Posts Tagged ‘prostate cancer’

New Tests to Improve Decision Making in Prostate Cancer Treatment

This blog was originally posted June 3, 2015 AACR Press Office.

Prostate Cancer Cells

Prostate Cancer Cells

A diagnosis of prostate cancer can often result in difficult choices for both patients and physicians. Prostate cancer is the most common non-skin cancer diagnosed in American men, with over 200,000 diagnosed cases and almost 28,000 deaths per year. A major reason why prostate cancer is diagnosed so frequently is that the FDA-approved blood test for prostate-specific antigen (PSA) is widely used and is highly sensitive. However, the PSA test cannot distinguish prostate cancers that are aggressive from indolent cases that will not spread if left untreated.

It has been estimated that about 50 percent of men who are diagnosed with prostate cancer as a result of PSA testing would remain asymptomatic if left untreated. Furthermore, the side effects of surgery or radiation therapy can be significant, and include urinary incontinence and sexual dysfunction. These side effects from overtreatment without clear survival benefit led the U.S. Preventive Services Task Force (USPSTF) to recommend against PSA screening. As a result, there is a pressing clinical need for new prostate cancer biomarkers that can discriminate aggressive from indolent disease to prevent overtreatment of indolent cases and undertreatment of aggressive cases. This is one example of how precision medicine can both improve cancer care and reduce overall health care expenditures.

While single biomarkers can be useful, quite often using a panel of many genes is more robust, predictive, and informative than a single biomarker such as PSA. Moreover, RNA is generally much easier to detect and quantitate than protein, even at low amounts, and RNA-based assays can test many targets simultaneously. RNA-based approaches to prostate cancer biomarker discovery include the analysis of which genes are switched on and off in a cancer cell, as well as measurement of previously unappreciated RNAs that do not code for proteins, and detection of known genetic mutations.

Biopsies themselves carry some risk of infection, discomfort, and expense. Consequently, less invasive biomarkers that can use blood or urine samples are more desirable, and likely to be adopted more broadly, resulting in better patient compliance and follow up. Many researchers are thus looking for prostate cancer biomarkers that can be readily measured from biofluid specimens.

There are several different clinical questions that new biofluid biomarkers for prostate cancer could potentially address. First, if I have a high PSA, do I really need a biopsy? Second, if my biopsy looks indolent, am I a good candidate for active surveillance, or do I really need surgery or radiation? And third, if I do need surgery or radiation, will it be curative, or should I think about enrolling in clinical trials? These are all important questions that many scientists and physicians are currently pursuing in their biomarker research.

Recent research in our lab has identified a gene panel that can predict whether a patient is likely to have a recurrence after surgery, and we are currently working on determining if this panel can also identify good candidates for active surveillance. This research is using advanced sequencing technologies on both urine and biopsy samples, and could make it easier for patients and their doctors to safely decide that surgery or radiation are unnecessary, reducing side effects and unnecessary treatments. A number of other commercially available panels are already in use including Prolaris, Oncotype Dx, and Decipher, though none are currently FDA approved. Hopefully, with additional research to determine the best biomarkers of cancer aggressiveness and approval of such tests, patients and physicians can be confident in the treatment decisions that they make, leading to the best possible health outcomes.

About Dr. Moreno

carolos moreno, phdCarlos S. Moreno, PhD, is an associate professor in the Departments of Pathology & Laboratory Medicine, and Biomedical Informatics at the Emory University School of Medicine. He is a member of the Cancer Genetics and Epigenetics research program at Winship Cancer Institute. Moreno specializes in cancer bioinformatics and systems biology, cancer genomics, cancer biomarkers, and transcriptional networks. He is the informatics project leader for the Emory Molecular Interaction Center for Functional genomics (MicFG) as part of the Cancer Target Discovery and Development (CTD²) Network to identify protein-protein interaction networks.

Moreno has been a member of the American Association for Cancer Research since 2003 and received an AACR Minority Scholar Award in 2006.

