While controversy has long loomed large regarding prostate cancer screening, a new study strengthens the case for testing as a method to reduce deaths from this cancer. This study has resolved the divided results of two earlier landmark clinical trials.
The two earlier trials, one in Europe and the other in the U.S., were the most informed available regarding whether screening lowers death risk due to prostate cancer. But while the European study found that the screened men had fewer deaths from prostate cancer than men who were not invited to be screened, the American study concluded there were similar numbers of cancer deaths in the screened and unscreened groups. Both studies were published in the New England Journal of Medicine in 2009.
The new study, published on September 4, 2017, was conducted with a rigorous analysis and comparison between the two groups in the earlier studies. A key feature turned out to be that the groups were analyzed without regard to the fact that some men invited to be tested weren’t, and about three-quarters of the subjects not invited got tested anyway, usually as part of their routine medical care. Taking this into account impacted the results. In the new analysis, researchers examined the actual number of those screened in each group, whether or not they were invited to get screening. That recalibrated number impacted the risk of death due to prostate cancer in the screened and not screened groups. This analysis provided a more definitive comparison of what people were actually after: the accurate results of screening versus not screening.
Prostate Cancer Screening
The prostate is a small gland located behind the bladder that secretes a fluid which nourishes and protects sperm. Routine screening for prostate cancer is done via a medical history, a digital rectal exam (DRE) and the PSA test. The PSA test is a blood test that measures the levels of the PSA protein in a man’s body. PSA is produced by both cancerous and noncancerous tissue in the prostate.
Whether or not to be screened has created much discussion and changing recommendations. That’s because prostate cancer can be slow growing, and possibly better left untreated due to potential side effects of that treatment. However, one thing is for certain, according to an editorial that accompanied the new study: there is no doubt that screening can curb the death rate from prostate cancer.
The United States Preventive Services Task Force latest recommendations are that men talk with their doctors about prostate cancer screening. Similarly, the American Cancer Society (ACS) recommends that screening for prostate cancer be based on an informed decision made with a healthcare provider. The ACS age guidelines for that discussion are:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
- Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).
Prostate Cancer Treatment
Prostate cancer is widespread. In fact, it is the most common non-skin cancer in American men, affecting one in seven. Screening does effectively identify men with the disease, but then the question becomes what to do with the results, since successful response to treatment varies. For some, the treatment is effective and might prevent premature death. But for others, treatment is not a clear-cut benefit because the cancer does not respond or because it is slow-growing, and the treatment’s side effects include a risk of lower quality of life. So, while the study doesn’t resolve the dilemmas of the screening or treatment decisions, the results may rebalance the tradeoffs for some, making a stronger case for screening and testing.
At Partners in Urology, we have followed the various studies and other new information regarding prostate cancer in our other blogs, particularly the issue of testing and treatment. In addition, our prostate surgery is state-of-the-art. Contact us for an appointment to discuss any aspects of prostate cancer screening or treatment.