New diagnostic tests for prostate cancer, as well as new information about the impact of the U.S. Preventive Services Task Force recommendations on prostate cancer screening, were presented at the 113th Annual Meeting of the American Urological Association (AUA).
PSA Screening of African American Veterans Before, During, and After Implementation of the 2012 USPSTF Recommendations
Prostate cancer screening rates at Department of Veterans Affairs' (VA) clinics declined for both African American and non–African American men following the release of the 2012 prostate cancer screening recommendations from the U.S. Preventive Services Task Force (USPSTF), according to this multi-institutional study (Abstract PD52-11).
Researchers examined prostate-specific antigen (PSA) screening rates for male veterans aged 40 to 80 without a diagnosis of prostate cancer who visited a VA primary care or urology clinic between 2009 and 2016 and assessed the differential effect of the USPSTF policy change on screening rates. Results were assessed for the pre-guidelines period (2009–2010), the transition period (2011–2014), and the post-guideline period (2015–2016).
They showed:
Prostate Cancer Genomics
The use of genomic tests to predict outcomes and guide treatment for prostate cancer is growing, but discrepancies exist between these tests and their recommendations for treatment vs active surveillance (AS). Researchers reviewed three unique tests (Decipher, Prolaris, and Oncotype DX) to evaluate genomic test results and the potential implications of their results on eligibility for AS (Abstract PD06-09).
By performing a retrospective chart review, researchers identified 22 patients who underwent at least two of these genomic tests at Hartford Hospital between 2014 and 2017. Results were compared to genomic standards for AS appropriateness based on guidelines from the National Comprehensive Cancer Network (NCCN). Percentage agreement rates were calculated, and kappa statistic (k) was used to obtain proportion of agreement over and above chance.
Results showed:
Novel Urine Exosome Gene Expression Assay to Predict High-Grade Prostate Cancer at Initial Biopsy
A new class 3-gene expression urine assay for prostate cancer—ExoDx Prostate IntelliScore, or EPI—may help identify patients with higher grade disease and could help reduce unnecessary biopsies. This extended validation study assessed outcome and cut-point performance for EPI test results compared with biopsy outcomes (Abstract MP40-10).
The validation cohort was comprised of 504 men with a mean age of 64 years and a mean PSA of 5.6 ng/mL. Fifty-three percent of the men had a positive biopsy, with 22% having a Gleason score of 6, 17% having a Gleason score of 3+4, and 14% having a Gleason score of 4+3.
Results showed:
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