This document summarizes a study analyzing media coverage of updated prostate cancer screening guidelines from the USPSTF and AUA. The study found that: 1) 92 news articles were analyzed from 2011-2013 covering the preliminary 2011 USPSTF guidelines, final 2012 guidelines, and 2013 AUA guidelines. 2) Articles frequently emphasized potential downsides of screening and inaccurately summarized guidelines/evidence. 3) Coverage of the USPSTF announcements was more extensive than the AUA guidelines. 4) Urologists were commonly interviewed but articles also cited costs and urologists' financial interests in screening. 5) The study provides insight into how media shapes views of

1. Source of Funding: This work is supported by a Department of
Defense Prostate Cancer Physician Training Award (W81XWH-
08-1-0283) presented to Dr. Hu. This study used the linked
SEER-Medicare database. The interpretation and reporting of
these data are the sole responsibility of the authors. The authors
acknowledge the efforts of the Applied Research Program,
NCI; the Office of Research, Development and Information,
CMS; Information Management Services (IMS), Inc.; and the
Surveillance, Epidemiology, and End Results (SEER) Program
tumor registries in the creation of the SEER-Medicare database.
MP63-02
MEDIA COVERAGE ANALYSIS OF THE UPDATED USPSTF AND
AUA PROSTATE CANCER SCREENING GUIDELINES
Kevin Koo*, Lebanon, NH; Ronald Yap, Concord, NH
INTRODUCTION AND OBJECTIVES: Recent changes to
prostate cancer screening guidelines by the United States Preventive
Services Task Force (USPSTF) and the American Urological Associa-
tion (AUA) gained national media attention. This study investigates
coverage of 3 news events: preliminary USPSTF guidelines (October,
2011); final USPSTF guidelines (May, 2012); and updated AUA
guidelines (May, 2013).
METHODS: The LexisNexis and ProQuest newspaper data-
bases were queried for English-language articles containing the words
"prostate" and "PSA" published in U.S. newspapers within 30 days of
each news event. Opinion pieces, duplicated entries, and articles not
primarily about the guidelines were excluded. A content analysis was
performed by coding articles using a standardized abstraction instru-
ment for the following themes: consequences of screening; specific
studies or evidence; accuracy of guideline description; costs; financial
impact; and references to current AUA guidelines. Headline bias and
the types of quoted sources were assessed. Statistical analysis was
performed using Stata.
RESULTS: Of 92 unique articles retrieved, 45 met inclusion
criteria. 24 articles were about the 2011 USPSTF preliminary guide-
lines, 17 about the 2012 final guidelines, and 4 about the 2013 AUA
guidelines. Mean number of sources per article was 3.6 (SD¼1.8). The
most frequently interviewed sources were physicians (89% of articles),
followed by USPSTF members (49%), non-profit leaders (47%), and
patients or patient advocates (31%). 36 articles (76%) quoted at least
one urologist. Over 80% of articles discussed potential adverse con-
sequences of screening, but fewer than half accurately summarized the
new guidelines or the scientific evidence behind them. Significantly
more articles in 2012 versus 2011 mentioned test-related costs, cited
urologists’ financial gains from screening, or had headlines opposing
testing (p<0.05). Of articles that cited the AUA’s initial opposition to
USPSTF recommendations, only 29% described AUA guidelines in
any form.
CONCLUSIONS: Both USPSTF announcements on prostate
cancer screening were more extensively covered by media outlets than
the updated AUA guidelines. While urologists were commonly inter-
viewed as sources, articles frequently emphasized the negative aspects
of screening, rather than reviewing nuances of the guidelines or current
evidence. Thisstudyaddsto ourunderstanding ofthemedia’sinfluencein
shaping patient perception and public discourse on men’s health issues.
Source of Funding: None
MP63-03
DELAY IN A BIOPSY TO ALLOW FOR ADDITIONAL PSA TESTING
OFTEN CAN ELIMINATE THE NEED FOR THE BIOPSY
R. Jeffrey Karnes*, Rochester, MN; Lori Rawson, Roy MacKintosh,
Reno, NV; Christopher Morrell, Baltimore, MD; Stacy Loeb, New York,
NY; Stephen Van Den Eeden, Oakland, CA; Thomas Neville, Incline
Village, NV
INTRODUCTION AND OBJECTIVES: A major challenge in
prostate cancer screening is to reduce the number of “unnecessary”
biopsies that do not find cancer. Observation of pre-diagnosis PSA
levels for men with deadly cancer often appears to show exponential
growth in PSA above a benign baseline PSA. The challenge is to
distinguish: 1) Increasing PSA caused by progressing cancer that will
continue to increase from 2) Increasing PSA caused by benign condi-
tions that often decelerates or decreases over time. Our objective was
to estimate the potential reduction in unnecessary biopsies by per-
forming a dynamic analysis of the PSA trend.
METHODS: We utilized Veterans Affairs data on 28,314 men
age 50-75 (median 64) who had biopsies from 2001-2012 that did not
find prostate cancer and had at least three PSA tests over at least two
years prior to biopsy and at least one additional test within one to thir-
teen months following the biopsy. Additional PSA tests after biopsy
allowed a “what-if” analysis of more PSA testing.
We fit an exponential plus constant trend to the PSA tests for each
man. We then calculated the percentage of biopsies that could have
been potentially deferred because a subsequent PSA test within one to
thirteen months of biopsy did not confirm the increasing PSA trend. For
this analysis, failure to confirm was defined in two ways: 1) deceleration
where the subsequent PSA increase was less than 50% of the ex-
pected trend increase and 2) decrease where the subsequent PSA was
below the level of PSA prior to the biopsy. We repeated the analysis for
ranges of exponential growth rates in PSA.
