No Survival Bump With More Frequent PSA Screens for Localized Prostate Cancer

Excerpt:

“Undergoing more frequent prostate-specific antigen (PSA) screening after radical prostatectomy or primary radiation for localized prostate cancer was not associated with improved overall survival (OS), regardless of disease risk, according to results of the AFT-30 study (abstract 6503) presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 1–5 in Chicago.

“‘Based on our study results, PSA testing every 3 to 6 months may represent overutilization of care,’ said Ronald Chen, MD, of the University of North Carolina at Chapel Hill. ‘This study provides empiric data to inform future guidelines and clinical practice.'”

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One-Off PSA Screening for Prostate Cancer Does Not Save Lives

Excerpt:

“Inviting men with no symptoms to a one-off PSA test for prostate cancer does not save lives according to results from the largest ever prostate cancer trial conducted over 10 years by Cancer Research UK-funded scientists and published today (Tuesday) in the Journal of the American Medical Association (JAMA).

“Researchers at the Universities of Bristol and Oxford found that testing asymptomatic men with PSA detects some disease that would be unlikely to cause any harm but also misses some aggressive and lethal prostate cancers.”

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Most Internet Sources on Prostate Cancer Disagree with Expert Panel's Recommendation

“Only 17 percent of top-ranked consumer health websites advise against screening for prostate cancer, a recommendation made more than two years ago by the U.S. Preventive Services Task Force (USPSTF), according to a study presented at the 2014 Clinical Congress of the American College of Surgeons.

“In an Internet search for the phrase ‘prostate cancer screening’ on three main U.S. search engines, study researchers found that most sites appearing on the first results page recommended a patient-individualized approach to screening.

“Prostate cancer is the most common cancer in men besides skin cancer, affecting one in seven American men over their lifetime according to the American Cancer Society.1 Screening, which is routine testing in the absence of symptoms, can detect prostate cancer early. Screening tests for this cancer are the prostate-specific antigen (PSA) blood test, a digital rectal exam, or both.

” ‘The recommendation not to screen men for prostate cancer is controversial,’ said lead author Philip Zhao, MD, a urologist at The Arthur Smith Institute for Urology at North Shore–Long Island Jewish Health System, New Hyde Park, N.Y. He performed the research while a resident physician at Rutgers–Robert Wood Johnson Medical School, New Brunswick, N.J, under the guidance of Robert E. Weiss, MD, professor of urology.

” ‘Our study results suggest that two-thirds of the online community disagree with the USPSTF recommendation against prostate cancer screening,’ Dr. Zhao said.”


New Prostate Cancer Screening Guideline Recommends Not Using PSA Test

“A new Canadian guideline recommends that the prostate-specific antigen (PSA) test should not be used to screen for prostate cancer based on evidence that shows an increased risk of harm and uncertain benefits. The guideline is published in CMAJ (Canadian Medical Association Journal)

” ‘Some people believe men should be screened for prostate cancer with the PSA test but the evidence indicates otherwise,’ states Dr. Neil Bell, member of the Canadian Task Force on Preventive Health Care and chair of the prostate cancer guideline working group. ‘These recommendations balance the possible benefits of PSA screening with the potential harms of false positives, overdiagnosis and treatment of prostate cancer.’

“For men with prostate cancer diagnosed through PSA screening, between 11.3% and 19.8% will receive a false-positive diagnosis, and 40% to 56% will be affected by overdiagnosis leading to invasive treatment. Treatment such as surgery can cause postoperative complications, such as infection (in 11% to 21% of men), urinary incontinence (in up to 17.8%), erectile dysfunction (23.4%) and other complications.”


Talking to Men About PSA Testing

“My patient looked back at me with a blank stare. I had just finished my take on the pros and cons of having a PSA test, and he looked lost. ‘What would you do if you were me, Doc?’ he said. I had just finished explaining the decision every man faces when he turns 50: whether to be screened for prostate cancer with a prostate-specific antigen (PSA) test. The decision is still unsettled despite the results of a giant, long-term study published earlier this month in the journal The Lancet. The study did not support the use of widespread screening.

“What makes the decision so tricky? It’s partly that prostate cancer is a weird cancer. Unlike cancer of the breast or the lung or the colon, which tends to kill people within five or 10 years, prostate cancer is usually slow growing. Men tend to die with it rather than of it. In fact, many live with it for 30 years or more and never even know they have it.

“That said, 3 percent of men do die of prostate cancer. So if we had an easy, safe treatment for prostate cancer, it would make sense to screen everyone and treat all the cancers we found. But the main treatments for prostate cancer carry a high risk of causing urinary incontinence and erectile dysfunction.”


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…


Prostate Cancer Screening Still Not Recommended for All

“A major European study has shown that blood test screening for prostate cancer saves lives, but doubts remain about whether the benefit is large enough to offset the harms caused by unnecessary biopsies and treatments that can render men incontinent and impotent.

“The study, published Wednesday in The Lancet, found that midlife screening with the prostate-specific antigen, or PSA, screening test lowers a man’s risk of dying of the disease by 21 percent. The relative benefit sounds sizable, but it is not particularly meaningful to the average middle-age man, whose risk of dying of prostate cancer without screening is about 3 percent. Based on the benefit shown in the study, routine PSA testing would lower his lifetime cancer risk to about 2.4 percent.

“Despite the fact that some men —one out of every 781 men in the screening group — were helped by PSA testing in the European study, the study authors say the finding does not support the use of widespread screening. Instead, cancer experts say, the focus should be on screening men at high risk and working to identify nonaggressive cancers so men will not be unnecessarily treated for the disease.”


Leading experts disagree on evidence behind prostate cancer screening recommendations

“The recommendation against routine PSA measurement relies too heavily on randomized trial data, according to an article by Ruth Etzioni, PhD, of Fred Hutchinson Cancer Research Center, Seattle, and colleagues. They argue that modeling studies provide a truer picture of the long-term benefits of PSA screening. But Dr Joy Melnikow of University of California, Davis, and colleagues disagree, asserting that randomized trials provide a sufficient level of certainty to recommend against PSA screening.”


Targeting Constitutively Activated β1 Integrin Could Be a New Target for Prevention of Metastasis of Prostate Cancer

Researchers from the MD Anderson Cancer Center in Houston show that β1 integrin activation occurs in metastatic progression of prostate cancer and is constitutively active in late state prostate cancer cells. The study shows the integrin palys a reole in survival of metastatic prostate cancer cells in circulation. Inhibition of β1 integrin activity by antibody or knockdown results in increased apoptosis.