NewYork-Presbyterian and Weill Cornell Medicine Urologists Urge Reconsideration of Prostate Cancer Screening After Finding Critical Flaw in Landmark Study

Excerpt:

“Evidence now favors that prostate specific antigen (PSA) testing can help reduce the number of fatal cases of prostate cancer, contrary to earlier recommendations based on a landmark national study. Researchers from NewYork-Presbyterian and Weill Cornell Medicine discuss their findings related to PSA screening in this week’s New England Journal of Medicine.

“In their letter to the editor, published May 5, the investigators question the results of a large-scale clinical trial assessing the value of PSA screening — which served as the basis for the U.S. Preventative Services Task Force’s 2012 recommendations against routine prostate cancer screening. They say limitations in the study’s methodology underscore the need for healthcare policy leaders to reevaluate the nation’s approach to PSA screening.

“Prostate cancer remains the second leading cause of cancer death among American men and is the most common cancer in men other than skin cancer.”

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Professional Recommendations Against Routine Prostate Cancer Screening Have Little Effect

“The effect of guidelines recommending that elderly men should not be routinely screened for prostate cancer ‘has been minimal at best,’ according to a new study led by researchers at Henry Ford Hospital.

“The study, published as a research letter online in JAMA Internal Medicine, focused on the use of PSA — prostate-specific antigen — to test for prostate cancer. ‘We found that the effect of the guidelines recommending against the routine screening of elderly men in particular has been minimal at best,’ says Jesse Sammon, D.O., a researcher at Henry Ford’s Vattikuti Urology Institute and lead author of the study.

“The researchers found an estimated 17 million men age 50 or older without a history of prostate cancer or prostate problems who reported undergoing PSA screening. Though credited with a significant improvement in 5-year cancer survival rates during the first decade after the FDA approved PSA testing of men without symptoms, its use for routine screening is controversial.

” ‘The concern is that the test often provides false-positives, leading subjects who do not have a prostate malignancy to undergo treatment they don’t need and suffer such side effects as impotence and urinary incontinence,’ says Dr. Sammon.

“Nearly three years ago, the debate led the U.S. Preventative Services Task Force to recommend against routine PSA screening in any age group.

” ‘But in the time since, nationwide patterns of PSA screening were largely unknown,’ says Dr. Sammon. ‘We sought to examine those patterns to determine the effects of the most recent USPSTF recommendation.’ “


Blood Test for 'Nicked' Protein Predicts Prostate Cancer Treatment Response

“Prostate cancer patients whose tumors contain a shortened protein called AR-V7, which can be detected in the blood, are less likely to respond to two widely used drugs for metastatic prostate cancer, according to results of a study led by researchers at the Johns Hopkins Kimmel Cancer Center. If large-scale studies validate the findings, the investigators say men with detectable blood levels of AR-V7 should avoid these two drugs and instead take other medicines to treat their prostate cancer. A report on the work is described online Sept. 3 in the New England Journal of Medicine.

“The study evaluated two groups of 31 men with prostate cancer that had spread and whose blood levels of prostate-specific antigen (PSA) were still rising despite low testosterone levels. Investigators gave each man either enzalutamide (Xtandi) or abiraterone (Zytiga) and tracked whether their PSA levels continued to rise, an indication that the drugs were not working. In the enzalutamide group, none of 12 patients whose blood samples tested positive for AR-V7 responded to the drug, compared with 10 responders among 19 men who had no AR-V7 detected. In the abiraterone group, none of six AR-V7-positive patients responded, compared with 17 responders among 25 patients lacking AR-V7.

“Enzalutamide and abiraterone have been very successful in lengthening the lives of about 80 percent of patients with metastatic prostate cancer, says Emmanuel Antonarakis, M.D., assistant professor of oncology at Johns Hopkins, but the drugs do not work in the remaining 20 percent of patients.

