Prevalence and predictors of colon and prostate cancer screening among volunteer firefighters: The United States Firefighter Cancer Assessment and Prevention Study.

BACKGROUND: Although firefighters have increased risk for colon and prostate cancer, limited information exists on screening practices for these cancers in volunteer firefighters who compose two-thirds of the US fire service. We estimated the prevalence of colon and prostate cancer screening among volunteer firefighters using eligibility criteria from 4 evidence-based screening recommendations and evaluated factors influencing screening. METHODS: We evaluated colon (n = 569) and prostate (n = 498) cancer screening prevalence in a sample of US volunteer firefighters using eligibility criteria from the US Preventive Services Taskforce (USPSTF), National Fire Protection Association, American Cancer Society, and National Comprehensive Cancer Network. We assessed associations with fire service experience, demographics, and cancer risk perception based on USPSTF guidelines. RESULTS: For those eligible based on USPSTF guidelines, colon and prostate cancer screening prevalence was 51.7% (95% CI: 45.7, 57.8) and 48.8% (95% CI: 40.0, 57.6), respectively. Higher odds of colon and prostate cancer screening were observed with older age and with some college education compared to those with less education. Fire service experience and cancer risk perception were not associated with screening practices. CONCLUSION: This is the first large study to assess colon and prostate cancer screening among US volunteer firefighters based on different screening guidelines. Our findings suggest gaps in cancer prevention efforts in the US volunteer fire service. Promoting cancer screening education and opportunities for volunteer firefighters by their fire departments, healthcare professionals, and public health practitioners, may help to address the gaps.

New technology in prostate cancer and financial toxicity.

The management of prostate cancer has significantly evolved over the last few decades with the emergence of new diagnostic and treatment technologies, which are typically more expensive than the previous alternatives. However, decision-making regarding which diagnostics and treatment to pursue is often influenced by perceived benefits, adverse effects, and physician recommendations, without considering the financial liability borne by patients. New technologies may exacerbate financial toxicity by replacing less costly alternatives, promoting unrealistic expectations, and expanding treatment to those who would have previously gone untreated. More judicious use of technologies with an understanding of the contexts in which they are most beneficial may help prevent avoidable financial toxicity to patients.

Breast and prostate cancer screening rates by cognitive status in US older adults.

INTRODUCTION: For most older adults with dementia, the short-term harms and burdens of routine cancer screening likely outweigh the delayed benefits. We aimed to provide a more updated assessment of the extent that US older adults with dementia receive breast and prostate cancer screenings. METHODS: Using the Health and Retirement Study (HRS) Wave 12 (2014-2015) linked to Medicare, we examine rates of breast and prostate cancer screenings in adults 65+ years by cognitive status. We used claims data to identify eligibility for screening and receipt of screening. We used a validated method using HRS data to define cognitive status. RESULTS: The analytic sample included 2439 women in the breast cancer screening cohort and 1846 men in the prostate cancer screening cohort. Average ages were 76.8 years for women and 75.6 years for men, with 9.0% and 7.6% with dementia in each cohort, respectively. Among women with dementia, 12.3% were screened for breast cancer. When stratified by age, 10.6% of those 75+ and have dementia were screened for breast cancer. When stratified by predicted life expectancy, 10.4% of those with predicted life expectancy of <10 years and have dementia were screened for breast cancer. Among men with dementia, 33.9% were screened for prostate cancer. When stratified by age, 30.9% of those 75+ and have dementia were screened for prostate cancer. When stratified by predicted life expectancy, 34.4% of those with predicted life expectancy of <10 years and have dementia were screened for prostate cancer. Using multivariable logistic regression, dementia was associated with lower odds of receiving breast cancer screening (OR 0.36, 95% CI 0.23-0.57) and prostate cancer screening (OR 0.58, 95% CI 0.36-0.96). DISCUSSION: Our results suggest potential over-screening in older adults with dementia. Better supporting dementia patients and caregivers to make informed cancer screening decisions is critical.

Effect of the 2012 US Preventive Services Task Force Recommendations on Prostate-Specific Antigen Screening in a Medicare Advantage Population.

