Navigation Links
Biopsy referral after PSA screening stays consistent over time
Date:12/12/2011

San Diego, CA -- 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 overtreatmentand 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."


'/>"/>
Contact: Beverly Lytton
eAJPM@ucsd.edu
858-534-9340
Elsevier Health Sciences
Source:Eurekalert

Related medicine news :

1. New study shows biopsy of recurrent breast cancer can alter treatment
2. Mayo Clinic study: PSA test valuable in predicting biopsy need, low-risk prostate cancer
3. Study reveals rise in prostate biopsy complications and high post-procedure hospitalization rate
4. Sentinel node biopsy safe, effective in head and neck melanomas, U-M study finds
5. For Many, Risks of Lung Biopsy May Outweigh Benefits: Study
6. Noninvasive diagnostics may offer alternative to liver biopsy for assessing liver fibrosis
7. Shave biopsy is a safe and acceptable method for initial evaluation of melanoma
8. New technology fuses MRI, ultrasound to achieve targeted biopsy of prostate cancer
9. Closely monitoring low-risk prostate cancer, with biopsy, does not raise risk of death
10. Elastography helps identify patients who need biopsy
11. Virtual biopsy may allow earlier diagnosis of brain disorder in athletes
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:1/23/2017)... ... January 23, 2017 , ... "ProRandom is a set of camera tools that allow ... looks in Final Cut Pro X," said Christina Austin - CEO of Pixel Film Studios. ... layers of text with video footage. ProRandom works by using a virtual camera to ...
(Date:1/23/2017)... ... ... “Crossing the Bar”: a moving and eloquent drama depicting the events that happen ... creation of published author, Charlotte Hotte, a North Carolina native, a mother of two, ... book to her sister, Denise, wishes to acknowledge her savior, Jesus Christ, along with ...
(Date:1/22/2017)... ... January 22, 2017 , ... Phytocéane invites clients to ... the rest of the world with ZANZIBAR MILKY CREAM. Inspired by the beauty of ... like Virgin Coconut Oil and moisturizing vegetal coral to create this gentle, velvety body ...
(Date:1/21/2017)... ... January 21, 2017 , ... Salveo for life, a company that distributes ... to the United States as part of its presence to expand its market reach. ... to reduce the productions of nasty toxins as a result of drinking alcohol, eliminating ...
(Date:1/21/2017)... ... January 21, 2017 , ... Northern California Medical ... recently joined their multi-specialty medical group. The dermatology practice provides general dermatologic treatment, ... excited to add this excellent dermatology practice to our group’s medical services,” explains ...
Breaking Medicine News(10 mins):
(Date:1/23/2017)... 23, 2017 A new Transparency Market Research ... was valued at US$0.53 bn in 2013 and is predicted to ... CAGR between 2014 and 2022. The title of the report is ... Share, Growth, Trends and Forecast 2014 - 2022." ... Non-invasive prenatal testing (NIPT), also referred ...
(Date:1/23/2017)... SAN DIEGO and PALMA, ... Laboratoris Sanifit S.L., a clinical-stage biopharmaceutical ... announced that the first patient has been enrolled ... of lead candidate, SNF472, for the treatment of ... haemodialysis (HD). Most ESRD patients, in ...
(Date:1/21/2017)... , Jan 20, 2017 Research and ... Laboratory Testing Market By Type of Test (Tumor, Clinical Chemistry, ... By Type of Diseases (Tuberculosis, Influenza, Cancer, HIV/AIDS etc.), Forecast ... ... destination for healthcare services, market segments, especially clinical lab testing, ...
Breaking Medicine Technology: