL BENEFIT TO THE DETECTION OF PROSTATE CANCER IN MEN OF VARIOUS AGES IN THE EARLY DETECTION RESEARCH NETWORK (EDRN) Padraic O’Malley*, David M. Golombos, Patrick Lewicki, Bashir Al Hussein Al Awamlh, Paul J. Christos, New York, NY; Ian M. Thompson, San Antonio, TX; Martin G. Sanda, Atlanta, GA; John T. Wei, Livonia, MI; Mark A. Rubin, Christopher E. Barbieri, Douglas S. Scherr, New York, NY INTRODUCTION AND OBJECTIVES: Prostate-specific antigen lacks specificity to accurately detect prostate cancer (PCa). Biomarkers
THE JOURNAL OF UROLOGYâ
e249
such as Prostate Cancer Antigen 3 (PCA3) and transmembrane protease, serine 2 and v-ets erythroblastosis virus E26 oncogene homolog gene fusion (T2:ERG) have been utilized to improve prediction models such as the Prostate Cancer Prevention Trial Risk Calculator (PCPT RC). However, the utility of such biomarkers in men < 55 years of age (Younger) vs men >55 years of age (Older) is unknown. This study assess the value added by PCA3 and/or T2:ERG to the PCPT RC for detection of PCa amongst Younger and Older men. METHODS: Prospective post-digital rectal exam urine was collected with informed consent from 718 men presenting for transrectal ultrasound (TRUS) guided biopsy at three academic sites as part of the Early Detection Research Network (EDRN) study. Outcome was defined as presence of PCa on TRUS biopsy. Receiver operating characteristic (ROC) curves were performed for the two age groups to evaluate predictive utility of PCA3 and T2:ERG via logistic regression models. The area under the curve (AUC) was compared to the base model of PCPT RC to delineate the added benefit of PCA3 and/or T2:ERG in the two cohorts. Decision curve analysis (DCA) was then employed to evaluate whether this predictive utility added clinical benefit. RESULTS: Of 718 men, 143 (19.92%) were Younger. 324 (45%) men were found to have PCa on biopsy; of these 54 of 143 (37.1%) were seen in Younger men. The AUCs for PCPT RC for the Younger and Older groups for the various models is summarized in Table 1. Models involving PCA3, T2:ERG, and both biomarkers were found to have a significantly higher predictive ability on ROC analysis in Younger men (p¼0.01, 0.03, and 0.002, respectively). Similarly, improved utility was also seen in Older men for the respective biomarkers (p<0.001). Decision curve analysis demonstrated clinical benefit to use of the biomarkers over a wide set of thresholds from 20-80% in both Younger and Older men (Fig 1). CONCLUSIONS: The addition of PCA3 and T2:ERG adds predictive value to the PCPT RC for diagnosing PCa in younger patients. Furthermore, it is clear there is clinical benefit to utilization of these biomarkers over a broad set of clinical thresholds.