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MP5-13 DOES DIGITAL RECTAL EXAMINATION PROVIDE ADDITIONAL VALUE IN THE ERA OF PSA SCREENING?: LESSONS FROM THE PLCO STUDY
THE JOURNAL OF UROLOGYâ
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Increased knowledge of the limitations of PSA screening (OR¼9.38 (4.68-18.81), compared to no knowledge) was, surprisingly, associated with a higher likelihood of screening. Higher knowledge of the limitations of PSA screening was associated with older age [Age 60e69: OR¼ 3.16 (1.71-5.84); Age 70þ: OR¼ 4.23 (2.01-8.91)], access to a regular healthcare provider (OR¼2.07 (1.16-3.68)), and a personal preference of knowing one’s cancer risk (OR¼ 2.19 (1.27-3.78)). CONCLUSIONS: Men who are uninformed about the limitations of PSA screening are less likely to be tested. Certain vulnerable populations, such as those without regular healthcare access, are less likely to be informed. Future efforts should focus on implementing shared decision-making into clinical practice to reduce healthcare disparities and ensure that variation in PSA screening are consistent with patient preferences, rather than those of physicians or policy makers. Source of Funding: None
MP5-13 DOES DIGITAL RECTAL EXAMINATION PROVIDE ADDITIONAL VALUE IN THE ERA OF PSA SCREENING?: LESSONS FROM THE PLCO STUDY Tao Cui*, Robert C. Kovell, David C. Brooks, Ryan P. Terlecki, Winston Salem, NC INTRODUCTION AND OBJECTIVES: Prostate cancer is the most prevalent cancer overall and the second leading cause of cancer death in men. Recently, the United States Preventive Services Task Force recommended against general screening for prostate cancer due to over diagnosis of indolent disease and the detrimental side effects associated with treatment. Despite this, screening with prostate specific antigen (PSA) testing and digital rectal examination (DRE) are still performed frequently in both primary care and urology clinics, primarily out of concern for missing clinically significant prostate cancer (CSPCA). We seek to evaluate the value of DRE in detecting CSPCA in the era of PSA testing. METHODS: We analyzed the data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Participants in the study arm were identified and categorized based on PSA testing and DRE status. We evaluated the ability of DRE to detect CSPCA in the setting of both normal (PSA < 4.0 ng/mL) and abnormal PSA testing. CSPCA was defined as intermediate risk or higher based on NCCN guidelines and age less than 75. Additionally, we compared the tumor characteristics of patients diagnosed with CSPCA by PSA testing vs DRE. RESULTS: Review of the PLCO database reviewed 38,340 men who participated in the screening arm of the trial with 13 year follow-up data available. All men with either an abnormal PSA test or abnormal DRE were offered prostate biopsy. In the setting of normal PSA and an abnormal DRE, 253 out of 4,448 (5.7%) participants were diagnosed with CSPCA. In the setting of an abnormal PSA and a normal DRE, 939 out of 4,840 (19.4%) participants were identified with CSPCA. In the setting of both an abnormal PSA and abnormal DRE, 397 out of 1,524 (26.0%) were diagnosed with CSPCA (RR ¼ 1.27 [1.14 e 1.41] compared to abnormal PSA alone). No significant differences were observed in terms of Gleason grading between these groups. CONCLUSIONS: Our analysis indicates that DRE screening has a poor specificity in men with normal PSA values. DRE does capture an additional small population of men with CSPCA in the setting of normal PSA testing and may contribute additional diagnostic and prognostic information in the setting of abnormal PSA testing. However, DRE subjects a large number of men to invasive, potentially uncomfortable examinations for relatively minimal gain. Source of Funding: None
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
MP5-14 RANDOMIZED, SINGLE CENTER TRIAL OF THE EFFECT OF EXTENDING TIME FROM PERI-PROSTATIC LIDOCAINE INJECTION TO ONSET OF TRANSRECTAL ULTRASOUNDGUIDED PROSTATE BIOPSY ON PATIENT-REPORTED PAIN SCORES Ram Pathak*, Alexander Parker, Andrea Tavlarides, Julia Crook, Nancy Diehl, Scott Alford, Michael Heckman, Todd Igel, Jacksonville, FL INTRODUCTION AND OBJECTIVES: Although the efficacy of peri-prostatic lidocaine injection in terms of site, dosage and method of administration has been previously described in prospective randomized control trials elsewhere, the time from lidocaine injection to prostate biopsy has not been thoroughly investigated. The primary aim was to compare Visual Analog Scale (VAS) pain scores between patients with a 2-minute delay of lidocaine injection to onset of prostate biopsy and patients with a 10-minute delay. Secondary aims compared VAS scores with 2 injections versus 3 injections. METHODS: A total of 80 prostate-biopsy naive males underwent standard 12 core transrectal ultrasound-guided prostate biopsy by a single surgeon in this prospective, single-blinded randomized study between September 2011 and July 2014. Patients were randomized into four treatment arms: bibasilar injection at 2 minutes, bibasilar and single apical injection at 2 minutes, bibasilar injection at 10 minutes, and bibasilar and single apical injection at 10 minutes. Patients were asked to report their level of pain on the VAS (1e10, with 10 indicating unbearable pain). All analyses were performed on the basis of intention-totreat principle. RESULTS: The mean age of the 80 patients was 65.0 years (41.9-90.3) with a median BMI of 29.5 (22.3-52.1). 