Introduction: Studies have demonstrated lower prevalence of prostate cancer among patients with spinal cord injury but more advanced stage at diagnosis. Current screening practices for prostate cancer in this population are further complicated by greater baseline PSA values, higher rates of bacteriuria, and improving life expectancies. However, there is a lack of literature on prostate cancer screening among these patients. We sought to evaluate prostate cancer screening occurrence in patients with spinal cord injury at our institution compared to a matched, unaffected population.
Methods: We conducted a retrospective review of patients with the criteria: male, age 50-70, and diagnosis of cerebral palsy, paraplegia, quadriplegia, or spina bifida. A control cohort was matched by age, race, insurance, and co-morbidities. PSA screening, PSA value, prostate MRI, prostate biopsy, and biopsy outcome were compared. Multivariate logistic regression analysis was performed to determine the association between patient variables and PSA screening.
Results: The study cohort and control cohort included 2180 patients each. Patients with spinal cord injury had significantly lower rates of PSA screening (15% vs 24%, p < 0.00001), MRI (0.1% vs 0.6%, p = 0.02), and biopsy (0.6% vs 1.3%, p = 0.01) compared to control. Spinal cord injury was associated with a lower likelihood of PSA screening (OR = 0.56, CI = 0.48 – 0.65, p < 0.00001). There was no significant difference between study and control cohorts in risk stratification on biopsy (p=0.255). Among those who were PSA screened, there was no significant difference in patients who were ultimately diagnosed with prostate cancer between the two cohorts (p = 0.076). There were no 30-day readmissions following prostate biopsy in the study cohort, and one readmission for hematuria and urinary tract infection in the control cohort.
Conclusions: Patients with spinal cord injury were less likely to undergo PSA screening compared to a matched control population. Since PSA screening is a shared decision making process, providers should consider individual factors along with overall increasing life expectancies for patients with spinal cord injury.
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