A critical session at the GU cancer meeting this morning was designed to address the pros and cons of screening patients for prostate cancer.
It would be fair to say that, even in light of the new guidelines issued by the American Cancer Society on Wednesday, there is probably greater consensus between the different organizations today than ever before, as Dr. Peter Carroll of the University of California at San Francisco pointed out in his initial presentation. But, as Americas Prostate Cancer Organizations have noted, there is still great confusion among the general public, and men at potential risk don’t know that they should be doing.
In his “pro” screening presentation, Carroll emphasized that, as far as he was aware, no organization today was recommending mass, population-based screening and no one was recommending that no individual get tested for early detection. The consensus is around the need for appropriate testing of specific types of individual based on their potential risk for prostate cancer. However, the devil is in the details and how we ensure that patients and their physicians work well together to make good decisions that have the following outcomes:
- Early detection of clinically significant prostate cancer that may lead to metastatic disease and/or death
- Avoidance of detection of indolent prostate cancer who are at absolutely minimal risk for clinicaly significant disease
- Changing the current close association between early detection and the immediate need for treatment so as to minimize over-treatment and minimize the impact of over-treatment on patients’ quality of life
In his “con” presentation, Dr. Peter Boyle of the International Presentation Research Institute gave a very clear explanation of why mass, population-based screening was not a viable strategy for the early detection of prostate cancer, as seen from a public health perspective. However, as we have pointed out above, this may no longer be the issue that is under discussion. What we are trying to address today is how we use the currently available tests more effectively in order to diagnose and treat the patients who really need that diagnosis and treatment while avoiding unnecessary diagnosis and unnecessary treatment in men with very low-risk and low-risk disease.
As a follow-up to these two studies, Dr. Eric Klein of the Cleveland Clinic made a very strong argument, yet again, for the use of 5α-reductase inhibition (with finasteride or dutasteride) to prevent prostate cancer in a defined subset of men probably those who have a PSA somewhere between 1.3 and 2.0 ng/ml at a relatively early age. Now there are men who have significant side effects to 5α-reductase inhibitors, and clearly those men will need to decide whether they want to use or stay on these drugs, but these side effects do not impact the majority of patients.
Finally, Dr. Otis Brawley of the American Cancer Society further addressed the entire of issue of distinguishing between the need to screen populations for prostate cancer (which he passionately rejected) and the need to identify and cure clinically significant prostate cancer in the men at high risk for such disease (which he greatly favored).
So perhaps it really is time to get everyone onto exactly the same page because we all do seem to be very close together (at last). Of course we still need a better test than the PSA and the DRE!
A critical session at the GU cancer meeting this morning was designed to address the pros and cons of screening patients for prostate cancer.
It would be fair to say that, even in light of the new guidelines issued by the American Cancer Society on Wednesday, there is probably greater consensus between the different organizations today than ever before, as Dr. Peter Carroll of the University of California at San Francisco pointed out in his initial presentation. But, as Americas Prostate Cancer Organizations have noted, there is still great confusion among the general public, and men at potential risk don’t know that they should be doing.
In his “pro” screening presentation, Carroll emphasized that, as far as he was aware, no organization today was recommending mass, population-based screening and no one was recommending that no individual get tested for early detection. The consensus is around the need for appropriate testing of specific types of individual based on their potential risk for prostate cancer. However, the devil is in the details and how we ensure that patients and their physicians work well together to make good decisions that have the following outcomes:
In his “con” presentation, Dr. Peter Boyle of the International Presentation Research Institute gave a very clear explanation of why mass, population-based screening was not a viable strategy for the early detection of prostate cancer, as seen from a public health perspective. However, as we have pointed out above, this may no longer be the issue that is under discussion. What we are trying to address today is how we use the currently available tests more effectively in order to diagnose and treat the patients who really need that diagnosis and treatment while avoiding unnecessary diagnosis and unnecessary treatment in men with very low-risk and low-risk disease.
As a follow-up to these two studies, Dr. Eric Klein of the Cleveland Clinic made a very strong argument, yet again, for the use of 5α-reductase inhibition (with finasteride or dutasteride) to prevent prostate cancer in a defined subset of men probably those who have a PSA somewhere between 1.3 and 2.0 ng/ml at a relatively early age. Now there are men who have significant side effects to 5α-reductase inhibitors, and clearly those men will need to decide whether they want to use or stay on these drugs, but these side effects do not impact the majority of patients.
Finally, Dr. Otis Brawley of the American Cancer Society further addressed the entire of issue of distinguishing between the need to screen populations for prostate cancer (which he passionately rejected) and the need to identify and cure clinically significant prostate cancer in the men at high risk for such disease (which he greatly favored).
So perhaps it really is time to get everyone onto exactly the same page because we all do seem to be very close together (at last). Of course we still need a better test than the PSA and the DRE!