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Cancer Clinical Study Leads to Video Tool for Prostate Cancer Patients

At Emory, research plays a key role in the mission to serve our patients and their families. Medical advances and improvements to patient care have been made possible by research and volunteer participation in clinical trials. More than 1,000 clinical trials are offered at Emory, making a difference in people’s lives, today.

Recently, a clinical study initiated by Winship Cancer Institute of Emory University, found that providing prostate cancer patients with a video-based education tool significantly improved their understanding of key terms necessary to making decisions about their treatment.

The breakthrough study was led by three Winship at Emory investigators; Viraj Master, MD, PhD, FACS; Ashesh Jani, MD; and Michael Goodman, MD, MPH; and is the feature cover story of this month’s Cancer, the peer-reviewed journal of the American Cancer Society.

In 2013, Master, Jani and Goodman released an Emory study that showed that prostate cancer patients (treated at Grady Hospital in Atlanta) experienced a severe lack of understanding of prostate key terms. The original study showed only 15 percent of the patients understood the meaning of “incontinence”; less than a third understood “urinary function” and “bowel habits”; and fewer than 50 percent understood the word “impotence.”

In response to their findings, the three principle investigators jumped to find a solution to the problem. The latest study explored using a video-based tool to educate prostate cancer patients on key terminology. The physicians predicted that with a better understanding of terms linked to disease, patients would be able to participate in shared and informed decision-making throughout the prostate cancer treatment process.

About the Prostate Cancer Video Trial:

  • 56 male patients were recruited from two low-income safety net clinics and received a key term comprehension test before and after viewing the educational video.
  • The video software (viewed by participants on iPads) featured narrated animations depicting 26 terms that doctors and medical staff frequently use in talking with prostate cancer patients.
  • Learn more by watching this video:

clinical trials for prostate cancer

Results of the Prostate Cancer Video Trial:

Participants who viewed the educational video demonstrated statistically significant improvements in comprehension of prostate terminology. For instance, before viewing the application, 14 percent of the men understood “incontinence”; afterward, 50 percent of them demonstrated understanding of the term.

“This shows that video tools can help patients understand these critical prostate health terms in a meaningful way. The ultimate goal is to give patients a vocabulary toolkit to further enable them to make shared and informed decisions about their treatment options,” says Viraj Master. “Our next goal is to improve the tool further, and study this tool at different centers.”

Learn more about clinical trials at Emory >>

Find a clinical trial at Emory >>

 

Additional Information about the Prostate Cancer Trial:

The research for this study was made possible by a Winship Cancer Institute multi-investigator pilot grant and the contributions of faculty and students from Winship, the Rollins School of Public Health and the Emory School of Medicine.

This study was led by three Winship at Emory investigators: Viraj Master, MD, PhD, FACS, Winship urologist and director of clinical research in the Department of Urology at Emory University; Ashesh Jani, MD, professor of radiation oncology in the Emory School of Medicine; and Michael Goodman, MD, MPH, associate professor of epidemiology with the Rollins School of Public Health.

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Takeaways from Dr. Sanda’s Chat on Prostate Cancer

Thank you for attending the live chat with Dr. Martin Sanda on prostate cancer. (Link to: ) Your questions and participation were terrific. Below are additional Q&As that we didn’t have time to get to during the live chat portion.

As you know, prostate cancer is the second most common cancer in men, second only to skin cancers. Emory Healthcare is privileged to partner with you in your health and is ready and able to assist if needed. Please use the resources on this page and this website to contact us if we can help in any way.

Question: What are today’s best prostate cancer diagnosis methodologies?
Answer: Despite a lot of advances in imaging tests such as MRI or higher-resolution ultrasound, there is still a need to biopsy the prostate in order to determine whether or not prostate cancer is present. The biopsy provides important information, not only as to whether there are cancer cells, but if so, how aggressive or how fast-growing those cancer cells appear to be. Bone scans and CT scans are useful to look for spread of prostate cancer elsewhere. Also, new PET (positron emission tomography) scans or other diagnostic studies that image molecules which are taken up by cancerous tissue and not by normal tissue are emerging. But, their role in standard care is not yet sorted out. MRI can provide valuable information about the size and configuration of tumors in the prostate itself and the immediate vicinity, as part of a watchful waiting monitoring plan, or as a guide for treatment planning.

