The Clinical Course of Patients With Prostate-Specific Antigen ≥100 ng/ml: Insight Into a Potential Population for...

Area of Science:

• Urology
• Oncology
• Public Health

Background:

• Prostate-specific antigen (PSA) screening is crucial for early prostate cancer detection.
• Safety-net hospitals serve vulnerable populations who may have unique health challenges.
• Elevated PSA levels (≥100 ng/mL) warrant thorough investigation for advanced prostate cancer.

Purpose of the Study:

• To characterize men presenting with high PSA levels (≥100 ng/mL) at a tertiary care safety-net hospital.
• To identify a potential population for targeted PSA screening initiatives.

Main Methods:

• Retrospective review of 100 patients with initial PSA ≥100 ng/mL from 2004-2011.
• Data collected on demographics, disease characteristics, and survival from hospital records.
• Analysis excluded data from incomplete paper charts.

Main Results:

• 65 patients newly diagnosed with prostate cancer; 35 previously diagnosed.
• Median PSA 405.5 ng/mL; 81% had metastatic disease; 94% had Gleason ≥7.
• 89% were African American; many had lower socioeconomic status (homeless, uninsured).
• Newly diagnosed patients showed low rates of prior screening (23%) or biopsy (9%).

Conclusions:

• Men with PSA ≥100 ng/mL at safety-net hospitals are predominantly African American with advanced disease.
• Lack of screening may lead to late diagnosis and poor outcomes in at-risk populations.
• Targeted PSA screening strategies should be considered for vulnerable, high-risk patient groups.