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Dr. Klein scans the journals, so you don’t have to!

Mark Klein, MD
            The introduction and subsequent application of the use of prostate specific antigen (PSA) for use in the detection and monitoring of prostate cancer demonstrates how challenging, and sometimes controversial, development of appropriate screening strategies in a cancer with highly heterogenous outcomes can be. In 2012, the United States Preventive Services Task Force (USPSTF) published a “D” recommendation (recommended against using PSA for screening) for the use of PSA for screening for prostate cancer, and PSA-based screening rates subsequently declined. However, based on new evidence, in 2017 the USPSTF upgraded the recommendation to a “C” recommendation (endorsing individual decision-making). Leapman et al examined claims from an insurance company (Blue Cross/Blue Shield) from 2016 to 2019 to determine if PSA testing rates increased after that decision. Over that time, PSA testing increased from 32.5 to 36.5 tests per 100 person-years, corresponding to a relative increase of 12.5%. While no definitive conclusions for addressing individual patients can be identified from this study, the results suggest that the USPSTF recommendations hold significant weight.

 

            Racial and ethnic disparities in prostate cancer diagnosis and treatment are well recognized. Prostate magnetic resonance imaging (MRI) as part of a diagnostic approach for people with elevated PSA may decrease unnecessary biopsies or better direct biopsies based on results, and its use is increasing significantly. Abashidze et al examined Medicare claims between 2011 and 2017 to determine if racial disparities were present with respect to the use of prostate MRI. Compared with White men, Black, Asian, and Hispanic men were less likely to have a prostate MRI within 180 days after an elevated PSA (results stratified at 2.5, 4, or 10 ng/mL). The differences were most pronounced for patients with a PSA at 4 ng/mL or higher. The results suggest that providers should be aware of potential system and individual factors that influence racial and ethnic disparities in the use of prostate MRI.

            Studies designed to evaluate germline and somatic genomic abnormalities in prostate cancer have come to the forefront in the last decade. Lynch syndrome is an inherited cancer syndrome of abnormalities in at least one of the commonly recognized mismatch repair genes: MLH1, MSH2, MSH6, or PMS2. While testing for mismatch repair deficiency is recommended in the advanced setting where systemic therapy is being considered, such testing outside of known family history is unclear in the setting of screening for prostate cancer. Bancroft et al compared PSA levels (and prostate cancer incidence) as part of baseline screening between carriers of one of mismatch repair genes (MLH1, MSH2, MSH6) and non-carrier controls. Carriers of MLH1 and MSH6 variants had a higher incidence of prostate cancer compared with controls. While not yet recommended for standard practice, further studies will be needed to verify these compelling results.

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Mark Klein, MD

Minneapolis VA Health Care System

University of Minnesota

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Mark Klein, MD

Minneapolis VA Health Care System

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Mark Klein, MD

Minneapolis VA Health Care System

University of Minnesota

Dr. Klein scans the journals, so you don’t have to!
Dr. Klein scans the journals, so you don’t have to!

Mark Klein, MD
            The introduction and subsequent application of the use of prostate specific antigen (PSA) for use in the detection and monitoring of prostate cancer demonstrates how challenging, and sometimes controversial, development of appropriate screening strategies in a cancer with highly heterogenous outcomes can be. In 2012, the United States Preventive Services Task Force (USPSTF) published a “D” recommendation (recommended against using PSA for screening) for the use of PSA for screening for prostate cancer, and PSA-based screening rates subsequently declined. However, based on new evidence, in 2017 the USPSTF upgraded the recommendation to a “C” recommendation (endorsing individual decision-making). Leapman et al examined claims from an insurance company (Blue Cross/Blue Shield) from 2016 to 2019 to determine if PSA testing rates increased after that decision. Over that time, PSA testing increased from 32.5 to 36.5 tests per 100 person-years, corresponding to a relative increase of 12.5%. While no definitive conclusions for addressing individual patients can be identified from this study, the results suggest that the USPSTF recommendations hold significant weight.

