From 2006 to 2010, prostate cancer accounted for the largest number (9,690) and the greatest percentage (25.4) of all invasive cancers diagnosed among men in Pennsylvania. Very troubling was the fact that the age-adjusted rate of prostate cancer among African-American men was 60 percent higher and the death rate was twice that of white men, with nearly one out of every six cases diagnosed at a late stage.
These data reinforce the need for health care providers, health systems and insurance carriers to reach a consensus on the value of prostate cancer testing and send a clear message to all men (particularly those with a family history or of African-American descent). The current situation is utterly confusing and stressful.
In 2010, the U.S. Preventive Services Task Force gave the prostate cancer blood test (PSA) a “D” rating (i.e. not recommended for screening). In response, the American Urological Association carefully reviewed the scientific evidence and advocated PSA screening for men between the ages of 55 and 70, along with earlier testing in men with a family history of prostate cancer.
The bottom line is that the PSA test continues to serve an integral role in men’s health by detecting prostate cancer in its early stage.
In March 2014, the National Comprehensive Cancer Network (NCCN), an alliance of 25 leading cancer centers, released new guidelines for prostate cancer screening and management. This work recognized that PSA screening has reduced prostate cancer mortality by 50 percent over the past 20 years and that more comprehensive European studies demonstrated a clear survival benefit by early detection with PSA.
The NCCN guidelines recommend a baseline test at age 45 and then stratifying patients based on disease risk. Recommended follow-up would be based on this risk.
Furthermore, the NCCN panel also emphasized the need for a significant number of men diagnosed with prostate cancer to be placed on “active surveillance” — meaning that the patient receives semi-annual PSA testing and yearly biopsy, without affirmative treatment. Evidence has clearly emerged that nearly 30 to 50 percent of newly diagnosed prostate cancers can be safely placed on active surveillance.
As clinicians who treat prostate cancer, we acknowledge that PSA uncovers indolent disease. But as our clinical tools and understanding continue to evolve, we will soon be able to identify those PSA-detected cancers that require treatment.
Still a valuable test
The bottom line is that the PSA test continues to serve an integral role in men’s health by detecting prostate cancer in its early stage. By ignoring the value of PSA testing, aggressive disease that shows no symptoms will progress and lead to increased mortality — precisely where we were before the widespread use of PSA testing.
PSA screening is a blood test; it is not treatment of the disease. Discouraging a simple and inexpensive blood test is not the way to address concerns about appropriate treatment for a disease once it is diagnosed. We should not throw out the proverbial baby with the bathwater.
Cancer is a disease for which the only cure is early diagnosis and, when appropriate, early treatment. For a disease that is diagnosed in nearly 10,000 males and takes the lives of over 1,000 men in Pennsylvania each year, it puzzles me that our medical community accepts recommendations from a selected government task force (with no urologists or oncologists on its panel) and rejects the recommendation from a consortium of leading cancer centers in the world.
If Memorial Sloan Kettering, Duke Cancer Center, and Fox Chase Cancer Centers recognize the evidence and adhere to these guidelines shouldn’t our own medical community also form a consensus that sends a clear message to our patients?
The Pennsylvania Prostate Cancer Coalition is a grassroots, cancer survivor organization that is committed to promoting early prostate cancer testing and other education about this deadly disease. With their “Don’t Fear the Finger” campaign, their message is infused with humor and education so that the goal of zero prostate cancer mortality can be reached.
I encourage our community to embrace this organization, understand the value of prostate cancer testing and not allow government policies to dictate medical care. Join me in supporting Prostate Cancer Awareness in the month of September by advocating and participating in this statewide campaign and promoting awareness for prostate cancer testing.
Dr. Scott Owens is a Board of Director of Urology of Central Pennsylvania and Chairman of the Board of Urologists for Patient Access to Care in Pennsylvania.