Question: What are the dangers of conventional biopsy?
Answer: The main risk of prostate cancer biopsy is infection, which can be seen in approximately one out of 50 to one out of 100 cases and can require hospitalization for treatment. More commonly, some men may feel faint after a biopsy and should plan on taking the day off or taking it easy if they undergo a prostate biopsy procedure. Rarely, men might experience bleeding from where the needle is inserted into the prostate and this, too, can require hospitalization. Common after prostate biopsy is having blood in the semen or ejaculate; however, this does not pose any danger or risks and will typically resolve in a matter of a few weeks.

Question: Are there new drugs and and prostate cancer treatments on the near horizon?
Answer: Major scientific discoveries have taken place over the past five to 10 years and many more are underway. This has led to a half-dozen new treatments for advanced prostate cancer that have become available in the past several years. A broad range of new treatments are being developed, including more refined types of hormonal therapy, including immune therapies or therapeutic vaccines and also targeted therapies that are aimed at molecular differences between the cancer cell and normal tissue.

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About Dr. Martin Sanda

Dr. Martin SandaMartin G. Sanda, MD, an internationally recognized prostate cancer surgeon and scientist, was appointed chair of the Department of Urology at Emory University School of Medicine and service chief for Emory Healthcare. He also serves as director of the Prostate Cancer Center, which will be established within Emory’s Winship Cancer Institute.

Sanda joins Emory from Harvard Medical School, where he was professor of surgery in urology, and from Beth Israel Deaconess Medical Center, where he served as director of the Prostate Cancer Center. He was also the co-leader of the Prostate Cancer Program at the Dana Farber Cancer Center.

 

Though Common, Prostate Cancer is Often Very Treatable – Join Our Q&A Chat for Details

Prostate Cancer Q&A ChatDid you know that prostate cancer is the second most common cancer experienced by men, after skin cancer? The good news is that, when caught early, it can often be treated with great success.

Millions of men are living today as survivors of prostate cancer. Being armed with good information in advance is a key ingredient in protecting yourself or your loved ones from this disease.

Join Emory Chairman of the Department of Urology, Dr. Martin Sanda, on Tuesday, September 24, for an online web chat to discuss “Prostate Cancer.”

Prostate Cancer Chat Sign Up

New Treatment for Prostate Cancer: Saint Joseph’s Hospital First in State to Treat Patient with Xofigo

Xofigo new prostate cancer treatment medicationA double bass player in the Atlanta Symphony Orchestra, Doug Sommer claims he was just “in the right place at the right time with the right doctors,” when he was offered the opportunity to be the first in the state to receive a new treatment option for his prostate cancer.

Doug is the first patient in Georgia to receive a new FDA-approved radioactive therapeutic drug for advanced metastatic prostate cancer. He received the treatment, a single injection of radium Ra 223 dichloride, (brand name Xofigo) at Saint Joseph’s Hospital. This was the first of six injections. Xofigo has been shown to reduce bone pain and improve quality of life.

“Patients with a type of cancer called castration-resistant prostate cancer (CRPC) with metastatic bone disease, who have failed hormone suppression therapy, now have a new treatment option for their disease.”

Peter Rossi, MD, medical director of radiation oncology at Saint Joseph’s Hospital and assistant professor of radiation oncology at Emory University School of Medicine & Winship Cancer Institute

Read more about this new treatment for prostate cancer on the Saint Joseph’s Hospital blog >>

A More Precise Blood Test Outperforms PSA Screening in Detecting Aggressive Prostate Cancers

Martin Sanda, MDMartin Sanda, MD, a member of the Winship Cancer Institute, chairman of the Emory Department of Urology and internationally recognized prostate cancer scientist, recently delivered big news about better prostate cancer diagnosis, at the American Urological Association’s 2013 Annual Meeting.

