Clinical implications of a positive prostate cancer screen in patients undergoing cardiac transplant evaluation
Kumar, Vaibhav.
2018
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Abstract: Background: Screening the general population for prostate cancer
with prostate specific antigen (PSA) testing continues to be controversial. Patients with
advanced heart failure undergoing evaluation for cardiac transplantation are often
requested to undergo prostate cancer screening, with guiding evidence generated from the
general population. The clinical implications of a positive... read moreprostate cancer screening
result in this patient population has not been determined. Methods: A retrospective cohort
study was performed on all men that were referred to a cardiac transplant center between
January, 2000 and December, 2015. Patients were classified as having either a 'positive
screen' (PSA ≥ 4ng/ml) or a 'negative screen' (PSA < 4ng/ml) at the point of initial
evaluation. The primary outcome of time to listing for cardiac transplant (days) was
calculated from the date of referral to the date of listing. A multivariable Cox
proportional hazards model was developed to assess the association between a positive
prostate cancer screening result and listing for cardiac transplantation. For patients with
a positive PSA screen individual chart review was performed to ascertain the subsequent
diagnostic evaluation and identify patients with a diagnosis of prostate cancer. Results:
Among the 704 patients included in our analysis, 66 men (9.4%) had a positive prostate
cancer screening result. Men with a positive prostate cancer screen were approximately 4
years older (58.5 ± 8.7 years vs 54.1 ± 11.2 years), more likely to have a diagnosis of
ischemic cardiomyopathy (74% vs 53%) and to be on mechanical support at the point of
transplant evaluation (61% vs 16%). After adjusting for age, renal function, clinical
status at evaluation, history of COPD and the year of evaluation, patients with a positive
prostate cancer screen had a 42% reduced likelihood for progressing to cardiac transplant
listing compared to those with a negative screen (HR 0.58, 95%CI 0.38-0.91). 4 patients
with a positive prostate cancer screen had a confirmed diagnosis of prostate cancer during
the evaluation process, representing a positive predictive value of PSA screening of 6.1%
and cancer detection rate of 0.6%. Conclusion: Serum PSA performs poorly as a screening
modality for prostate cancer in men undergoing a cardiac transplant evaluation, especially
in those who are acutely unwell at the point of evaluation. Patients with a positive screen
have more adverse clinical characteristics in addition to a reduced likelihood for
progressing to listing for cardiac transplant. Given the unique nature of the decision to
perform prostate cancer screening in this population, an individualized approach in
particular with regards to timing of PSA screening should be encouraged.
Thesis (M.S.)--Tufts University, 2018.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: David Kent.
Committee: David DeNofrio, and Jason Nelson.
Keyword: Epidemiology.read less - ID:
- nk322r98p
- Component ID:
- tufts:25422
- To Cite:
- DCA Citation Guide EndNote
