title: Randomized trial finds that prostate cancer genetic risk score feedback targets prostate-specific antigen screening among at-risk men.
abstract: BACKGROUND
  Prostate-specific antigen (PSA) screening may reduce death due to prostate cancer but leads to the overdiagnosis of many cases of indolent cancer. Targeted use of PSA screening may reduce overdiagnosis. Multimarker genomic testing shows promise for risk assessment and could be used to target PSA screening.
  
  
  METHODS
  To test whether counseling based on the family history (FH) and counseling based on a genetic risk score (GRS) plus FH would differentially affect subsequent PSA screening at 3 months (primary outcome), a randomized trial of FH versus GRS plus FH was conducted with 700 whites aged 40 to 49 years without prior PSA screening. Secondary outcomes included anxiety, recall, physician discussion at 3 months, and PSA screening at 3 years. Pictographs versus numeric presentations of genetic risk were also evaluated.
  
  
  RESULTS
  At 3 months, no significant differences were observed in the rates of PSA screening between the FH arm (2.1%) and the GRS-FH arm (4.5% with GRS-FH vs. 2.1% with FH: χ2= 3.13, P = .077); however, PSA screening rates at 3 months significantly increased with given risk in the GRS-FH arm (P = .013). Similar results were observed for discussions with physicians at 3 months and PSA screening at 3 years. Average anxiety levels decreased after the individual cancer risk was provided (P = .0007), with no differences between groups. Visual presentation by pictographs did not significantly alter comprehension or anxiety.
  
  
  CONCLUSIONS
  This is likely the first randomized trial of multimarker genomic testing to report genomic targeting of cancer screening. This study found little evidence of concern about excess anxiety or overuse/underuse of PSA screening when multimarker genetic risks were provided to patients. Cancer 2016;122:3564-3575. © 2016 American Cancer Society.
authors.affiliation: Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Aubrey R
authors.initials: AR
authors.lastname: Turner
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan.|College of Human Medicine, Michigan State University, Grand Rapids, Michigan.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
authors.affiliation: Van Andel Research Institute, Grand Rapids, Michigan.
authors.forename: Dan
authors.initials: D
authors.lastname: Rogers
authors.affiliation: School of Nursing, Duke University, Durham, North Carolina.
authors.forename: Isaac
authors.initials: I
authors.lastname: Lipkus
authors.affiliation: Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Weaver
authors.affiliation: Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Danhauer
authors.affiliation: Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Fang-Chi
authors.initials: FC
authors.lastname: Hsu
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan.
authors.forename: Sabrina L
authors.initials: SL
authors.lastname: Noyes
authors.affiliation: Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Tamara
authors.initials: T
authors.lastname: Adams
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan.
authors.forename: Helga
authors.initials: H
authors.lastname: Toriello
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan.
authors.forename: Thomas
authors.initials: T
authors.lastname: Monroe
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan.
authors.forename: Trudy
authors.initials: T
authors.lastname: McKanna
authors.affiliation: Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Tracey
authors.initials: T
authors.lastname: Young
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan.
authors.forename: Ryan
authors.initials: R
authors.lastname: Rodarmer
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Kahnoski
authors.affiliation: Spectrum Health Hospital System, Grand Rapids, Michigan.
authors.forename: Mouafak
authors.initials: M
authors.lastname: Tourojman
authors.affiliation: Department of Surgery, University of California San Diego, San Diego, California.
authors.forename: A Karim
authors.initials: AK
authors.lastname: Kader
authors.affiliation: Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: S Lilly
authors.initials: SL
authors.lastname: Zheng
authors.affiliation: Grand Valley Medical Specialists, Grand Rapids, Michigan.
authors.forename: William
authors.initials: W
authors.lastname: Baer
authors.affiliation: Center for Cancer Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xu
keywords: genetic counseling; genetic risk score; genetic testing; prostate cancer; prostate-specific antigen (PSA) screening; randomized controlled trial