92.4% of patients were Caucasian. All groups were comparable with respect to age, BMI and prostatic volume. In general, VAS scores were fairly low with a mean of 1.7. Only 16% of patients reported a VAS score greater than 4 for any one core. VAS scores were significantly higher for the 2-minute delay group compared to the 10-minute delay group when subtracted from the baseline VAS score (mean: -0.7 vs. -1.6, p¼0.025). Subset analysis of mean VAS scores during biopsies 1e3, 4e6, 7e9 and 10e12 minus baseline VAS score also demonstrated statistical significance when comparing 2-minute to 10-minute delay (p¼0.023, p¼0.020, p¼0.021 and p¼0.043, respectively). Secondary aims comparing mean VAS scores subtracted from baseline VAS scores of 2-injection vs. 3-injection groups demonstrated a trend toward significance with a mean of -0.8 vs. -1.4, p¼0.11. CONCLUSIONS: Extending the time from lidocaine injection to prostate biopsy results in lower VAS scores. Although this may lengthen the time of each individual prostate biopsy session, patients experience less pain, thereby reducing anxiety. Source of Funding: none
MP5-15 EMERGING DISPARITY IN TREATMENT FOR PROSTATE CANCER AMONG HISPANIC MEN- DATA FROM SEER 2004e2009 Kelvin Moses*, Nashville, TN; Heather Orom, Alicia Brasel, Buffalo, NY; Jacquelyne Gaddy, Chicago, IL; Willie Underwood III, Buffalo, NY INTRODUCTION AND OBJECTIVES: Racial disparities in the treatment of prostate cancer represent a significant source of poorer outcomes, particularly among African-American men. Prior data indicated that Hispanic men received similar treatment compared to nonHispanic White men. The purpose of this study is to determine the treatment trends among Hispanic men. METHODS: Utilizing the Surveillance, Epidemiology and End Results (SEER) database, we identified 16,495 Hispanic and 145,436 non-Hispanic White men diagnosed with prostate cancer from
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Increased knowledge of the limitations of PSA screening (OR¼9.38 (4.68-18.81), compared to no knowledge) was, surprisingly, associated with a higher likelihood of screening. Higher knowledge of the limitations of PSA screening was associated with older age [Age 60e69: OR¼ 3.16 (1.71-5.84); Age 70þ: OR¼ 4.23 (2.01-8.91)], access to a regular healthcare provider (OR¼2.07 (1.16-3.68)), and a personal preference of knowing one’s cancer risk (OR¼ 2.19 (1.27-3.78)). CONCLUSIONS: Men who are uninformed about the limitations of PSA screening are less likely to be tested. Certain vulnerable populations, such as those without regular healthcare access, are less likely to be informed. Future efforts should focus on implementing shared decision-making into clinical practice to reduce healthcare disparities and ensure that variation in PSA screening are consistent with patient preferences, rather than those of physicians or policy makers. Source of Funding: None
MP5-13 DOES DIGITAL RECTAL EXAMINATION PROVIDE ADDITIONAL VALUE IN THE ERA OF PSA SCREENING?: LESSONS FROM THE PLCO STUDY Tao Cui*, Robert C. Kovell, David C. Brooks, Ryan P. Terlecki, Winston Salem, NC INTRODUCTION AND OBJECTIVES: Prostate cancer is the most prevalent cancer overall and the second leading cause of cancer death in men. Recently, the United States Preventive Services Task Force recommended against general screening for prostate cancer due to over diagnosis of indolent disease and the detrimental side effects associated with treatment. Despite this, screening with prostate specific antigen (PSA) testing and digital rectal examination (DRE) are still performed frequently in both primary care and urology clinics, primarily out of concern for missing clinically significant prostate cancer (CSPCA). We seek to evaluate the value of DRE in detecting CSPCA in the era of PSA testing. METHODS: We analyzed the data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Participants in the study arm were identified and categorized based on PSA testing and DRE status. We evaluated the ability of DRE to detect CSPCA in the setting of both normal (PSA < 4.0 ng/mL) and abnormal PSA testing. CSPCA was defined as intermediate risk or higher based on NCCN guidelines and age less than 75. Additionally, we compared the