BACKGROUND: In 2012, the US Preventive Service Task Force revised its recommendations for prostate-specific antigen (PSA) screening from "insufficient evidence" to "do not recommend" for men aged 70-74 while maintaining "do not recommend" for men aged 75+. METHODS: Using the difference-in-difference approach, we evaluated whether the rate of change in the use of low-value PSA screening differed between the control group (men aged 75+, N=7,856,204 person-years) and the intervention group (men aged 70-74, N=5,329,192 person-years) enrolling in the Medicare Advantage plan without a history of prostate cancer within the OptumLabs Data Warehouse claims data (2009-2019). A generalized estimating equation logistic model was specified with independent variables: an intervention group indicator, a pre- and post-period (after 2012 Q2) indicator, index time, and interaction terms. We assumed a 12-month dissemination period. RESULTS: Before the revised recommendation in 2012, the trends did not significantly differ between the 2 age groups with the odds of receiving PSA screening decreasing by 1.2% (95% confidence interval [1.0, 1.4%]) per quarter. However, the odds of receiving PSA screening increased by 3.0% [2.8, 3.2%] per quarter across both groups since the revision. There was no significant additional change in the trend for those aged 70-74 (0.1% [-0.2, 0.5%]). CONCLUSIONS: Although the 2012 US Preventive Service Task Force's recommendations were expected to only change behaviors among men aged 70-74, our analysis found that men aged 70-74 and aged 75+ exhibited similar trends from 2009 to 2019, including the increased use of low-value PSA screening since 2016. Multifaceted efforts to discourage low-value PSA screening would be important for a sustained impact.

Formative Assessment to Improve Cancer Screenings in American Indian Men: Native Patient Navigator and mHealth Texting.

Cancer screening rates among American Indian men remain low, without programs specifically designed for men. This paper describes the Community-Based Participatory Research processes and assessment of cancer screening behavior and the appropriateness of the mHealth approach for Hopi men's promotion of cancer screenings. This Community-Based Participatory Research included a partnership with H.O.P.I. (Hopi Office of Prevention and Intervention) Cancer Support Services and the Hopi Community Advisory Committee. Cellular phone usage was assessed among male participants in a wellness program utilizing text messaging. Community surveys were conducted with Hopi men (50 years of age or older). The survey revealed colorectal cancer screening rate increased from 51% in 2012 to 71% in 2018, while prostate cancer screening rate had not changed (35% in 2012 and 37% in 2018). Past cancer screening was associated with having additional cancer screening. A cellular phone was commonly used by Hopi men, but not for healthcare or wellness. Cellular phone ownership increased odds of prostate cancer screening in the unadjusted model (OR 9.00, 95% CI: 1.11-73.07), but not in the adjusted model. Cellular phones may be applied for health promotion among Hopi men, but use of cellular phones to improve cancer screening participation needs further investigation.

Addressing Disparities by Evaluating Depression as a Predictor of Prostate Screenings among Black Men in a Community Health Clinic.

To explore prostate and depression screening practices as well as predictors for prostate screening among a diverse group of men seen at a nurse-led community health center. This was a retrospective, exploratory study. Social factors, depression, and prostate screening data on 267 male patients were retrieved from medical records from 2014 to 2018. Patients that were not screened for depression were associated with a lower probability of having received a PSA screening (OR = .40, p = 02). Of those screened for depression, higher scores were associated with lower PSA screening (OR = .89, p = .02). Patients who self-identified as Hispanic (OR = .19, p <. 001), African American (AA) (OR = .06, P = .01) or White (OR = .12, P = .02) had lower odds of PSA screening compared to Black-Caribbean. The above clinical evidence is a practice implication for nurses and health care professionals. Depression screening predicted higher rates of prostate screening, while higher depression scores predicted lower prostate screening. AA and Hispanic subgroups were less likely to be screened for prostate cancer than the non-U.S. born Black-Caribbean men. Findings underscore the importance of developing community-based culturally sensitive approaches to prostate preventative care. Nurses and health providers must understand that diversity within the "Black" population exists, and these differences drive health behaviors. Person-centered care that is culturally sensitive will be essential in developing trust with communities of color to increase prostate cancer screening and health equity.

Study protocol: One plus one can be greater than two-Ecological momentary assessment for Black prostate cancer survivors and partners.

