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Int. braz. j. urol ; 44(4): 697-703, July-Aug. 2018. tab
Artigo em Inglês | LILACS | ID: biblio-954078

RESUMO

ABSTRACT Introduction: We compared characteristics of patients undergoing prostate biopsy in a high-risk inner city population before and after the 2012 USPSTF recommendation against PSA based prostate cancer screening to determine its effect on prostate biopsy practices. Materials and Methods: This was a retrospective study including patients who received biopsies after an abnormal PSA measurement from October 2008-December 2015. Patients with previously diagnosed prostate cancer were excluded. Chi-square tests of independence, two sample t-tests, Mann-Whitney U tests, and Fisher's exact tests were performed. Results: There were 202 and 208 patients in the pre-USPSTF and post-USPSTF recommendation cohorts, respectively. The post-USPSTF cohort had higher median PSA (7.8 versus 7.1ng/mL, p=0.05), greater proportion of patients who were black (96.6% versus 90.5%, p=0.01), and greater percentage of biopsy cores positive for disease (58% versus 29.5%, p<0.001). Multivariable analysis supported that the increase in PSA was independent of the increase in the proportion of patients who were black. The proportion of patients who were classified as D'Amico intermediate and high-risk disease increased in the post-USPSTF cohort and approached statistical significance (70.1% versus 58.8%, p=0.12). Conclusions: Our study suggests that the USPSTF recommendations may have led to an increase in pre-biopsy PSA as well as greater volume of disease. Also, a greater proportion of patients were being classified with intermediate or high risk disease. While the clinical significance of these findings is unknown, what the data suggests is somewhat troubling. Future research should further examine these changes in a larger cohort as well as resultant long-term outcomes.


Assuntos
Humanos , Masculino , Idoso , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Antígeno Prostático Específico/sangue , Guias de Prática Clínica como Assunto/normas , Medição de Risco/métodos , Biópsia Guiada por Imagem/normas , Neoplasias da Próstata/etnologia , Neoplasias da Próstata/sangue , Padrões de Referência , Hospitais Urbanos , Análise Multivariada , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Detecção Precoce de Câncer/normas , Gradação de Tumores , Pessoa de Meia-Idade
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