Dataset Information

Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123?697 Australian men.

ABSTRACT: OBJECTIVES:To develop and validate a prediction model for short-term mortality in Australian men aged ?45years, using age and self-reported health variables, for use when implementing the Australian Clinical Practice Guidelines for Prostate-Specific Antigen (PSA) Testing and Early Management of Test-Detected Prostate Cancer. Implementation of one of the Guideline recommendations requires an estimate of 7-year mortality. DESIGN:Prospective cohort study using questionnaire data linked to mortality data. SETTING:Men aged ?45years randomly sampled from the general population of New South Wales, Australia, participating in the 45 and Up Study. PARTICIPANTS:123?697 men who completed the baseline postal questionnaire (distributed from 1 January 2006 to 31 December 2008) and gave informed consent for follow-up through linkage of their data to population health databases. PRIMARY OUTCOME MEASURES:The primary outcome was all-cause mortality. RESULTS:12?160 died during follow-up (median=5.9 years). Following age-adjustment, self-reported health was the strongest predictor of all-cause mortality (C-index: 0.827; 95%?CI 0.824 to 0.831). Three prediction models for all-cause mortality were validated, with predictors: Model-1: age group and self-rated health; Model-2: variables common to the 45 and Up Study and the Australian Health Survey and subselected using stepwise regression and Model-3: all variables selected using stepwise regression. Final predictions calibrated well with observed all-cause mortality rates. The 90th percentile for the 7-year mortality risks ranged from 1.92% to 83.94% for ages 45-85 years. CONCLUSIONS:We developed prediction scores for short-term mortality using age and self-reported health measures and validated the scores against national mortality rates. Along with age, simple measures such as self-rated health, which can be easily obtained without physical examination, were strong predictors of all-cause mortality in the 45 and Up Study. Seven-year mortality risk estimates from Model-3 suggest that the impact of the mortality risk prediction tool on men's decision making would be small in the recommended age (50-69?years) for PSA testing, but it may discourage testing at older ages.

SUBMITTER: Joshy G

PROVIDER: S-EPMC6303562 | biostudies-other | 2018 Dec

REPOSITORIES: biostudies-other

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Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123 697 Australian men.

Joshy Grace G Banks Emily E Lowe Anthony A Wolfe Rory R Tickle Leonie L Armstrong Bruce B Clements Mark M

BMJ open 20181214 12

<h4>Objectives</h4>To develop and validate a prediction model for short-term mortality in Australian men aged ≥45years, using age and self-reported health variables, for use when implementing the Australian Clinical Practice Guidelines for Prostate-Specific Antigen (PSA) Testing and Early Management of Test-Detected Prostate Cancer. Implementation of one of the Guideline recommendations requires an estimate of 7-year mortality.<h4>Design</h4>Prospective cohort study using questionnaire data link ...[more]

PMID: 30552254

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Project description:BackgroundIncreased use of prostate specific antigen (PSA) has been associated with increased prostate cancer incidence. Ireland is estimated to have one of the highest prostate cancer incidences in Europe and has no national guidelines for prostate cancer screening. GPs have a pivotal role in influencing PSA testing, therefore, our aim was to describe GP testing practices and to identify factors influencing these.MethodsA postal survey, including questions on clinical practice and experience, knowledge and demographics was distributed to all GPs (n = 3,683). The main outcomes were (i) PSA testing asymptomatic men and (ii) "inappropriate" PSA testing, defined as testing asymptomatic men aged < 50 or > 75 years. Factors associated with these outcomes were identified using logistic regression.Results1,625 GPs responded (response rate corrected for eligibility = 53%). Most respondents (79%) would PSA test asymptomatic men. Of these, 34% and 51% would test asymptomatic men < 50 and > 75 years, respectively. In multivariate analyses, GPs were more likely to test asymptomatic men if they were >or= 50 years, in practice >or= 10 years, female or less knowledgeable about PSA efficacy. Male GPs who would have a PSA test themselves were > 8-times more likely to PSA test asymptomatic men than GPs who would not have a test. GPs who had an asymptomatic patient diagnosed with prostate cancer following PSA testing, were > 3-times more likely to test asymptomatic men. Practice-related factors positively associated with testing included: running 'well man' clinics, performing occupational health checks and performing other tests routinely with PSA. Factors positively associated with 'inappropriate' testing included; being male and willing to have a PSA test, having worked/trained in the UK and supporting annual PSA testing. 91% of respondents supported the development of national PSA testing guidelines.ConclusionOur findings suggest that widespread PSA testing of asymptomatic men in primary care is primarily due to a combination of clinical experience, poor knowledge and the support of doctors for PSA testing, as evidenced by the willingness of male doctors to have a PSA test. There is an urgent need for education and support for GPs concerning prostate cancer screening, starting with the implementation of national guidelines.

Project description:ImportanceGermline testing guidelines are suggested for specific disease types or a family history of cancer, yet alterations are found in cancer types in which germline testing is not routinely indicated. The clinical role of identifying germline variants in these populations is valuable to patients and their at-risk relatives.ObjectiveTo evaluate the prevalence of germline findings in patients undergoing tumor/normal matched sequencing among cancer types lacking guidelines.Design, setting, and participantsThis retrospective cross-sectional study took place on August 18, 2021, and included data from deidentified records of patients tested, using the Tempus xT tumor/normal matched approach from November 2017 to August 2021. Records included in this study were from 34 642 patients treated in geographically diverse oncology practices in the US with a diagnosis of any of the following cancers: bladder, brain, lung, esophagus, cholangiocarcinoma, head and neck, breast, ovarian, pancreatic, prostate, endometrial, and colorectal.Main outcomes and measuresThe rate of germline findings (ie, single-nucleotide variants and small insertions or deletions) detected in 50 reportable hereditary cancer genes was calculated for cancer types lacking guidelines for germline testing (bladder, brain, lung, esophagus, cholangiocarcinoma, and head and neck) and cancer types for which germline testing is frequently performed (breast, ovarian, pancreatic, prostate, endometrial, and colorectal). Same-gene second somatic hits were assessed to provide a comprehensive assessment on genomic drivers.ResultsOf 34 642 patients, 18 888 were female (54.5%); of 27 498 patients whose age at diagnosis was known, mean (SD) age was 62.23 (3.36) years. A total of 2534 of 34 642 patients (7.3%) harbored pathogenic or likely pathogenic germline variants. Within the tumor types lacking testing guidelines, germline mutations were at 6.6% (79/1188) in bladder cancer and 5.8% (448/7668) in lung cancer.Conclusions and relevanceThis study may present the largest retrospective analysis to date of deidentified real-world data from patients diagnosed with advanced cancer with tumor/normal matched sequencing data and the prevalence of pathogenic or likely pathogenic germline variants in cancer types lacking hereditary cancer testing guidelines. The findings suggest there may be clinical implications for patients and their at-risk family members in cancers for which germline assessment primarily based on the cancer diagnosis is rarely obtained.

Dataset Information

Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123?697 Australian men.

Publications

Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123 697 Australian men.

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