As corresponding and presenting author of the abstract “Prostate Health Index (phi) for Reducing Overdetection of Indolent Prostate Cancer and Unnecessary Biopsy While Improving Detection of Aggressive Cancers,” Sanda presented findings that represent a significant step towards better detection and diagnosing of fast-growing prostate cancers, and fewer unnecessary biopsies of indolent cancers.

The Prostate Health Index (phi), a blood test used to evaluate the probability of prostate cancer diagnosis, outperformed commonly used prostate-specific antigen (PSA) and free/total prostate-specific antigen (%fPSA) tests in predicting the presence of clinically significant prostate cancer and in improving prostate cancer detection, according to the new study. The phi test focuses on measuring a subtype of PSA, called pro-PSA, that unlike the rudimentary total PSA, is preferentially made by aggressive prostate cancers and less so by normal prostate or slow-growing cancers. Sanda and his collaborators found that among men being considered for prostate biopsy due to abnormal results on the traditional “total” PSA test, one in four had phi test results that indicated no aggressive cancer would be found and unnecessary biopsy could be averted.

To learn more about this exciting new screening test, read the full story in the Emory News Center. For more prostate cancer and PSA screening related articles, check out our related resources at the end of this post.

About Martin Sanda, MD

Martin G. Sanda, MD is chair of the Department of Urology at Emory University School of Medicine and Urology service chief for Emory Healthcare. Before joining Emory in 2013, Sanda was Professor of Surgery in Urology at Harvard Medical School, Director of the Prostate Cancer Center at Beth Israel Deaconess Medical Center and co-leader of the Prostate Cancer Program at the Dana Farber Cancer Center.

As a urological surgeon specializing in cancers of the prostate and bladder, Sanda focuses on developing new surgical and non-surgical approaches to cancer care and to improving the quality of life among cancer survivors.  Currently, he is spearheading studies that seek to develop urine tests for detecting prostate cancer; develop benchmarks for improving quality of life among cancer survivors; and develop innovative prostate cancer vaccines.

Sanda has served as chair of the Prostate and Genito-Urinary Collaborative Group of the National Cancer Institute’s Early Detection Research Network (2007-2010), has led two nationwide, NCI Cooperative Group prostate cancer clinical trials, and has served on the Research Council of the American Urological Association since 2011.  Dr. Sanda will also serve as Director of the Prostate Cancer Center, being established within the Winship Cancer Institute of Emory University.

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PSA Screening for Prostate Cancer: A Healthy Debate

Prostate cancer is the second leading cause of cancer death among American men. In 2013, nearly 250,000 men will be diagnosed with prostate cancer and more than 32,000 men will die from prostate cancer across the United States. In Georgia, it is estimated that 7,360 men will be diagnosed and 1,080 will die.  With alarming statistics such as these, we want every advantage possible in our fight with this disease.

Over the last few years, the topic of PSA testing as a screening tool for prostate cancer has been under heavy debate in the medical community. PSA (prostate specific antigen) is a protein produced by the prostate gland and its levels can be measured by a simple blood test.  A higher number could indicate prostate cancer, but the test doesn’t differentiate between an aggressive, fast-growing cancer, and one that is so slow-growing it wouldn’t threaten a man’s life.

On January 8, Emory University School of Medicine’s Department of Medicine Grand Rounds took on an unusual format: a debate between Otis Brawley, MD and John Petros, MD on the validity of PSA testing as a prostate cancer screening tool.

Dr. Otis Brawley

Dr. Otis Brawley

Dr. Otis Brawley is a professor of hematology and medical oncology and chief medical officer for the American Cancer Society. He kicked off the debate asserting that research demonstrates PSA testing to be unreliable, possibly leading to too many diagnoses and unnecessary treatment for prostate cancer.