Given that romantic partners play a pivotal role in patients' survivorship period, integrating partners into survivorship care and broadening the focus of behavioral interventions from the individual (survivor) to the survivor-partner dyad may make healthy lifestyle behaviors more easily adopted and potentially maintained. Understanding the role of dyadic processes in Black survivors is particularly important because their lifestyle behaviors are poor and they have higher cancer-specific and all-cause mortality. To develop an effective dyadic lifestyle behavior intervention for Black survivors, micro-level investigations of interactions between Black survivors and their partners are necessary to pinpoint how survivors and partners facilitate or hinder each other's lifestyle behaviors in their natural, everyday lives. Accordingly, the objective of the present study is to fill these gaps using ecological momentary assessment to eventually develop more effective lifestyle interventions for Black prostate cancer (PCa) survivors and partners. A total of 120 dyads (i.e., 240 individuals) who are Black adult survivors diagnosed with non-metastatic PCa and their romantic partners will be asked to complete four assessments per day for 14 consecutive days on a smartphone after an initial retrospective survey. Over the 14 days, participants will be asked to complete a brief survey regarding their lifestyle behaviors (physical activity, sedentariness and eating behaviors), contexts of lifestyle behaviors, stress, and coping. Physical activity and sedentary behavior will be assessed via accelerometer; eating behaviors will be assessed with the Automated Self-Administered 24-hour Dietary Assessment Tool. After completing the 14-day assessment, participants will be asked to complete a final retrospective survey. Results of the proposed study will inform the rigorous development of a theory-based dyadic lifestyle intervention in this vulnerable survivorship population with the ultimate goal to improve overall survival and reduce morbidities (for survivors) and reduce cancer incidence (for partners).

Economic Evaluation of Urine-Based or Magnetic Resonance Imaging Reflex Tests in Men With Intermediate Prostate-Specific Antigen Levels in the United States.

OBJECTIVES: For men with intermediate prostate-specific antigen (PSA) levels (4-10 ng/mL), urine-based biomarkers and multiparametric magnetic resonance imaging (MRI) are increasingly used as reflex tests before prostate biopsy. We assessed the cost effectiveness of these reflex tests in the United States. METHODS: We used an existing microsimulation model of prostate cancer (PCa) progression and survival to predict lifetime outcomes for a hypothetical cohort of 55-year-old men with intermediate PSA levels. Urine-based biomarkers-PCa antigen (PCA3), TMPRSS2:ERG gene fusion (T2:ERG), and the MyProstateScore (MPS) for any PCa and for high-grade (Gleason score ≥7) PCa (MPShg)-were generated using biomarker data from 1112 men presenting for biopsy at 10 United States institutions. MRI results were based on published sensitivity and specificity for high-grade PCa. Costs and utilities were sourced from literature and Medicare reimbursement schedules. Outcome measures included life years, quality-adjusted life years (QALYs), and lifetime medical costs per patient. Incremental cost-effectiveness ratios were empirically calculated on the basis of simulated life histories under different reflex testing strategies. RESULTS: Biopsying all men provided the most life years and QALYs, followed by reflex testing using MPShg, MPS, MRI, T2:ERG, PCA3, and biopsying no men (QALY range across strategies 15.98-16.09). Accounting for costs, MRI and MPShg were dominated by other strategies. PCA3, T2:ERG, and MPS were likely to be the most cost-effective strategy at willingness-to-pay thresholds of $100 000/QALY, $125 000/QALY, and $150 000/QALY, respectively. CONCLUSIONS: Using PCA3, T2:ERG, or MPS as reflex tests has greater economic value than MRI, biopsying all men, or biopsying no men with intermediate PSA levels.

Independent and Joint Effects of Testosterone Replacement Therapy and Statins use on the Risk of Prostate Cancer Among White, Black, and Hispanic Men.

