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PSA screening in Patients with de novo Metastatic Prostate Cancer
Rian J. Dickstein, M.D., Courtney K. Rowe, B.A., Jessica E. Kreshover, M.D., Richard K. Babayan, M.D., Mark H. Katz, M.D..
Boston University School of Medicine, Boston, MA, USA.

BACKGROUND: There has recently been an escalation in the controversy regarding PSA screening for prostate cancer. In our experience, there continues to be a fair volume of patients presenting with metastatic disease at the time of initial diagnosis. We sought to identify whether or not those patients presenting initially with metastatic prostate cancer (MPC) underwent PSA screening.
METHODS: We identified patients with MPC at initial diagnosis from 2003 to 2008 at a single institution. Patient related factors including age, Gleason score, PSA, and radiographic findings were recorded among others. We compared those patients who had a PSA prior to diagnosis of MPC versus those that did not. A qualitative data analysis ensued.
RESULTS: Eighty one patients were found to have MPC at initial diagnosis. Of the 81, 18 patients were found to have a prior PSA recorded before their diagnosis, for a screening rate of 21.9%. Six of 81 patients (7.4%) had a prior PSA < 4.0 ng/mL (Table 1). In only one of these patients was MPC diagnosed within a year of their first screening PSA. The remainder developed MPC between one and five years later. Twelve of 81 patients (14.8%) had a PSA > 4.0 ng/mL and had never returned for a scheduled prostate biopsy (Table 2). In this group only two patients were found to have MPC within a year of their first PSA. However, the other ten patients developed metastases between one and five years later. The majority of those patients that were screened 12 of 18 (66.7%) were lost to follow up, until their de novo diagnosis of MPC.
CONCLUSIONS: Most patients (> 75%) who were found to have MPC at initial diagnosis had never been screened for cancer by PSA. Unfortunately, the majority of patients screened for prostate cancer had delayed their follow up. This may suggest that in a portion of these patients, progression to metastases may have been spared if they had returned for diagnostic biopsy and sought treatment for their disease. Alternatively, these patients may have been destined for metastatic disease regardless of whether or not they were screened.


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