NOV 08, 2017 12:00 PM PST

Testing for Prostate-Specific Antigen (PSA): To Screen or Not to Screen

Speaker
  • Senior Health Scientist, Laboratory Research & Evaluation Branch, Division of Laboratory Systems, Centers for Surveillance, Epidemiology, & Laboratory Services, Centers for Disease Control
    Biography
      Dr. Shahram Shahangian has been a senior health scientist at the CDC's Division of Laboratory Systems since 1993. During this time, Dr. Shahangian has conducted studies in various areas of clinical laboratory medicine including clinical laboratory performance and proficiency testing, appropriate laboratory test utilization, problems in the total laboratory testing process, national surveys of coagulation laboratory testing practices, critical review of clinical laboratory quality indicators, and publications of good laboratory practices in molecular genetic testing, biochemical genetic tests, and newborn screening. He is the first or sole author of 25 original articles published in various peer-reviewed clinical laboratory journals. Prior to joining the CDC, Dr. Shahangian worked as a technical director and senior scientist in several biotechnology firms (1989-1993), as a research faculty member at the University of Texas MD Anderson Center (1985-1989), and as a postdoctoral fellow in clinical chemistry at the University of Utah School of Medicine (1982-1984). Dr. Shahangian received his PhD in 1982 and MS in 1979, both in biochemistry, from the University of Illinois at Urbana-Champaign. He has been a diplomate of the American Board of Clinical Chemistry since 1994 and a fellow of the National Academy of Clinical Biochemistry since 1995.

    Abstract

    Despite the fact that screening for many cancers is associated with net harm, healthcare consumers continue to be screened. PSA is the most commonly performed laboratory screening test for cancer in men, but is associated with harms including complications such as erectile dysfunction, urinary incontinence and bowel dysfunction that may result from prostatectomy or radiation therapy after being diagnosed. In addition, various psychosocial morbidities may result from positive or false-positive results, and a cascade of follow-up tests and treatments. Appropriate use of laboratory screening tests has been documented to improve health outcomes.

    This presentation will describe/list:

    •    Major epidemiological biases that positively impact perception of screening effectiveness including lead-time and length biases
    •    Current recommendations in the United States for PSA screening for prostate cancer
    •    Criteria adopted by the World Health Organization (WHO) for effectiveness of any health screening program and how well the PSA test meets each.

    These relate to:

    o    Societal burden of the disease
    o    Clinical performance of the screening test
    o    Acceptability and feasibility
    o    Cost-effectiveness
    o    Ability for disease intervention
    o    Informed consent
    o    Better population health outcome with screening


    The presentation will also note the consequences from screening and the dilemmas with laboratory-based screening tests such as PSA, while providing some recommendations for future use of these tests. The discussions are aimed at raising awareness about various issues surrounding prostate cancer screening using the PSA test to promote better use of laboratory screening services. 


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