Presentation Authors: River Black*, Hascal Humes, Eyitemi Owens, Nashville, TN, Lisa Bolton, Nashvllle, TN, Kelvin Moses, Nashville, TN
Introduction: African-American (AA) men are disproportionately affected by socio-economic factors that limit their access to care. AA men are also less likely to receive prostate cancer (PCa) screening, and when diagnosed with PCa, have an increased morbidity and mortality when compared to patients of other ethnicities. Despite controversy regarding PSA screening, it is not known if targeted screening in a high-risk population is valuable, or whether screening provides an opportunity for identification of other comorbid conditions. We designed a community-based and literacy-appropriate PCa screening program, with attention to other general health concerns.
Methods: The Prostate Screening and Cancer Awareness-Nashville (P-SCAN) program invited men 40 and older who had never received PCa screening to receive education about the disease. Literature written at a sixth grade level was given to all participants, and they spoke with a nurse practitioner about the risks and benefits of screening. Patients who chose to undergo screening had PSA and digital rectal examination (DRE), as well as serum lipid panel, basic metabolic panel (BMP), and blood pressure measurements. Demographic data, family history, and current medication information were also collected.
Results: A total of 249 men participated in the program from February 2017-April 2018, of which 218 (87.6%) were AA. Median PSA was 1.07 (range 0.13-28.89 ng/ml), median age was 54.9, and 5.2% of men had an abnormal DRE. Testing resulted in 36 referrals to Urology for elevated PSA or abnormal DRE (83% attendance), 21 referrals to Internal Medicine (85% attendance), 27 referrals to Family Medicine (33% attendance), and 7 referrals to Emergency Medicine for hypertensive crises (100% attendance). Subsequent new diagnoses included hypertension, diabetes, diabetic ketoacidosis, chronic obstructive pulmonary disease, heart failure, metastatic colon cancer, and metastatic renal cell carcinoma.
Conclusions: The P-SCAN program represents an opportunity for comprehensive health care in a high-risk, low-income population. We demonstrate the ability to provide health-literacy appropriate education regarding screening in a group characterized by minimal exposure to primary healthcare. Community-based comprehensive screening offers a unique opportunity to improve overall health outcomes in disadvantaged populations outside of traditionally singular diagnoses. In high-risk populations targeted by these plans, overall health status may be improved through implementation of similar programs.
Source of Funding: Astellas