 

            Racial and ethnic disparities in prostate cancer diagnosis and treatment are well recognized. Prostate magnetic resonance imaging (MRI) as part of a diagnostic approach for people with elevated PSA may decrease unnecessary biopsies or better direct biopsies based on results, and its use is increasing significantly. Abashidze et al examined Medicare claims between 2011 and 2017 to determine if racial disparities were present with respect to the use of prostate MRI. Compared with White men, Black, Asian, and Hispanic men were less likely to have a prostate MRI within 180 days after an elevated PSA (results stratified at 2.5, 4, or 10 ng/mL). The differences were most pronounced for patients with a PSA at 4 ng/mL or higher. The results suggest that providers should be aware of potential system and individual factors that influence racial and ethnic disparities in the use of prostate MRI.

            Studies designed to evaluate germline and somatic genomic abnormalities in prostate cancer have come to the forefront in the last decade. Lynch syndrome is an inherited cancer syndrome of abnormalities in at least one of the commonly recognized mismatch repair genes: MLH1, MSH2, MSH6, or PMS2. While testing for mismatch repair deficiency is recommended in the advanced setting where systemic therapy is being considered, such testing outside of known family history is unclear in the setting of screening for prostate cancer. Bancroft et al compared PSA levels (and prostate cancer incidence) as part of baseline screening between carriers of one of mismatch repair genes (MLH1, MSH2, MSH6) and non-carrier controls. Carriers of MLH1 and MSH6 variants had a higher incidence of prostate cancer compared with controls. While not yet recommended for standard practice, further studies will be needed to verify these compelling results.

Mark Klein, MD
            The introduction and subsequent application of the use of prostate specific antigen (PSA) for use in the detection and monitoring of prostate cancer demonstrates how challenging, and sometimes controversial, development of appropriate screening strategies in a cancer with highly heterogenous outcomes can be. In 2012, the United States Preventive Services Task Force (USPSTF) published a “D” recommendation (recommended against using PSA for screening) for the use of PSA for screening for prostate cancer, and PSA-based screening rates subsequently declined. However, based on new evidence, in 2017 the USPSTF upgraded the recommendation to a “C” recommendation (endorsing individual decision-making). Leapman et al examined claims from an insurance company (Blue Cross/Blue Shield) from 2016 to 2019 to determine if PSA testing rates increased after that decision. Over that time, PSA testing increased from 32.5 to 36.5 tests per 100 person-years, corresponding to a relative increase of 12.5%. While no definitive conclusions for addressing individual patients can be identified from this study, the results suggest that the USPSTF recommendations hold significant weight.

 

            Racial and ethnic disparities in prostate cancer diagnosis and treatment are well recognized. Prostate magnetic resonance imaging (MRI) as part of a diagnostic approach for people with elevated PSA may decrease unnecessary biopsies or better direct biopsies based on results, and its use is increasing significantly. Abashidze et al examined Medicare claims between 2011 and 2017 to determine if racial disparities were present with respect to the use of prostate MRI. Compared with White men, Black, Asian, and Hispanic men were less likely to have a prostate MRI within 180 days after an elevated PSA (results stratified at 2.5, 4, or 10 ng/mL). The differences were most pronounced for patients with a PSA at 4 ng/mL or higher. The results suggest that providers should be aware of potential system and individual factors that influence racial and ethnic disparities in the use of prostate MRI.

            Studies designed to evaluate germline and somatic genomic abnormalities in prostate cancer have come to the forefront in the last decade. Lynch syndrome is an inherited cancer syndrome of abnormalities in at least one of the commonly recognized mismatch repair genes: MLH1, MSH2, MSH6, or PMS2. While testing for mismatch repair deficiency is recommended in the advanced setting where systemic therapy is being considered, such testing outside of known family history is unclear in the setting of screening for prostate cancer. Bancroft et al compared PSA levels (and prostate cancer incidence) as part of baseline screening between carriers of one of mismatch repair genes (MLH1, MSH2, MSH6) and non-carrier controls. Carriers of MLH1 and MSH6 variants had a higher incidence of prostate cancer compared with controls. While not yet recommended for standard practice, further studies will be needed to verify these compelling results.

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