Michael Liss

MD, MAS

University of Texas Health Science Center San Antonio

Assistant Professor

PLCO (Learn more about this study)

PLCO-100

Aug 15, 2014

Impact of Prostate Cancer Screening on Behavior Modifications and Racial Disparities

Prostate cancer screening is on the decline after the United States Preventative Services Task Force recommended against prostate cancer screening and other regulatory entities followed. A paradigm shift is needed in prostate cancer screening; however, the screening visits may provide an additional "teaching moment" to provide information regarding screening and education on general health topics. An example in cancer patients is smoking cessation, specifically in lung, ENT, and bladder cancer patients. Smoking is thought to have a causal relationship to these cancers and is probably more frequently discussed. Moreover, subsequent data has shown improved survival if smoking cessation is initiated at the onset of diagnosis. Bladder cancers have a significant number of follow-up visits with their physicians providing more opportunity to encourage smoking cessation. More recent studies in prostate cancer have shown a significant improvement in prostate cancer outcomes in patients eating more vegetables and engaged in regular exercise. These strategies are now being tested in clinical trials (specifically MEAL - Men Eating and Living study) for those men on active surveillance of low grade prostate cancer. If an intervention such as screening can provide a teaching moment the urologist may have the ability for behavior modification in men. Furthermore, these practices can encouraged in urologists offices to improve the overall health of our patients.

Specific Aim 1: To determine if additional benefits of prostate cancer screening by secondarily affecting all overall mortality by creating more opportunities to engage patients and intervene earlier in other disease processes.

Hypothesis 1: Overall and Cardiovascular mortality is reduced in the screening arm of the PLCO trial as compared to the usual care arm. (sub-analysis in race)

Specific Aim 2: To determine the incidence and impact of smoking on mortality and if it is reduced in the screening arm that could be directly or indirectly influenced by visiting the physician more regularly in the screening arm.

Hypothesis 2: Smoking is cessation is more common and relapse is less common in the supplemental questionnaire in the screening arm compared to the usual care arm and improves overall, cardiovascular, and prostate specific mortality. (sub-analysis in race)

Specific Aim 3: To determine the incidence and impact of exercise on mortality outcomes and if exercise is effected by prostate cancer screening.

Hypothesis 3: Exercise with confirmatory reduction in body mass index is more common in the screening arm compared to the usual care arm and improves overall, cardiovascular, and prostate specific mortality. (sub-analysis in race)