Dr. John Petros

Dr. John Petros

Dr. John Petros is a professor of urology who treats prostate cancer patients, and he argues that after looking at other studies (more details below), the PSA test is a tool that has helped save lives by detecting prostate cancer in its early stages.

Less than a year ago, a “grade D” rating for PSA screening was issued by the U.S. Preventive Services Task Force, stating that PSA testing offers more harm than good due to complications from PSA-test-driven treatment such as incontinence and blood clots. Despite not ruling out its use, Dr. Brawley is in agreement with the assessment of the U.S. Preventive Services Task Force and says he’s not convinced the PSA test saves lives. As he puts it, “Pretend you are offered the choice of taking a pill that will double the risk of prostate cancer diagnosis from 10 to 20 percent, but could decrease risk of prostate cancer death by one fifth: from 3 to 2.4 percent. […] Do you feel lucky?” Brawley quipped.

To counterpoint Dr. Brawley’s assertion, Dr. Petros cited the National Cancer Institute’s epidemiology data, which indicates the rate of metastatic prostate cancer has substantially dropped over the last few decades due to prostate cancer being diagnosed earlier on. Dr. Petros also discussed research conducted in Sweden and Austria, which shows significant drops in prostate cancer-related mortality as a result of PSA testing.

Despite their differing views on the validity and use of PSA testing as a prostate cancer screening tool, there are five things Dr. Brawley and Dr. Petros agree on:

  1. The PLCO study, a NCI-sponsored randomized clinical trial to examine the effects of screening on cancer-related mortality, was flawed. In particular, the “control” arm had a substantial rate of PSA testing.
  2.  Brawley said: “Some cancers that are detected early do not pose a threat and do not need to be treated.” Similarly, Petros said: “Prostate cancer can be low risk if safely observed, but high risk forms are lethal. We need to focus on cancers that matter.”
  3. PSA testing should be performed in the context of a physician-patient relationship, with men making an informed decision about the value of the information they will receive and the associated risks.
  4. Vans in supermarket parking lots – more broadly, community- or employer-based screening  — are not the ideal setting for PSA testing.
  5. Biomarkers that are better than PSA alone are needed. Brawley said: “We need a 2013 definition of prostate cancer, informed by genomics, rather than going by what Virchow decided prostate cancer looks like under the microscope 160 years ago.”

In regards to the last point, Dr. Petros added that more sophisticated tests than PSA have already been developed. The prostate health index, which measure levels for three types of PSA and is also more cancer-specific is a good example. Research is currently being conducted at Emory by Carlos Moreno and Dr. Petros to help further this goal. To build on the research they’ve already performed around a panel of biomarkers that can predict prostate cancer outcomes after prostatectomy, Moreno and Dr. Petros will seek to evaluate in coming months whether the same biomarkers could be useful on prostate biopsy samples. The results of this research are expected to help inform treatment option decision making regarding the use of surgery versus radiation.

For now, Petros is an advocate of initiating a conversation about PSA screening with patients 50 and older, or younger if they are at risk for the disease. He believes the decision to have routine PSA testing, follow-up tests and prostate cancer treatments, is a very individualized process.

“It comes down to, what do you tell the man standing in front of you?” he said. “You have to consider where they are in life and what their goals are, and that varies with every man.”

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Two Patients Benefit from Two Alternative Treatment Options for Prostate Cancer

Prostate Cancer Awareness MonthWhen Mike Melton celebrated Prostate Cancer Awareness Month in September, this time, he was a survivor.

Melton was just 51 years old when he heard the words that every man fears: “You have prostate cancer.” As he researched his options for treatment, he was unsatisfied. The most common prostate cancer treatments often were described as invasive, uncomfortable and prone to side effects. But with three children, a wife and a bustling business to run, Melton couldn’t afford to wait.

“As I was doing my research, I noticed that so many men reported having side effects that no man would want, much less someone as young as I am,” says Melton. “Then I came across laser ablation during my online research, and it sounded exactly like what I was looking for because it was less invasive and has few side effects.”

