Primary and secondary outcomes after 2 years’ follow-up: Adjusted multilevel logistic regression model (OR).

BackgroundAssessing genetic lifetime risk for prostate cancer has been proposed as a means of risk stratification to identify those for whom prostate-specific antigen (PSA) testing is likely to be most valuable. This project aimed to test the effect of introducing a genetic test for lifetime risk of prostate cancer in general practice on future PSA testing.Methods and findingsWe performed a cluster randomized controlled trial with randomization at the level of general practices (73 in each of two arms) in the Central Region (Region Midtjylland) of Denmark. In intervention practices, men were offered a genetic test (based on genotyping of 33 risk-associated single nucleotide polymorphisms) in addition to the standard PSA test that informed them about lifetime genetic risk of prostate cancer and distinguished between “normal” and “high” risk. The primary outcome was the proportion of men having a repeated PSA test within 2 years. A multilevel logistic regression model was used to test the association.After applying the exclusion criteria, 3,558 men were recruited in intervention practices, with 1,235 (34.7%) receiving the genetic test, and 4,242 men were recruited in control practices. Men with high genetic risk had a higher propensity for repeated PSA testing within 2 years than men with normal genetic risk (odds ratio [OR] = 8.94, p < 0.01). The study was conducted in routine practice and had some selection bias, which is evidenced by the relatively large proportion of younger and higher income participants taking the genetic test.ConclusionsProviding general practitioners (GPs) with access to a genetic test to assess lifetime risk of prostate cancer did not reduce the overall number of future PSA tests. However, among men who had a genetic test, knowledge of genetic risk significantly influenced future PSA testing.Trial registrationThis study is registered with ClinicalTrials.gov, number NCT01739062.

ObjectiveThis study aimed to evaluate the awareness rate of prostate-specific antigen (PSA) among the general public in China and provide data about prostate cancer (PCa) for related scientific research.MethodsA cross-sectional survey of PSA awareness was conducted in multiple regional populations using an online questionnaire. The questionnaire included basic information, knowledge about PCa, the awareness rate and application of PSA, and future expectations toward applying PSA screening in clinical practice. The study applied the methods of Pearson chi-square analysis and Logistic regression analysis.ResultsA total of 493 valid questionnaires were included. Two hundred and nineteen respondents (44.4%) were males, and 274 (55.6%) were females. Of all respondents, 212 (43.0%) were under 20 years old, 147 (29.8%) were 20–30 years old, 74 (15.0%) were 30–40 years old, and 60 (12.2%) were over 40 years old. There are 310 people (62.9%) with medical educational background and 183 (37.1%) without. One hundred eighty-seven (37.9%) of the respondents were aware of PSA, and 306 (62.1%) were unaware of PSA. Statistically significant differences were obtained between the two groups regarding different ages, educational backgrounds, occupations, departments, and habits of knowing medical knowledge (all p < 0.05). In addition, the differences between the group of aware of PSA (AP) and the group unaware of PSA (UAP) in terms of whether they had been exposed to PSA screening and whether they had exposure to PCa patients or related knowledge were also observed (all p < 0.05). Age ≥30 years, medical educational background, understanding of medical knowledge, exposure to PCa patients or related knowledge, exposure to PSA screening, and status as a graduate student and above were independent factors for the occurrence of PSA awareness events (all p < 0.05). In addition, age ≥ 30 years, medical educational background, and awareness of PSA were independent factors for future expectations toward PSA (all p < 0.05).ConclusionsWe first analyzed the public awareness of PSA. Cognition degrees of PSA and PCa awareness vary among different populations in China. Therefore, we should designate corresponding widespread scientific educational programs for different populations to increase the awareness rate of PSA.

Association of clinical and pathologic staging with risk of lethal prostate cancer among men who underwent radical prostatectomy for clinically localized prostate cancer, HPFS and PHS, 1981–2015.

Clinical characteristics of men diagnosed with prostate cancer who underwent radical prostatectomy for clinically localized prostate cancer in HPFS, PHS, and the JH RRP cohort.

BackgroundProstate-specific antigen (PSA) based screening for early detection of prostate cancer is common although it is associated with both benefits and potential harms (e.g., the risk of overdiagnosis). Evidence-based health information could help individuals make informed decisions about whether to undergo PSA testing or not. This evaluation aimed to determine whether the written health information materials available in Germany provide appropriate information for informed decision-making on PSA based screening.MethodsA list of criteria was developed and used to systematically assess the quality of information on the benefits and harms of prostate cancer screening included in written health information materials. Fourteen information materials identified by information requests and online searches were evaluated independently by two of three reviewers. Consensus was achieved with a third reviewer.ResultsOf the 14 information materials evaluated, 10 (71%) list the ability to reduce the absolute risk of death from prostate cancer as a benefit of PSA testing, 9 (64%) point out the risks of follow-up diagnostics, 13 (93%) describe the risks of the available prostate cancer treatments, and all 14 specify the risk of overdiagnosis. The minority provide numerical data on benefits and risks. Partially mismatched framing was identified in four cases: two information materials report only the relative frequencies of benefits, and two report only the absolute frequencies of harms. Half of the materials encouraged participation using downplaying or frightening language.ConclusionsThe majority of health information materials in Germany describe the benefits and harms of PSA based screening, including overdiagnosis, but often lack adequate balance, neutrality and numbers.