The associations of testosterone therapy (TTh) and statins use with prostate cancer remain conflicted. However, the joint effects of TTh and statins use on the incidence of prostate cancer, stage and grade at diagnosis, and prostate cancer-specific mortality (PCSM) have not been studied.We identified White (N = 74,181), Black (N = 9,157), and Hispanic (N = 3,313) men diagnosed with prostate cancer in SEER-Medicare 2007-2016. Prediagnostic prescription of TTh and statins was ascertained for this analysis. Weighted multivariable-adjusted conditional logistic and Cox proportional hazards models evaluated the association of TTh and statins with prostate cancer, including statistical interactions between TTh and statins.We found that TTh (OR = 0.74; 95% CI, 0.68-0.81) and statins (OR = 0.77; 95% CI, 0.0.75-0.88) were inversely associated with incident prostate cancer. Similar inverse associations were observed with high-grade and advanced prostate cancer in relation to TTh and statins use. TTh plus statins was inversely associated with incident prostate cancer (OR = 0.53; 95% CI, 0.48-0.60), high-grade (OR = 0.43; 95% CI, 0.37-0.49), and advanced prostate cancer (OR = 0.44; 95% CI, 0.35-0.55). Similar associations were present in White and Black men, but among Hispanics statins were associated with PCSM.Prediagnostic use of TTh or statins, independent or combined, was inversely associated with incident and aggressive prostate cancer overall and in NHW and NHB men. Findings for statins and aggressive prostate cancer are consistent with previous studies. Future studies need to confirm the independent inverse association of TTh and the joint inverse association of TTh plus statins on risk of prostate cancer in understudied populations. PREVENTION RELEVANCE: The study investigates a potential interaction between TTh and statin and its effect on incident and aggressive prostate cancer in men of different racial and ethnic backgrounds. These results suggest that among NHW and non-Hispanic Black men TTh plus statins reduced the odds of incident prostate cancer, high-grade and advance stage prostate cancer.

Movember in a pandemic - it matters, more than ever.

Dear Editor, in recent years there has been an increase in the number of new cases of cancer. This increase, in part, is closely related to the increase in average life expectancy, as well as more accurate diagnostic techniques and well-defined screening programs. [...].

Exploring the impact of public health campaigns for glaucoma and macular degeneration utilising Google Trends data in a New Zealand setting.

AIM: To evaluate the impact of public health campaigns for glaucoma and age-related macular degeneration compared to breast cancer and prostate cancer using Google Trends data. METHODS: Relative search volumes for the terms 'glaucoma', 'macular degeneration', 'breast cancer' and 'prostate cancer' for New Zealand from October 2008-September 2018 were obtained via Google Trends. Intervention time-series analyses were used to compare observations before and after each awareness campaign. RESULTS: Of the campaigns occurring in the 10-year study period, statistically significant increases in search behaviour were observed for breast cancer (45%, p<0.01), prostate cancer (32%, p<0.01) and glaucoma (16%, p<0.01). Macular degeneration search behaviour increased on average 14% but this was not statistically significant (p>0.1), although increased activity (294%) was observed in December 2016, corresponding with the release of a report, public meeting and media release on the socioeconomic impact of macular degeneration. CONCLUSIONS: Glaucoma and macular degeneration search behaviour in New Zealand has a low impact following health awareness campaigns in comparison to breast and prostate cancer. This implies there is scope for improvement with these campaigns and a large increase in macular degeneration activity following a public meeting, and report release suggests that increased funding may increase impact. This study also highlights the utility of internet data for cost-effective monitoring of public interest in health issues.

Prostate cancer awareness and screening practice among Kenyan men.

Despite globally increased awareness and widespread availability of screening tools, little is known about prostate cancer (PCa) awareness and screening practices in Kenya. To assess PCa awareness and screening practice among Kenyan men (age: 15-54 years), a cross-sectional study was carried out using Kenya Demographic Health Survey (KDHS 2014) data. A subsample of 12 803 men was taken and analyzed using SPSS version 22. Overall, 7926 (61.9%) men were aware of PCa. Three hundred eleven (3.9%) men who were aware of PCa reported ever screening for PCa. A strong association was found by crude and adjusted logistic regression analysis between men's awareness and age categories [age: 25-34 years, 95% confidence interval (CI) = 1.32-1.73, P < 0.001; age: 35-44 years, 95% CI = 1.51-2.08, P < 0.001; age: 45-54 years, 95% CI = 1.70-2.44, P < 0.001] compared with men in the age category of 15-24 years. Similarly, an association was observed in men with insurance coverage with awareness (95% CI = 1.35-1.76, P < 0.001) and with screening practice (95% CI = 1.35-2.37, P < 001). Compared with illiterate men, men with primary education (95% CI = 1.82-2.72, P < 001), secondary education (95% CI = 3.84-5.89, P < 001), and higher education (95% CI = 9.93-17.38, P < 0.001) were more likely to be aware of PCa. Sociodemographically, richer (95% CI = 1.36-1.79, P < 0.001) and richest (95% CI = 1.62-2.27, P < 0.001) men were more likely to be aware of PCa than those in the poorest wealth index category. The awareness of Kenyan men of PCa is good. However, the PCa screening practice among Kenyan men is very poor. Hence, health promotion in a PCa screening program should be strengthened to improve public understanding about PCa, available screening tests, and the importance of early PCa screening.