Emory radiologist Sherif Nour, MD, FRCR, is one of a few radiologists nationwide performing a new, more targeted procedure called MRI-guided focal laser ablation to treat prostate cancer. Using a multi-parametric MRI that utilizes four types of sequences to collectively identify the area of the cancerous lesion, Nour can pinpoint the precise location of the tumor to verify that the procedure should take place. Once he locates the tumor, interventional MRI technology is used to selectively target and ablate the tumor while maintaining the integrity of the rest of the prostate gland. According to Nour, when compared to breast cancer in women, this new treatment is equivalent to a “male lumpectomy.”

“The options prostate cancer patients have had in the past are to either have surgery, radiation or whole gland ablation that comes with the risk of undesirable complications or to wait under their doctor’s close observation, which causes considerable stress knowing that they may have untreated cancer,” says Nour, associate professor of radiology and Imaging Sciences at Emory University School of Medicine and director of Emory’s new Interventional MRI Program. “MRI-guided focal laser ablation offers our patients who have had a positive biopsy for prostate cancer a less invasive option with minimal recovery time and fewer side effects.”

Traditionally, patients with suspected prostate cancer often undergo a more invasive form of tumor detection and biopsy that can lead to unpleasant side effects. Patients with confirmed prostate cancer may choose a “watchful waiting” approach, which can lead to anxiety. Traditional forms of treatment, such as prostatectomy or radiation, can in some cases, lead to urinary incontinence and erectile dysfunction.
Melton, who was back on the tennis court less than a month after his procedure was the first patient to undergo MRI-guided laser ablation for prostate cancer at Emory. At his three-month check-up, he was declared cancer-free.

“It’s like having a 400-pound elephant sitting on your chest that all of the sudden gets up,” says Melton. “It’s a huge relief. “

Melton is not the only Emory patient benefiting from alternative treatment options for prostate cancer. In the video below, hear from another one of our patients how he found hope and comfort after meeting Dr. Peter Rossi, an Emory radiation oncologist at Winship Cancer Institute of Emory University and, now, also practicing at Saint Joseph’s Hospital.

The 5-year survival rate for men with prostate cancer found in its early stages is nearly 100 percent. Use this time to remind the men in your life to talk to their doctors about their risk and family history and the appropriate screenings.For more information on prostate cancer treatment options at Emory, please use the linked resources below.

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Understanding Nutrition’s Role in Fighting Cancer

Nutrition's Role in Fighting CancerMaintaining a healthy diet is important, especially during cancer treatment. Your body is stressed– both from the treatment and cancer itself. It’s imperative to make sure that you’re getting the proper nutrition, vitamins, and minerals you need to stay strong and fight infections.

According to the American Cancer Society’s (ACS) Nutrition Guidelines, it’s best to eat a diet consisting of plant-based foods like fruits, vegetables, grains, and foods low in fat.

Omer Kucuk, MD and Professor of Hematology and Medical Oncology at Winship Cancer Institute of Emory University says, “there are bioactive compounds in foods, particularly in fruits and vegetables. These bioactive compounds have potent anti-cancer activities; for example, broccoli contains indole 3 carbinol, which has been shown to have anti-cancer affects, especially in prostate cancer and breast cancer.”

While certain foods have been show to help prevent cancer, evidence also shows that specific food compounds, such as soy isoflavones and curcumin, can increase the effectiveness of cancer treatment.

“We have found that soy isoflavones enhanced the efficacy of cancer treatment, specifically the efficacy of chemotherapy and radiation therapy. In addition to that, soy isoflavones may also prevent the side effects of these two cancer treatments,” reports Dr. Kucuk. Soy isoflavones are plant-derived compounds with estrogen-like activity that may help protect against hormone-dependent cancers according to ACS. Get more information on soy isoflavones and how proper nutrition can help during cancer treatments.

More in-depth studies are currently underway to find which bioactive compounds in foods aid in cancer treatment and reduce the risk of cancer recurrence. The American Cancer Society reports “that a higher intake of vegetables may have a helpful effect on recurrence or survival for breast, prostate, and ovarian cancers, but this is not definite.”