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2. RESULTS: The potential reduction in unnecessary biopsies for
the entire population using this approach was 80% based on deceler-
ation and 72% based on decrease below the level prior to biopsy. The
reduction varied substantially among the groups of exponential growth
rates in PSA. For example, reductions for decrease started at 59% for
very slow exponential PSA growth rates of 0%-5% and reached 93% for
fast PSA growth greater than 100% per year.
CONCLUSIONS: This analysis suggests that a delay in a bi-
opsy to allow additional PSA testing provides useful information about
PSA trends. In many cases, subsequent PSA trends showed a sub-
stantial deceleration or decrease that could have reduced the number of
unnecessary biopsies by 72-80%. The fastest growth in PSA per year
was also the most likely to decrease, with potential reductions of 93%
in biopsies.
Source of Funding: NONE
MP63-04
NEW ANALYSIS OF PSA TRENDS HELPS IDENTIFY DEADLY
CANCERS PRIOR TO BIOPSY
Lori Rawson*, Roy MacKintosh, Reno, NV; Christopher Morrell,
Baltimore, MD; R. Jeffrey Karnes, Rochester, MN; Stacy Loeb,
New York, NY; Stephen Van Den Eeden, Oakland, CA; Thomas Neville,
Incline Village, NV
INTRODUCTION AND OBJECTIVES: A major prostate cancer
screening challenge is to balance the potential harm of biopsies and
over-treatment with the need to identify deadly cancers early for
effective treatment. Observation of men with deadly cancer and their
prior PSA levels often appears to show exponential growth in PSA
over and above baseline PSA of a benign nature. Preliminary
research on small populations has suggested that faster exponential
growth rates in PSA above a no-cancer baseline are indicative of
more deadly cancers. Our objective was to validate the relationship
between dynamic PSA trends and later prostate cancer mortality on a
large population.
METHODS: We analyzed Veterans Affairs data on 58,523 men
age 50-75 (median 66) who had been diagnosed with prostate cancer
between 2001-2012 with at least three PSA tests over at least two years
prior to diagnosis. We fit an exponential plus constant trend to the PSA
tests for each man. This process allowed us to estimate for each man
the amount of PSA that might be coming from cancer and its annual
exponential growth rate. Men were grouped by ranges of age, cancer
PSA and growth rates. For each group, we utilized Kaplan Meier
methods to estimate all-cause death risk for years after diagnosis.
Cancer-specific death was estimated for each group using net-survival
methods based on an estimate of cancer-free survival and were
compared by the log rank test.
RESULTS: For a given PSA range, the faster the growth in PSA
measured in this way, the more deadly the cancer. For every range of
cancer PSA, all-cause and cancer-specific death increased substan-
tially for faster PSA growth (p<0.0001). For example, Figure 1 shows
the robust relationship between dynamic PSA trends with later prostate
cancer death in >30,000 men ages 50 to 75. These results held up for
various age ranges and types of treatment.
CONCLUSIONS: Higher annual exponential growth rates in
cancer PSA were significantly associated with all-cause and cancer-
specific death in our large population-based cohort. For men with a PSA
history, the growth rate calculated using these methods is highly
indicative of which men harbor life-threatening prostate cancer. This
result may help address the challenge issued by the U.S. Preventive
Services Task Force to develop screening methods to distinguish
potentially deadly cancers from non-progressive or slowly progres-
sive disease.
Source of Funding: NONE
MP63-05
SERUM TESTOSTERONE IMPROVES THE ACCURACY OF
PROSTATE HEALTH INDEX FOR THE DETECTION OF PROSTATE
CANCER
Frank Friedersdorff*, Kurt Miller, Klaus Jung, Carsten Stephan, Berlin,
Germany
INTRODUCTION AND OBJECTIVES: The detection of pros-
tate cancer (PCa) hampers on low specificity when using prostate-
specific antigen (PSA) alone. This study investigated the effects of total
testosterone (tT) and its free (fT) and bioavailable (bioT) subforms in
serum to improve the diagnostic validity of serum (-2)pro-PSA-based
prostate health index (PHI).
METHODS: Total and free PSA (tPSA, fPSA), (-2)pro-PSA,
testosterone, and sex-hormone-binding protein were measured by
automated immunoassays from the serum of 193 men scheduled for
prostate biopsy (99 with PCa and 94 with no evidence of malignancy).
FT and bioT were calculated using an online calculator. Statistical an-
alyses were performed by non-parametric tests (Wilcoxon signed rank,
Mann-Whitney, Kruskal-Wallis), binary logistic regression, and receiver
operating characteristics (ROC) analyses.
RESULTS: Compared to the non-malignant controls, PCa pa-
tients had significantly higher levels of tPSA and PHI, but lower levels of
%fPSA, tT, fT, and bioT. PCa could be differentiated from controls by
PHI, tT, fT, bioT, and %fPSA. PHI showed the largest area under the
ROC curve (AUC ¼ 0.73) that was additionally increased by the in-
clusion of bioT or tT in a binary logistic regression model. The AUC of
PHI in patients with tT concentrations of <8 nmol/L indicating
biochemical hypogonadism was significantly larger than that in patients
with higher tT values (0.86 vs 0.70).
CONCLUSIONS: The PHI based discrimination between PCa
patients and non-malignant controls could be improved by the simul-
taneous determination of testosterone, while patients with testosterone
concentration of <8 nmol/L have the greatest advantage.
Source of Funding: none
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