Broad- and narrow-sense validity performance of three polygenic risk score methods for prostate cancer risk assessment.

BACKGROUND: Several polygenic risk score (PRS) methods are available for measuring the cumulative effect of multiple risk-associated single nucleotide polymorphisms (SNPs). Their performance in predicting risk at the individual level has not been well studied. METHODS: We compared the performance of three PRS methods for prostate cancer risk assessment in a clinical trial cohort, including genetic risk score (GRS), pruning and thresholding (P + T), and linkage disequilibrium prediction (LDpred). Performance was evaluated for score deciles (broad-sense validity) and score values (narrow-sense validity). RESULTS: A training process was required to identify the best P + T model (397 SNPs) and LDpred model (3 011 362 SNPs). In contrast, GRS was directly calculated based on 110 established risk-associated SNPs. For broad-sense validity in the testing population, higher deciles were significantly associated with higher observed risk; Ptrend was 7.40 × 10-11 , 7.64 × 10-13 , and 7.51 × 10-10 for GRS, P + T, and LDpred, respectively. For narrow-sense validity, the calibration slope (1 is best) was 1.03, 0.77, and 0.87, and mean bias score (0 is best) was 0.09, 0.21, and 0.10 for GRS, P + T, and LDpred, respectively. CONCLUSIONS: The performance of GRS was better than P + T and LDpred. Fewer and well-established SNPs of GRS also make it more feasible and interpretable for genetic testing at the individual level.

The preventive effect of metformin on progression of benign prostate hyperplasia: A nationwide population-based cohort study in Korea.

Metformin, a first-line treatment for type 2 diabetes mellitus (T2DM), has recently been recognized for its pleotropic anti-proliferative, anti-cancer, and anti-aging effects. Contrary to the studies characterizing metformin effects in prostate cancer, little is known about these effects in BPH progression. With the Sample Cohort DB data during 2007 and 2017 from the Health Insurance Review and Assessment Service (HIRA) in South Korea, we investigated the preventative effect of metformin on BPH progression. The study population consisted of 211,648 BPH naïve patients that were diagnosed with BPH in 2009 and a follow-up occurrence of prostatectomy until 2017 that was defined as progression of BPH. These patients were divided into three treatment groups: without T2DM, T2DM without metformin, and T2DM with metformin. The hazard ratio in the T2DM with metformin group was 0.86 for prostatectomy compared to the group without T2DM (CI = 0.77-0.96, P value = 0.007) after adjusting for confounding factors such as age, comorbidity, residential area, level of hospital, and category of BPH medications. The T2DM with high-dose metformin group had a significantly lower risk of prostatectomy with hazard ratio of 0.76 (CI = 0.62-0.92, P value = 0.005) in stratified analysis. Our results suggest that metformin may improve BPH progression based on the reduced risk of prostatectomy, although T2DM effects on BPH were unclear. Future observational studies and prospective trials are needed to confirm the effects of metformin on BPH progression.

Uptake of cancer screening services among middle and older ages in Ireland: the role of healthcare eligibility.

