Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Biopsy referral after PSA screening stays consistent over time

13.12.2011
No movement toward more aggressive follow-up, study in American Journal of Preventive Medicine finds

After the US Prostate Cancer Prevention Trial found cancer in many men with low levels of prostate specific antigen (PSA), many debated which PSA level should lead to a biopsy recommendation. The US Preventive Screening Task Force (USPSTF) recently concluded, amid considerable controversy, that the evidence does not support recommending PSA screening for men under 75 years old at all, because the risks outweigh the benefits. Now, a study shows that physicians in a large Washington state health plan were being conservative in biopsy referral even before the USPSTF recommendation.

"Despite considerable recent debate about lowering the threshold for referring men to biopsy, we detected no change toward more aggressive biopsy referral practices in data spanning more than a decade for one integrated delivery system," says lead author Steven Zeliadt, PhD, of the Department of Veterans Affairs Medical Center in Seattle, Washington. "In fact, we observed an opposite pattern, with biopsies becoming slightly less common over the study period. This may reflect growing awareness of the problems of overdiagnosis and overtreatment—and the fact that many men die with prostate cancer but not from it."

Controversy is longstanding about what PSA threshold should be used to refer men for biopsy. The generally accepted standard is 4.0 ng/mL. However, some have urged lowering the level to 2.5 ng/mL, abandoning a specific cutoff altogether, or measuring the PSA velocity, or change over time, instead of absolute level. Dr. Zeliadt and his colleagues set out to determine if the actual biopsy referral practices in a community setting had changed in response to new recommendations, and to determine if PSA velocity is associated with follow-up biopsy.

The study examined PSA tests in members of Group Health, a health plan in Washington State and Northern Idaho, between 1997 and 2008. The final sample included 111,369 index tests among 54,831 subjects. For each test, the study evaluated the PSA level and velocity and the specific follow-up: receiving a biopsy within a year after the test date; attending a urology appointment within a year without biopsy; additional PSA testing within a year with no urology visit; and no PSA-related follow-up.

The researchers found that of tests with a PSA value greater than 4.0 ng/mL, 28% led to a biopsy within 12 months, and 38.6% were followed up by a urologist but did not result in a biopsy. Biopsies were slightly more common in the early years of the study, but biopsy rates did not differ over time for men with mild to moderate PSA levels. The threshold used for biopsy referral appeared not to change over time.

PSA velocity was strongly associated with biopsy. Among men whose PSA tests exceeded 4.0 ng/mL, those with a rapidly rising velocity were more likely to undergo biopsy. This rate was also consistent across the years of the study. "PSA velocity has been promoted for many years as having value for predicting death from prostate cancer, although several recent studies and evidence from screening trials have demonstrated that in practice, velocity adds little value. This is not surprising given that PSA is a continuous marker, and a rapid rise may be likely to trigger follow-up, thus reducing rates of death from prostate cancer," notes Dr. Zeliadt.

"Even small changes in the PSA threshold can substantially alter the potential harms and benefits of screening. However, providers have limited evidence to help them discuss this with patients," concludes Dr. Zeliadt, who is also affiliated with Group Health Research Institute and the University of Washington. "This study highlights the importance of acknowledging that how aggressively patients are referred for biopsy is an important component of the PSA screening discussion."

The article is "Biopsy Follow-Up of Prostate-Specific Antigen Tests," by S.B. Zeliadt, D.S. Buist, R.J. Reid, D.C. Grossman, J. Ma, and R. Etzioni (doi: 10.1016/j.amepre.2011.08.024). The article appears in the American Journal of Preventive Medicine, Volume 42, Issue 1 (January 2012), published by Elsevier.

Beverly Lytton | EurekAlert!
Further information:
http://www.ucsd.edu

More articles from Health and Medicine:

nachricht Novel anti-cancer nanomedicine for efficient chemotherapy
17.09.2019 | University of Helsinki

nachricht Researchers have identified areas of the retina that change in mild Alzheimer's disease
16.09.2019 | Universidad Complutense de Madrid

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Happy hour for time-resolved crystallography

Researchers from the Department of Atomically Resolved Dynamics of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg, the University of Hamburg and the European Molecular Biology Laboratory (EMBL) outstation in the city have developed a new method to watch biomolecules at work. This method dramatically simplifies starting enzymatic reactions by mixing a cocktail of small amounts of liquids with protein crystals. Determination of the protein structures at different times after mixing can be assembled into a time-lapse sequence that shows the molecular foundations of biology.

The functions of biomolecules are determined by their motions and structural changes. Yet it is a formidable challenge to understand these dynamic motions.

Im Focus: Modular OLED light strips

At the International Symposium on Automotive Lighting 2019 (ISAL) in Darmstadt from September 23 to 25, 2019, the Fraunhofer Institute for Organic Electronics, Electron Beam and Plasma Technology FEP, a provider of research and development services in the field of organic electronics, will present OLED light strips of any length with additional functionalities for the first time at booth no. 37.

Almost everyone is familiar with light strips for interior design. LED strips are available by the metre in DIY stores around the corner and are just as often...

Im Focus: Tomorrow´s coolants of choice

Scientists assess the potential of magnetic-cooling materials

Later during this century, around 2060, a paradigm shift in global energy consumption is expected: we will spend more energy for cooling than for heating....

Im Focus: The working of a molecular string phone

Researchers from the Department of Atomically Resolved Dynamics of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg, the University of Potsdam (both in Germany) and the University of Toronto (Canada) have pieced together a detailed time-lapse movie revealing all the major steps during the catalytic cycle of an enzyme. Surprisingly, the communication between the protein units is accomplished via a water-network akin to a string telephone. This communication is aligned with a ‘breathing’ motion, that is the expansion and contraction of the protein.

This time-lapse sequence of structures reveals dynamic motions as a fundamental element in the molecular foundations of biology.

Im Focus: Milestones on the Way to the Nuclear Clock

Two research teams have succeeded simultaneously in measuring the long-sought Thorium nuclear transition, which enables extremely precise nuclear clocks. TU Wien (Vienna) is part of both teams.

If you want to build the most accurate clock in the world, you need something that "ticks" very fast and extremely precise. In an atomic clock, electrons are...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Society 5.0: putting humans at the heart of digitalisation

10.09.2019 | Event News

Interspeech 2019 conference: Alexa and Siri in Graz

04.09.2019 | Event News

AI for Laser Technology Conference: optimizing the use of lasers with artificial intelligence

29.08.2019 | Event News

 
Latest News

Novel mechanism of electron scattering in graphene-like 2D materials

17.09.2019 | Materials Sciences

Novel anti-cancer nanomedicine for efficient chemotherapy

17.09.2019 | Health and Medicine

Fungicides as an underestimated hazard for freshwater organisms

17.09.2019 | Ecology, The Environment and Conservation

VideoLinks
Science & Research
Overview of more VideoLinks >>>