” ‘Until now, we haven’t been able to predict which patients will not respond to these therapies. If our results are confirmed by other researchers, a blood test could use AR-V7 as a biomarker to predict enzalutamide and abiraterone resistance, and let us direct patients who test positive for AR-V7 toward other types of therapy sooner, saving time and money while avoiding futile therapy,’ says Antonarakis.”


Not So Simple: Why PSA Screening Needs to Change


First, a little history: the protein PSA (prostate-specific antigen) was discovered in 1970 by Richard Ablin, PhD, while searching for a way to detect prostate cancer. He determined that PSA is indeed found in most prostate cancers, but is also present in healthy prostate glands, and is therefore not useful for diagnosing the disease. However, he did find that rising levels of PSA may signal a return of cancer in patients who were treated for prostate cancer, but relapsed. Continue reading…


Reasearcher Recommends Wider Use of Androgen-Deprivation Therapy for High PSA Levels

“Men whose prostate-specific antigen (PSA) level increases after radical prostatectomy or radiotherapy but who have no known metastases comprise the second-largest group of patients with prostate cancer. However, no standard of care exists for these patients, according to James Mohler, MD, Associate Director, Senior Vice President of Translational Research and Chair of the Department of Urology at Roswell Park Cancer Institute (RPCI).

“In a review article that was recently published in the prestigious American Cancer Society journal Cancer, Dr. Mohler shares his expert perspective on the future of androgen-deprivation therapy for men with persistently increasing PSA levels after failed local therapy. He explains that earlier and more complete androgen-deprivation therapy may cure many men with advanced prostate cancer.”


ASCO: Visceral Spread Guts Prostate Ca Survival Odds

“Lung, liver, and other visceral metastases are associated with the poorest survival in advanced hormone-refractory prostate cancer, according to results from a meta-analysis that sets the benchmark for prognosis.

“Lung metastases were associated with 30% higher adjusted odds of death compared with bone metastases (median survival 17 versus 20 months, P<0.002), Susan Halabi, PhD, of Duke University, and colleagues found.

“Liver metastases were even worse, with 40% higher adjusted odds of death compared with lung metastases after adjustment for performance status, prostate specific antigen (PSA), and age (median 12 months, P<0.001), the group reported here at the American Society of Clinical Oncology meeting.”


Androgen Deprivation Therapy—To Wait, or Not to Wait?


Every year, tens of thousands of patients diagnosed with localized prostate cancer are treated with some form of radiation therapy to kill cancer cells or with surgery to remove the cancerous prostate gland. After these invasive treatments, patients are monitored for disease progression with various tests, such as imaging (scans) and regular measurements of a protein called prostate-specific androgen (PSA) in the blood. Unfortunately, many patients find themselves in an ambiguous situation: their PSA levels are rising, but imaging tests fail to detect a return of their cancer. Continue reading…


Low Risk Prostate Cancer Not Always Low Risk

“More and more men who believe they have low-risk prostate cancers are opting for active surveillance, forgoing treatment and monitoring the cancer closely with prostate-specific antigen (PSA) tests, digital rectal exams and ultrasounds at regular intervals to see if their tumors are growing. Nearly 400 men are now enrolled in the UCLA Active Surveillance program, the largest in Southern California.

“However, according to a new UCLA study, selection of men for active surveillance should be based not on the widely used conventional biopsy, but with a new, image-guided targeted prostate biopsy. The new biopsy method, pioneered by a multi-disciplinary team on the Westwood campus, is now a routine part of the UCLA active surveillance program.”


New Fusion Technology Increases Prostate Cancer Detection Accuracy to 97 Percent

“A powerful new tool for visualizing and monitoring the prostate in men who have high prostate-specific antigen (PSA) levels and in detecting prostate cancer more accurately is now available in some American hospitals. The new technology combines or “fuses” magnetic resonance (MR) and ultrasound images uses electromagnetic tracking/guidance, similar to your car’s GPS system. A tiny tracking sensor is attached to an ultrasound probe and generates a small, localized electromagnetic field that helps determine the location and orientation of the biopsy device.”