PubMed Health⌕ Search

Biomedical subjects

K L Schwartz

Publications and source records attributed to K L Schwartz.

5 recordsLinked to original sources
PubMed1999

Prostate cancer histologic trends in the metropolitan Detroit area, 1982 to 1996.

OBJECTIVES: One of the concerns regarding the widespread use of serum prostate-specific antigen (PSA) as a screening tool for prostate cancer is the possibility that it may detect latent or clinically insignificant cancers. One indicator of clinical importance is thought to be histologic grade, with clinically unimportant cancers more likely to be well differentiated and clinically important tumors more likely to be moderately or poorly differentiated. METHODS: Data from the metropolitan Detroit population-based Surveillance, Epidemiology, and End Results Program were examined to determine trends in prostate cancer histologic grading before and after the introduction of PSA screening. RESULTS: From 1989 through 1996, the most recent year for which data are available, a dramatic increase in the incidence of prostate cancer occurred in the Detroit area, corresponding to the routine use of PSA as a screening test for prostate cancer. Local stage cancer demonstrated the largest increase in incidence. The incidence of moderately differentiated cancers also rose substantially during the same period; the incidence of poorly differentiated tumors remained about the same, and the incidence of well differentiated tumors decreased. Coincident with the increasing proportion of moderately differentiated cancers was a significant increase in the proportion of prostate biopsies performed (P = 0.001). CONCLUSIONS: These population-based data add important evidence that prostate cancers identified with PSA are more likely to be moderately than well differentiated. Additionally, if the definition of clinical significance depends on histopathologic grade, this finding could further be interpreted as evidence that PSA is more likely to detect clinically significant prostate cancer.

Adult↗
PubMed1996

Trends in the stage specific incidence of prostate carcinoma in the Detroit metropolitan area, 1973-1994.

BACKGROUND: Much of the recent increase in prostate carcinoma incidence has been attributed to screening with prostate specific antigen (PSA). Controversy exists as to whether this screening will ultimately impact prostate carcinoma mortality. Until adequate time elapses since PSA screening became widespread, or a randomized trial of PSA screening is completed, the effect of PSA screening on prostate carcinoma mortality cannot be determined. In the interim, stage specific prostate carcinoma incidence rates may provide an indication of the effect of PSA screening. METHODS: Annual stage specific age-adjusted prostate carcinoma incidence rates for the years 1973 through 1994 were obtained from the Metropolitan Detroit Cancer Surveillance System (MDCSS), a member of the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. These incidence rates were analyzed for trends using Poisson regression analysis. RESULTS: There were 10,801 cases of prostate carcinoma in black men and 31,501 in white men during the 22-year period. Incidence rates for stages of local and regional prostate carcinoma reached a maximum in 1992 and 1993. Distant stage prostate carcinoma incidence has steadily declined since 1989 (P < 0.001), the year in which the increasing trend in the incidence rates for local and regional stage prostate carcinoma were first noted. CONCLUSIONS: These findings suggest that a substantial proportion of early stage prostate carcinoma detected by PSA is in fact clinically important and that early detection of these carcinomas has resulted in a continuous decline in the stage of metastatic prostate carcinoma since 1989.

Age Factors↗
PubMed1995

Prostate-specific antigen in a community screening program.

BACKGROUND: This study was designed to determine who participates in community-based prostate-specific antigen (PSA) screening programs and what serum PSA levels can be expected. METHODS: A descriptive analysis of men who participated in an annual community health screening program was used to compare men who chose PSA screening with those who did not. The relationship of demographic variables to PSA level was evaluated by multivariate regression analysis. Data were available on 5548 men, 6% of whom were black. RESULTS: The population of PSA screening participants included proportionately more middle-aged white men with higher median income, as compared with men who did not participate. Those who did not participate in the screening were more likely to be either very old or very young. PSA levels increased with age, and the percentage of men with elevated PSA levels increased with age. One tenth (9.6%) of all participants had PSAs between 4 ng/mL and 10 ng/mL, and 1.9% had levels greater than 10 ng/mL. Within 1 year of the screening, 1.7% of the screened participants had a diagnosis of prostate cancer. The mean PSA in this group was 15.9 ng/mL. CONCLUSIONS: These data confirm the need for age-specific PSA reference ranges. It is likely that the same reference range can be used for all racial ethnic populations.

Black or African American↗