tumor characteristics of patients diagnosed with CSPCA by PSA testing vs DRE. RESULTS: Review of the PLCO database reviewed 38,340 men who participated in the screening arm of the trial with 13 year follow-up data available. All men with either an abnormal PSA test or abnormal DRE were offered prostate biopsy. In the setting of normal PSA and an abnormal DRE, 253 out of 4,448 (5.7%) participants were diagnosed with CSPCA. In the setting of an abnormal PSA and a normal DRE, 939 out of 4,840 (19.4%) participants were identified with CSPCA. In the setting of both an abnormal PSA and abnormal DRE, 397 out of 1,524 (26.0%) were diagnosed with CSPCA (RR ¼ 1.27 [1.14 e 1.41] compared to abnormal PSA alone). No significant differences were observed in terms of Gleason grading between these groups. CONCLUSIONS: Our analysis indicates that DRE screening has a poor specificity in men with normal PSA values. DRE does capture an additional small population of men with CSPCA in the setting of normal PSA testing and may contribute additional diagnostic and prognostic information in the setting of abnormal PSA testing. However, DRE subjects a large number of men to invasive, potentially uncomfortable examinations for relatively minimal gain. Source of Funding: None
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
MP5-14 RANDOMIZED, SINGLE CENTER TRIAL OF THE EFFECT OF EXTENDING TIME FROM PERI-PROSTATIC LIDOCAINE INJECTION TO ONSET OF TRANSRECTAL ULTRASOUNDGUIDED PROSTATE BIOPSY ON PATIENT-REPORTED PAIN SCORES Ram Pathak*, Alexander Parker, Andrea Tavlarides, Julia Crook, Nancy Diehl, Scott Alford, Michael Heckman, Todd Igel, Jacksonville, FL INTRODUCTION AND OBJECTIVES: Although the efficacy of peri-prostatic lidocaine injection in terms of site, dosage and method of administration has been previously described in prospective randomized control trials elsewhere, the time from lidocaine injection to prostate biopsy has not been thoroughly investigated. The primary aim was to compare Visual Analog Scale (VAS) pain scores between patients with a 2-minute delay of lidocaine injection to onset of prostate biopsy and patients with a 10-minute delay. Secondary aims compared VAS scores with 2 injections versus 3 injections. METHODS: A total of 80 prostate-biopsy naive males underwent standard 12 core transrectal ultrasound-guided prostate biopsy by a single surgeon in this prospective, single-blinded randomized study between September 2011 and July 2014. Patients were randomized into four treatment arms: bibasilar injection at 2 minutes, bibasilar and single apical injection at 2 minutes, bibasilar injection at 10 minutes, and bibasilar and single apical injection at 10 minutes. Patients were asked to report their level of pain on the VAS (1e10, with 10 indicating unbearable pain). All analyses were performed on the basis of intention-totreat principle. RESULTS: The mean age of the 80 patients was 65.0 years (41.9-90.3) with a median BMI of 29.5 (22.3-52.1). 92.4% of patients were Caucasian. All groups were comparable with respect to age, BMI and prostatic volume. In general, VAS scores were fairly low with a mean of 1.7. Only 16% of patients reported a VAS score greater than 4 for any one core. VAS scores were significantly higher for the 2-minute delay group compared to the 10-minute delay group when subtracted from the baseline VAS score (mean: -0.7 vs. -1.6, p¼0.025). Subset analysis of mean VAS scores during biopsies 1e3, 4e6, 7e9 and 10e12 minus baseline VAS score also demonstrated statistical significance when comparing 2-minute to 10-minute delay (p¼0.023, p¼0.020, p¼0.021 and p¼0.043, respectively). Secondary aims comparing mean VAS scores subtracted from baseline VAS scores of 2-injection vs. 3-injection groups demonstrated a trend toward significance with a mean of -0.8 vs. -1.4, p¼0.11. CONCLUSIONS: Extending the time from lidocaine injection to prostate biopsy results in lower VAS scores. Although this may lengthen the time of each individual prostate biopsy session, patients experience less pain, thereby reducing anxiety. Source of Funding: none
MP5-15 EMERGING DISPARITY IN TREATMENT FOR PROSTATE CANCER AMONG HISPANIC MEN- DATA FROM SEER 2004e2009 Kelvin Moses*, Nashville, TN; Heather Orom, Alicia Brasel, Buffalo, NY; Jacquelyne Gaddy, Chicago, IL; Willie Underwood III, Buffalo, NY INTRODUCTION AND OBJECTIVES: Racial disparities in the treatment of prostate cancer represent a significant source of poorer outcomes, particularly among African-American men. Prior data indicated that Hispanic men received similar treatment compared to nonHispanic White men. The purpose of this study is to determine the treatment trends among Hispanic men. METHODS: Utilizing the Surveillance, Epidemiology and End Results (SEER) database, we identified 16,495 Hispanic and 145,436 non-Hispanic White men diagnosed with prostate cancer from