Still, ACS recommends that cancer survivors get at least five servings of colorful fruits and vegetables each day due to the overall benefit they provide. All cancer and cancer treatments affect the body differently. An individualized nutrition plan based on your likes and dislikes, and what your stomach can handle, is going to be beneficial during your treatment journey. A registered dietitian can help you and your family answer questions and address concerns about managing your diet, weight, treatment side effects, and supplement information.

If you’re looking for specific tips, ideas, and ways to incorporate cancer fighting foods into your diet, check out the transcript from our online live chat on Nutrition’s Role in Fighting Cancer. Also, check out Emory Healthcare’s recipe page for some easy, tasty and healthy dishes!

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Questions on Validity of PSA Test as Prostate Cancer Screening Tool?

Prostate Cancer PSA ScreeningViraj Master, MD Prostate cancer is the second leading cause of cancer death among American men.  Nearly 250,000 men will be diagnosed with prostate cancer this year.  More than 32,000 men will die from prostate cancer this year.  In Georgia, 7,360 men will be diagnosed and 1,080 will die.  With statistics like that, we want every advantage possible in our fight with this disease.

Since the early 1990s, the Prostate Specific Antigen (PSA) test has been the primary screening tool used to detect prostate cancer. The PSA is a simple blood test, non-invasive and easy to administer and process.  The US Preventive Services Task Force has recently recommended, however, that the PSA test no longer be offered to men as a screening tool.

This task force is a federally funded independent panel of experts in prevention and evidence-based medicine.  It is comprised of primary care providers such as internists, family practitioners and pediatricians, but not oncologists or urologists.  Their job is to evaluate the benefits of preventive services like screening and make recommendations about which services should be routinely incorporated into primary medical care.

Screening, or early detection, for prostate cancer is a complicated issue.  Unlike the colonoscopy, which provides clear evidence of early detection and has been determined to have saved lives in multiple studies, the PSA test has been contradictory, with some studies showing a benefit, while others did not.  There are many reasons, including the fact that most forms of prostate cancer are relatively slow-growing cancers.  Generally, a man with prostate cancer may live for many years without ever having the cancer discovered.  In fact, many men with prostate cancer will not die from it, but with it.  In addition, high or increasing levels of PSA can indicate an increased risk for prostate cancer, but can also indicate an infection or an enlarged prostate.  So, the USPSTF determined that because of these uncertainties, the risk of over treatment is greater than the benefit, and their recommendation states that PSA tests should no longer be offered as a screening tool.

The biggest issue in prostate cancer that confronts patients, their families and their healthcare providers is to delink screening with treatment.  Not all forms of prostate cancer require active therapeutic interventions, but some do.

While the PSA test is imperfect, it is – at this time – the best tool we have at our disposal for early detection of prostate cancer.  The Winship Cancer Institute of Emory University aligns with the American Urological Association, the American Cancer Society, American College of Physicians and the American College of Preventive Medicine and recommends informed decision-making.  Our recommendation is that men at average risk should receive information, including a PSA test if they want it, at an appropriate middle age, although African American men or men with a family history of prostate cancer should receive information at an earlier age, such as 40, or 45 years.

So, what do we mean when we say “informed decision-making”?  This means that doctors should discuss the potential benefits and harms of PSA screening with their patients and consider their patients’ preferences, overall health, and family history when making decisions regarding screening with a PSA test.

Unfortunately, there is no easy answer.  Each patient comes to us with his own distinctive characteristics, and those characteristics must be taken into consideration when deciding whether to have the PSA test.

About Dr. Viraj Master
Dr. Master specializes in the treatment of adrenal cancer, bladder cancer, kidney cancer, prostate cancer, testicular cancer. He is also an expert in laparoscopic surgery. Dr. Master received his Medical Degree in the University of Chicago in Chicago, Illinois, in 1997. He completed his Internship at University of California, San Francisco in 1999, where he also completed his Fellowship in 2003.