Characteristics of patients with PSA failure.

Predictive significance of clinical factors for the occurrence of PSA failure.

List of 47 assessment criteria by categories (n = 5) and subcategories (n = 11).

Patient characteristics (n = 85).

Summary statistics by treatment arm.

Cross-sectional analysis of the % differences in mean serum PSA level according participant characteristics.

BackgroundPropionibacterium acnes has recently been implicated as a cause of chronic prostatitis and this commensal bacterium may be linked to prostate carcinogenesis. The occurrence of intracellular P. acnes infection in prostate glands and the higher frequency of P. acnes-positive glands in radical prostatectomy specimens from patients with prostate cancer (PCa) than in those from patients without PCa led us to examine whether the P. acnes-positive gland frequency can be used to assess the risk for PCa in patients whose first prostate biopsy, performed due to an increased prostate-specific antigen (PSA) titer, was negative.MethodsWe retrospectively collected the first and last prostate biopsy samples from 44 patients that were diagnosed PCa within 4 years after the first negative biopsy and from 36 control patients with no PCa found in repeated biopsy for at least 3 years after the first biopsy. We evaluated P. acnes-positive gland frequency and P. acnes-positive macrophage number using enzyme-immunohistochemistry with a P. acnes-specific monoclonal antibody (PAL antibody).ResultsThe frequency of P. acnes-positive glands was higher in PCa samples than in control samples in both first biopsy samples and in combined first and last biopsy samples (P < 0.001). A frequency greater than the threshold (18.5 and 17.7, respectively) obtained by each receiver operating characteristic curve was an independent risk factor for PCa (P = 0.003 and 0.001, respectively) with odds ratios (14.8 and 13.9, respectively) higher than those of serum PSA titers of patients just before each biopsy (4.6 and 2.3, respectively). The number of P. acnes-positive macrophages did not differ significantly between PCa and control samples.ConclusionsThese results suggested that the frequency of P. acnes-positive glands in the first negative prostate biopsy performed due to increased PSA titers can be supportive information for urologists in planning repeated biopsy or follow-up strategies.

Unadjusted Prognostic effect and adjusted prognostic effect of PSA on overall survival.

Logistic regression analysis with the mean score of P. acnes-positive glands.

Model results under base case and scenario analyses.

Laboratory monitoring during first treatment course with MTX.

BackgroundPrognostic models in metastatic castrate resistant prostate cancer (mCRPC) may have clinical utility. Using data from PDS, we aimed to 1) validate a contemporary prognostic model (Templeton et al., 2014) 2) evaluate prognostic impact of concomitant medications and PSA decrease 3) evaluate factors associated with docetaxel toxicity.MethodsWe accessed data on 2,449 mCRPC patients in PDS. The existing model was validated with a continuous risk score, time-dependent receiver operating characteristic (ROC) curves, and corresponding time-dependent Area under the Curve (tAUC). The prognostic effects of concomitant medications and PSA response were assessed by Cox proportional hazards models. One year tAUC was calculated for multivariable prognostic model optimized to our data. Conditional logistic regression models were used to assess associations with grade 3/4 adverse events (G3/4 AE) at baseline and after cycle 1 of treatment.ResultsDespite limitations of the PDS data set, the existing model was validated; one year AUC, was 0.68 (95% CI 95% CI, .66 to .71) to 0.78 (95%CI, .74 to .81) depending on the subset of datasets used. A new model was constructed with an AUC of .74 (.72 to .77). Concomitant medications low molecular weight heparin and warfarin were associated with poorer survival, Metformin and Cox2 inhibitors were associated with better outcome. PSA response was associated with survival, the effect of which was greatest early in follow-up. Age was associated with baseline risk of G3/4 AE. The odds of experiencing G3/4 AE later on in treatment were significantly greater for subjects who experienced a G3/4 AE in their first cycle (OR 3.53, 95% CI 2.53–4.91, p < .0001).ConclusionDespite heterogeneous data collection protocols, PDS provides access to large datasets for novel outcomes analysis. In this paper, we demonstrate its utility for validating existing models and novel model generation including the utility of concomitant medications in outcome analyses, as well as the effect of PSA response on survival and toxicity prediction.

Characteristics of patients with psoriasis or psoriatic arthritis.

Clinicopathologic profiles of the patients.