NEW YORK (Reuters Health) – Men with spinal-cord injury are less likely to undergo prostate-specific antigen (PSA) screening for prostate cancer compared with the general population, a new study suggests.
People with this type of injury are thought to have a reduced risk of prostate cancer, but tend to experience greater morbidity and mortality if they do develop the malignancy, note Stacy Jeong, a medical student at Case Western Reserve University School of Medicine in Cleveland, Ohio, and colleagues in Urology. Not much is known about prostate-cancer screening in this population.
To investigate, the researchers analyzed data on 2,180 men between 50 and 70 years of age who had a diagnosis of cerebral palsy, spina bifida, or quadriplegia. They included a control cohort of 2,180 men without spinal-cord injury who were matched by age, race, insurance and co-morbidities for comparison.
Significantly fewer men with spinal-cord injury underwent PSA screening (15% vs. 24%, P<0.00001). They also had lower rates of prostate MRI (0.1% vs. 0.6%, P=0.02) and biopsy (0.6% vs. 1.3%, P=0.01) compared with the controls.
Meanwhile, older age (odds ratio, 1.03), Black race (OR, 1.3), private insurance (OR, 1.69), self-pay insurance (OR, 1.46), diabetes (OR, 1.90), obesity (OR, 1.74) and chronic obstructive pulmonary disease (OR, 1.76) were all significantly associated with a higher likelihood of undergoing PSA screening.
Dr. Benjamin Davies, a professor of urology at the University of Pittsburgh, in Pennsylvania, told Reuters Health by phone that one reason why it may be more difficult to measure PSA in patients who have spinal-cord injury is that they catheterize themselves.
“When you catheterize yourself, that PSA value goes up, and so it’s hard for doctors to know what to do with PSA numbers in these people,” said Dr. Davies, who wasn’t involved in the research. “But just because they have fluctuations in their PSA doesn’t mean these values should be ignored in this population.”
Dr. Stephanie Kielb, a professor of urology at Northwestern University Feinberg School of Medicine, who also was not involved in the study, said disability associated with the injury may be a strong contributor to the lower screening rates. “Just being able to get in and out of a clinic if you’re in a wheelchair and if you’re a spinal-cord patient can make this very difficult,” she told Reuters Health by phone.
She added that although patients with spinal-cord injury may have lower rates of prostate cancer, the disease is often more advanced in these patients once it is diagnosed.
“It is important that these patients get the proper medical care and be screened just like everyone else,” Dr. Kielb said. “It’s just getting them the access to their proper care is what we should do as physicians, as we owe it to our patients to take care of them and to properly screen them as recommended for all people.”
Jeong was not available for comment.
SOURCE: https://bit.ly/3tumxsr Urology, online February 16, 2022.
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