Key Points on Screening
The proposed guidelines of the U. S. Preventive Services Task Force would recommend the PSA blood test for prostate cancer only if the patient has prostate symptoms. However, by the time a patient has symptoms the disease is usually late-stage (advanced) and cannot be cured.
The Prostate Conditions Education Council (PCEC) endorses the use of a baseline PSA for men beginning at age 40. PSA screening is currently the only way to detect prostate cancer in its earliest stages, as the disease does not present with symptoms until advanced disease. Individuals in the United States have a fundamental right to choose whether or not they know if they have prostate cancer prior to becoming symptomatic. By focusing on the PSA/Early detection we are doing a disservice to the individual by minimizing discussions for the men and putting them at increased risk of prostate cancer death.
PCEC does not support unnecessary treatment; however, the USPSTF Recommendation would prevent men with potentially deadly disease from learning their true diagnosis in time for curative care and would condemn them to death.
It is the belief of the PCEC that knowledge is power. Testing for and diagnosing prostate cancer does not have to lead to over-treatment; men with clinically insignificant prostate cancer can select active surveillance, and those with aggressive cancer can be actively treated. When balancing the possible side effects of treatment against saving of a life, most men would choose to live.
We should be discussing and educating the men and their loved ones on biopsy and appropriate treatment.
According to the U.S. SEER* Database (1992-2007):
- There has been a 75% decrease in metastatic disease at time of diagnosis
- And a 40% decrease in age-adjusted prostate cancer mortality rate
*SEER = Surveillance Epidemiology and End Results as published in CA: Causes and Control, 19:175,2007 by Etzioni et al.
Two mathematical modeling teams of the US National Cancer Institute's Cancer Modeling Network independently projected disease mortality in the absence and presence of PSA screening. Etzioni, et al. Ca Causes and Control 19:175, 2007
|Statistical Group||Mortality Benefit Due to PSA Screening|
|University of Michigan||70%|
|Fred Hutchinson Cancer Research Center||45%|
As a diagnostic tool, PSA testing must not be confused with treatment and its side effects.
USPSTF Members failed to review the updated publications on the PLCO trial that show that after 10 years of follow-up, 9,565 deaths occurred, 164 from PC. A significant decrease in the risk of PCSM (22 v 38 deaths; adjusted hazard ratio [AHR], 0.56; 95% CI, 0.33 to 0.95; P = .03) was observed in men with no or minimal comorbidity randomly assigned to intervention versus usual care, and the additional number needed to treat to prevent one PC death at 10 years was five. Among men with at least one significant comorbidity, those randomly assigned to intervention versus usual care did not have a decreased risk of PCSM (62 v 42 deaths; AHR, 1.43; 95% CI, 0.96 to 2.11; P = .08). CONCLUSION: Selective use of PSA screening for men in good health appears to reduce the risk of PCSM with minimal overtreatment. Crawford et al, J Clin Oncol. 2011 Feb 1;29(4):355-61. Epub 2010 Nov 1.
Multiple world wide studies indicate that screening saves lives. Trends documented in the World Health Organization database show that lives are saved in countries where PSA screening is practiced. The below publications review some of this data.
- Bouchardy C, et al: Int J Cancer, 123:421-9, 2008
- Kvale R et al: JNCI, 99:181-7, 2007
- Van Leeuwen PJ et al: Eur J Cancer, 46:377-83, 2010
- Bartsch G et al: BJU Int, 101:810-6, 2009
- PCEC believes that the USPSTF recommendations will do more harm to the men at risk for prostate cancer, specifically African American men.