Vol. 44 (4): 697-703, July – August, 2018
Andrew W. Tam 1, Johnathan A. Khusid 1, Igor Inoyatov 1, Adan Z. Becerra 2, 3, Jonathan Davila 1, Jyoti D. Chouhan 1, Jeffrey P. Weiss 1, Llewellyn M. Hyacinthe 1, Brian K. McNeil 1, Andrew G. Winer 1
1 Department of Urology, University Hospital of Brooklyn, State University of New York Downstate College of Medicine, Brooklyn, NY, USA; 2 Department of Public Health Sciences and Division of Epidemiology, University of Rochester Medical Center, Rochester, NY, USA; 3 Department of Surgery, University of Rochester Medical Center, Surgical Health Outcomes and Research Enterprise (SHORE), Rochester, NY, USA
Introduction: We compared characteristics of patients undergoing prostate biopsy in a high-risk inner city population before and after the 2012 USPSTF recommendation against PSA based prostate cancer screening to determine its effect on prostate biopsy practices.
Materials and Methods: This was a retrospective study including patients who received biopsies after an abnormal PSA measurement from October 2008-December 2015. Patients with previously diagnosed prostate cancer were excluded. Chi-square tests of independence, two sample t-tests, Mann-Whitney U tests, and Fisher’s exact tests were performed.
Results: There were 202 and 208 patients in the pre-USPSTF and post-USPSTF recommendation cohorts, respectively. The post-USPSTF cohort had higher median PSA (7.8 versus 7.1ng/mL, p=0.05), greater proportion of patients who were black (96.6% versus 90.5%, p=0.01), and greater percentage of biopsy cores positive for disease (58% versus 29.5%, p<0.001). Multivariable analysis supported that the increase in PSA was independent of the increase in the proportion of patients who were black. The proportion of patients who were classified as D’Amico intermediate and high-risk disease increased in the post-USPSTF cohort and approached statistical significance (70.1% versus 58.8%, p=0.12).
Conclusions: Our study suggests that the USPSTF recommendations may have led to na increase in pre-biopsy PSA as well as greater volume of disease. Also, a greater proportion of patients were being classified with intermediate or high risk disease. While the clinical significance of these findings is unknown, what the data suggests is somewhat troubling. Future research should further examine these changes in a larger cohort as well as resultant long-term outcomes.
Keywords: Mass Screening; Prostatic Neoplasms; Prostate-Specific Antigen