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News from CaSfA's Director
News from CaSfA's Director
Blog
USPSTF's Recommendations for PSA Testing
Posted on April 18, 2017 at 1:17 PM |
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The
US Preventive Services Task Force recently released a draft statement with updated
advice for the use of Prostate Specific Antigen (PSA) in screening for prostate
cancer. They will be accepting public
feedback regarding their recommendations until May 8, 2017, after which time a
final recommendation will be released. Back
in 2012, the USPSTF unequivocally told doctors to discourage patients from
getting PSA testing. They stated that
the risks of false positives and overtreatment outweighed the benefits. But after much debate, the USPSTF has backed
off that advice. Here
is the upshot of their updated recommendations from https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/prostate-cancer-screening1 ▪ PSA tests for men age 70 and
older and men under age 55 are still discouraged ▪ For men between 55 and 69, the
panel is punting the decision to doctors. “The decision about whether to be screened for
prostate cancer should be an individual one.
Screening offers a small potential benefit of reducing the chance of dying of
prostate cancer. However, many men
will experience potential harms of screening, including false-positive results that require
additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment
complications, such as incontinence and impotence. The USPSTF recommends individualized decision making about
screening for prostate cancer after
discussion with a clinician, so that each man has an opportunity to understand the potential benefits and
harms of screening and to incorporate his values and preferences into his decision.” ▪ The task force backed down on
its earlier advice in light of new evidence. Back in 2012, the best evidence suggested that for
every 1,000 men screened, 0.8 prostate cancer deaths would be prevented in the
next 10 to 15 years. But a longer look at the participants in prostate cancer
studies has raised that to 1.3 deaths prevented in the same time frame. Additionally, studies have since reported
that screening 1,000 men ages 55 to 69 years may prevent approximately 3 men
from developing metastatic prostate cancer. ▪ The panel also took into
consideration that how men seek treatment has shifted. More men now who receive cancer
diagnoses are opting for active surveillance — watching their cancer closely —
rather than treatment. That lessens the potential harms, such as impotence and
incontinence after surgery; compared to the last time the task force evaluated
the screenings. More detailed information is in CaSfA's April 18, 2017 newsletter. Join CaSfA to receive our newsletters!! |
Treatment Options in Early Prostate Cancer
Posted on September 18, 2016 at 7:53 PM |
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An important study looking at the
treatment of early stage prostate cancer was published in the New England
Journal of Medicine on Wednesday (http://www.nejm.org/doi/full/10.1056/NEJMoa1606220?query=featured_home#t=articleBackground
). The use of prostate-specific antigen
(PSA) testing has dramatically increased the diagnosis of prostate cancer. Close to 181,000 cases of prostate cancer
will be diagnosed in the US in 2016 and over 26,000 men will die of the
disease. But many cases of this cancer
will progress slowly and not lead to death.
Studies have been trying to determine if some men can safely avoid
radical treatments and their associated side effects and complications. This
study looked at 3 different treatment approaches to men diagnosed with early
prostate cancer: surgery (radical
prostatectomy), radiotherapy and active monitoring/surveillance. Here are the basics of the study: ·
The study
recruited men 50-69 years old in the UK ·
1643 men were
diagnosed with localized prostate cancer and agreed to be in the study ·
The men were
followed for a median of 10 years ·
The study
looked at prostate-cancer mortality (deaths that were definitely or probably
due to prostate cancer or its treatment) at a median of 10 years follow
up. It found that death from prostate
cancer remained low, at approximately 1%, irrespective
of the treatment assigned. ·
Of the 545
men assigned to the active monitoring/surveillance treatment arm, 291 men required
intervention during the study (56 within 9 months of starting the study). 142 (49%) underwent surgery; 97 (33%)
received radiotherapy according to the study protocol. The rest received non-protocol radiotherapy,
brachytherapy (insertion of radioactive pellets into the prostate), or other
treatment. ·
The study also looked at mortality from all
causes, rates of metastases, clinical progression of cancer, treatment failure
and treatment complications. ·
There was no difference in mortality from all
causes between the three treatment groups ·
204 men had disease progression, including
metastases. The incidence was highest in
the active monitoring/surveillance group (112 men vs. 46 in the surgery group
and 46 in the radiotherapy group). ·
There were no deaths attributable to surgery,
but 9 men had blood clots/cardiovascular complications; 14 required multiple
blood transfusions for blood loss; 1 had rectal injury; 9 had anastomotic
problems (leakage of urine into the body from a damaged ureter). ·
One limitation of the study was a protocol that was
developed almost 20 yrs ago (treatments and diagnostic techniques have evolved
since then). Also the men will need to
be followed for a longer period of time to determine if any difference in
survival rates will emerge. The study authors conclude: “At a median follow-up of 10 years, the ProtecT trial
showed that mortality from prostate cancer was low, irrespective of treatment
assignment. Prostatectomy and radiotherapy were associated with lower rates of
disease progression than active monitoring; however, 44% of the patients who
were assigned to active monitoring did not receive radical treatment and
avoided side effects. Men with newly diagnosed, localized prostate cancer need
to consider the critical trade-off between the short-term and long-term effects
of radical treatments on urinary, bowel, and sexual function and the higher
risks of disease progression with active monitoring, as well as the effects of
each of these options on quality of life. Further follow-up of the ProtecT
participants with longer-term survival data will be crucial to evaluate this
trade-off in order to fully inform decision making for physicians and patients
considering PSA testing and treatment options for clinically localized prostate
cancer.” |
16th Annual Prostate Cancer Symposium
Posted on May 20, 2013 at 4:20 PM |
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I attended the Annual Massachusetts Prostate Cancer Symposium on Friday, May 17. I listened to some great lectures. Especially interesting were the talks about PSA (prostate-specific antigen) testing. This blood test started being used in the mid 1990's. Since it's use began, we have seen a doubling in the rate of prostate cancer, but not much change in the number of men dying from the disease. Many have taken a closer look at the PSA screening test and prostate cancer as a whole. It has been discovered that many cases of prostate cancer follow a slowly progressive course and men may even remain asymptomatic throughout their lifetime. For these men, the complications from treatment of prostate cancer outweigh any benefit of treatment. So, last year the US Preventative Services Task Force released this recommendation: "The reduction
in prostate cancer mortality 10 to 14 years after PSA-based screening is, at most,
very small, even for men in the optimal age range of 55 to 69 years. The harms
of screening include pain, fever, bleeding, infection, and transient urinary
difficulties associated with prostate biopsy,
psychological harm of false-positive test results, and overdiagnosis. Harms of
treatment include erectile dysfunction, urinary incontinence, bowel
dysfunction, and a small risk for premature death. Because of
the current inability to reliably distinguish tumors that will remain indolent
from those destined to be lethal, many men
are being subjected to the harms of treatment for prostate cancer that will
never become symptomatic. The benefits of PSA-based screening for prostate
cancer do not outweigh the harms." We need to determine which men are a risk for aggressive prostate cancer because these are the men who are dying from this cancer. We do know there are certain genetic mutations which are important (BRCA for example). Men who have any relatives with prostate cancer may choose to have a PSA test, or one of the newer (PCA-3) urinary screens. All men need to have a discussion with their physicians to determine their individual risk for prostate cancer and whether screening will be of benefit. |
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