Objective
To characterize men presenting to a tertiary care safety-net hospital with prostate-specific
antigen (PSA) values ≥100 ng/mL and to identify a potential population for targeted
PSA screening.
Materials and Methods
Retrospective review of 100 randomly selected patients of a total of 204 who presented
to Grady Memorial Hospital from 2004 to 2011 with initial PSA ≥100 ng/mL was performed.
Demographics, disease characteristics, and survival status were obtained via the Tumor
Registry and a combination of electronic medical records and older paper charts, with
missing data from paper charts excluded on analyses.
Results
Sixty-five patients were newly diagnosed with prostate cancer on presentation and
35 were previously diagnosed. Median PSA at presentation was 405.5 ng/mL (minimum,
100 and maximum, 7805), 81% had metastatic disease, and 94% had Gleason ≥7. Median
Cancer of the Prostate Risk Assessment score was 8. Median age at presentation was
67.4 years (minimum, 40.8 and maximum, 90.6). Eighty-nine percent of patients were
African American, 24% lived alone, 12% were homeless or incarcerated, 51% were insured
by Medicare or Medicaid, and 47% were uninsured. Only 1% had human immunodeficiency
virus, 19% had diabetes, and 13% had chronic kidney disease. Of the 65 newly diagnosed
patients, only 23% had ever been screened and 9% were previously biopsied. Median
time from presentation to death was 17.8 months (minimum, 0.16 and maximum, 107.1).
Conclusion
Among men presenting with PSA ≥100 ng/ml at a safety-net hospital, the majority were
African American, of lower socioeconomic status, and had metastatic disease. Uniform
absence of prostate cancer screening may expose greater numbers of at-risk men to
similar outcomes. Discussion is needed regarding targeted PSA screening in higher
risk, vulnerable patients.
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Article info
Publication history
Published online: April 12, 2018
Accepted:
January 24,
2018
Received:
October 8,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