OBJECTIVES: The aim of this analysis was to examine the association between public healthcare eligibility combined with private health insurance (PHI) status and the uptake of breast and prostate cancer screening services among middle and older age groups in Ireland. STUDY DESIGN: This is a cross-sectional analysis using The Irish Longitudinal Study on Ageing (TILDA). METHODS: The analysis included 6902 people aged 50 years and older who completed an in-house interview as part of TILDA. The interview collects information on a range of demographic, socio-economic, health and health service usage variables including the uptake of cancer screening services. An eligibility variable was created using information on public healthcare entitlement and PHI status. The association between eligibility and the uptake of two cancer screening services-mammogram and prostate-specific antigen (PSA) test-was examined using weighted multivariate logistic regression analysis. RESULTS: The uptake of a mammogram and PSA testing was significantly higher in those with PHI. This relationship held after controlling for a range of confounders including health and socio-economic status. CONCLUSIONS: More research is required to identify the reasons for the higher uptake of cancer screening services among those with PHI, given that insurance does not confer any advantages in accessing these services. It is possible that the higher uptake is explained by differential access to secondary care services between those with and without PHI. Consideration of the integrated nature of healthcare systems is essential when seeking to maximise the uptake of services (such as cancer screening) that potentially involve multiple parts of the healthcare system.

Diet assessment among men undergoing genetic counseling and genetic testing for inherited prostate cancer: Exploring a teachable moment to support diet intervention.

BACKGROUND: Genetic counseling (GC) and genetic testing (GT) for prostate cancer (PCA) is a rapidly growing, affording opportunity for healthy lifestyle promotion in men aligned with cancer survivorship and cancer prevention goals. We conducted a targeted dietary analysis of men undergoing GC/GT for PCA for adherence to the United States Department of Agriculture (USDA) Food Pattern recommendations which align with preventing cancer and recurrences in the Genetic Evaluation of Men (GEM) study at two academic centers to inform future strategies for diet intervention. METHODS: Participants of GEM with PCA or at-risk for PCA completed a structured food frequency questionnaire indicating number of servings consumed per day or per week of fruits, vegetables, red meat, seafood, processed meat, and foods high in saturated fat. Adherence to the USDA recommendations was assessed for the total sample and by PCA status and aggressiveness, family history, and body mass index (BMI) through χ 2 contingency analyses. One-sample t tests were used to compare the dietary behaviors of men to USDA Recommendations. Levels of α were set a priori at P < 0.05. RESULTS: Of 239 males undergoing GC on the study, surveys were completed by 197 men (82.4%), and complete survey data was available on 113 men (47.3%). By the Centers for Disease Control and Prevention BMI classification, 82.3% of the cohort was overweight (45.1%) or obese (37.2%). GEM participants reported consuming less fruits (P = 0.015), less vegetables ( P < 0.001), less seafood ( P < 0.001), more processed meats ( P < 0.001), and more foods high in saturated fats ( P < 0.001) than recommended. CONCLUSION: A high proportion of men receiving GC/GT for PCA were overweight and/or obese with lack of adherence to national diet recommendations for cancer risk and recurrence, affording a teachable moment and supporting the systematic focus of introducing nutrition intervention during GC to promote survivorship.

Prostate Cancer Disparity, Chemoprevention, and Treatment by Specific Medicinal Plants.

Prostate cancer (PC) is one of the most common cancers in men. The global burden of this disease is rising. Its incidence and mortality rates are higher in African American (AA) men compared to white men and other ethnic groups. The treatment decisions for PC are based exclusively on histological architecture, prostate-specific antigen (PSA) levels, and local disease state. Despite advances in screening for and early detection of PC, a large percentage of men continue to be diagnosed with metastatic disease including about 20% of men affected with a high mortality rate within the African American population. As such, this population group may benefit from edible natural products that are safe with a low cost. Hence, the central goal of this article is to highlight PC disparity associated with nutritional factors and highlight chemo-preventive agents from medicinal plants that are more likely to reduce PC. To reach this central goal, we searched the PubMed Central database and the Google Scholar website for relevant papers. Our search results revealed that there are significant improvements in PC statistics among white men and other ethnic groups. However, its mortality rate remains significantly high among AA men. In addition, there are limited studies that have addressed the benefits of medicinal plants as chemo-preventive agents for PC treatment, especially among AA men. This review paper addresses this knowledge gap by discussing PC disparity associated with nutritional factors and highlighting the biomedical significance of three medicinal plants (curcumin, garlic, and Vernonia amygdalina) that show a great potential to prevent/treat PC, as well as to reduce its incidence/prevalence and mortality, improve survival rate, and reduce PC-related health disparity.