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UPJ INSIGHT Prostate-Specific Antigen Screening in Smokers: Analysis Using a National Behavioral Survey
By: I. Mitchell Harmatz, BS, University of Pennsylvania, Philadelphia; Khalid Y. Alkhatib, MD, MMSc, University of Pennsylvania, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia; Morgan Leff, BS, University of Pennsylvania, Philadelphia; José I. Nolazco, MD, MMSc, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts Hospital Universitario Austral, Universidad Austral, Pilar, Argentina; Katharine F. Michel, MD, MSHP, University of Pennsylvania, Philadelphia; Michelle Slinger, BS, University of Pennsylvania, Philadelphia; Nathaniel McLauchlan, BS, University of Pennsylvania, Philadelphia; Brian D. Cortese, BS, University of Pennsylvania, Philadelphia; Daniel S. Roberson, MD, University of Pennsylvania, Philadelphia; Benjamin Schurhamer, MD, University of Pennsylvania, Philadelphia; Daniel J. Lee, MD, MS, University of Pennsylvania, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia; S. Bruce Malkowicz, MD, University of Pennsylvania, Philadelphia; Quoc-Dien Trinh, MD, MBA, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Trinity J. Bivalacqua, MD, PhD, University of Pennsylvania, Philadelphia; Thomas J. Guzzo, MD, MPH, University of Pennsylvania, Philadelphia; Phillip M. Pierorazio, MD, University of Pennsylvania, Philadelphia Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia | Posted on: 20 May 2024
Harmatz IM, Alkhatib KY, Leff M, et al. Prostate-specific antigen screening in smokers: a comprehensive analysis using a national behavioral survey. Urol Pract. 2024;11(3):547-556. doi:10.1097/UPJ.0000000000000553
Study Need and Importance
Cigarette smoking has been associated with high-risk prostate cancer (PCa) at diagnosis and with higher overall and PCa-specific mortality. Ambiguity remains regarding the relative contributions of underlying biochemical pathways leading to aggressive disease in smokers vs reduced PSA screening in smokers contributing to delayed presentations, hence diagnosed with high-risk disease.
What We Found
Using nationally representative data from the US-based Behavioral Risk Factor Surveillance System survey, we investigated the relationship between smoking status and PSA screening uptake. After adjusting for potential sociodemographic cofounders, our study revealed that current smokers had a statistically significant lower recommended PSA screening prevalence by 8% compared to nonsmokers (adjusted risk difference: −0.078; 95% CI: −0.107 to −0.048; P < .001) irrespective of daily or nondaily smoking habits. However, no significant difference in screening prevalence was found among former smokers when compared to nonsmokers (adjusted risk difference: 0.006; 95% CI: −0.028 to 0.040; P = .53; Figure).
Limitations
Our study is limited by the inherent biases associated with the retrospective study design and not accounting for other potential cofounders not captured by the Behavioral Risk Factor Surveillance System survey.
Interpretation for Patient Care
Our findings indicate that the high incidence of high-risk PCa disease among smokers is at least partially due to low PSA screening when compared to those who never smoked. Improved adherence to PSA screening guidelines among smokers could lead to earlier PCa detection and thus more favorable outcomes. Additionally, our results suggest that smoking cessation is associated with improved health screening practices equivalent to those who have never smoked. Therefore, enhanced PSA screening strategies tailored for smokers are needed to improve the overall outcomes of PCa. Furthermore, a robust smoking cessation program will yield an improved adherence to PSA screening recommendations.
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