“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.'”
“A multi-center study that validates the clinical performance of IsoPSA—a new blood test that has proven to be more accurate in predicting overall risk of prostate cancer than standard prostate-specific antigen (PSA) – will be presented during a special press conference at the 13th Annual Meeting of the American Urological Association (AUA) on May 18 in San Francisco.
“Results showed that more than 40 percent of biopsies could have been avoided in both the preliminary study (45.1 percent) and validation study (47 percent), suggesting that use of IsoPSA may substantially reduce the need for biopsy, and may thus lower the likelihood of overdetection and overtreatment of nonlethal prostate cancer.”
“They look like glowing jade necklaces of such unearthly brilliance they could be a Ming emperor’s. But if Dr. Gerardo Fernandez is right, the green fluorescent images of prostate cells could be even more valuable, at least to the thousands of men every year who unnecessarily undergo aggressive treatment for prostate cancer.
“That’s because the glimmering images promise to show which prostate cancers are destined to remain harmless for the rest of a man’s life, and thus might spare many patients treatment that can cause impotence and incontinence.”
“In the UK ProtecT trial reported in TheNew England Journal of Medicine, Freddie C. Hamdy, FRCS, FMedSci, of the University of Oxford, and colleagues found no significant differences in prostate cancer–specific or overall mortality among men with clinically localized prostate cancer detected by prostate-specific antigen (PSA) testing who underwent active monitoring, surgery, or radiotherapy. Metastases and disease progression were more common with active monitoring. Median follow-up in the study was 10 years.”
“About a dozen new medical tests are coming to market that aim to more accurately diagnose prostate cancer and go well beyond the standard PSA (prostate-specific antigen) blood screenings used today. Several of them may even allow men to forego getting a biopsy that more than 1 million men diagnosed with prostate cancer undergo each year. That’s because these new tests will help doctors distinguish between aggressive disease and slow-growing tumors.”
When I was in my ’30s, I worked as a medical writer at the Chicago Sun-Times. I occasionally wrote articles about the troublesome prostate gland.
Here’s what I knew about the prostate:
A normal healthy gland is about the size of a walnut.
Older men often have enlarged prostates that cause them to wake up frequently at night to urinate. (I once overheard my father and father-in-law quietly discussing how their prostates kept them up at night.)
Advanced prostate cancer could spread into the bones and cause unbearable pain.
In most cases the disease grows slowly, which means men typically died with, but not from prostate cancer.
What did I know about my own prostate? Again, not much.
“A blood test called the 4Kscore results in accurate detection of high-grade prostate cancer. In a prospective study of 1,012 men, this test more accurately predicted the presence of high-grade disease compared with a commonly used risk calculator in men with elevated prostate-specific antigen (PSA) levels.
“The results from this study (Abstract 1) were presented by Sanoj Punnen, MD, a urologic oncologist at the University of Miami in Florida at the 2015 Genitourinary Cancers Symposium.
“In this study, men scheduled for a prostate biopsy were enrolled, regardless of their PSA level or clinical findings, at 26 centers across the United States between October 2013 and April 2014. A total of 231 (23%) high-grade prostate cancers were detected. The 4Kscore showed a higher net benefit in comparison with the PCPTRC at all threshold possibilities for high-grade disease used in clinical practice.
“The test is able to detect aggressive prostate cancer with high accuracy, Punnen told Cancer Network. ‘The area under the curve is better than any other biomarker in this area. There was a significant reduction in biopsies that could be attained if we used this test,’ he said.
“The goal of the 4Kscore is to reduce unnecessary biopsies, as the vast majority of biopsies show either no cancer or a low-grade tumor. These biopsies result in high medical costs, as well as morbidities for the patient.”
“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.”
“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.”