Prostate cancer screening: 1 Myth, 1 Reality

Wouldn’t it be great if precision medicine could also mean precision early detection? Screening that could tell you at the earliest possible time that a disease, like cancer, was setting up shop inside your body?

I firmly believe that day will come, and soon – but in the meanwhile, we have to rely on established screening methods for early detection. Those methods, which include mammograms to detect breast cancer and PSA screening to detect prostate cancer, are the current standard-of-care protocol for early detection. They have been called into question over the last few years, on both when to screen and how to assess the screening results. Here’s a look at one myth, and one reality, on one of those standard screens: PSA testing for prostate cancer.

Myth: routine PSA screening increases survival

Sadly, this is not the case. In the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial that began in 1993, 76,693 men between the ages of 55 and 74 at 10 U.S. medical centers were randomly assigned to either annual PSA testing for six years, along with annual digital rectal exams (DREs) for four years. Men with PSA-test levels above 4.0 or with abnormal DREs were advised to get further evaluation, usually a prostate biopsy. The comparison group continued to receive their usual medical care. Men in both groups who were diagnosed with prostate cancer were treated by their personal physicians; the study researchers found that both groups had similar treatments.

After seven years (in 2000), the researchers had found 22% more cases of prostate cancer in the men who had regular PSA screenings. PSA screening increased the diagnosis of prostate cancer, but it did not improve survival. There were no real differences in the numbers of deaths in the two groups – the group who was screened with PSAs and DREs, and the group that received no screening.

Reality: PSA testing is still your best bet for detection

calendar schedule board with hand collaboration plan board

I spoke to Bryce Olson, Global Marketing Director of the Health and Life Sciences Group at Intel, as I was preparing to write this post. Bryce is living with prostate cancer, since he was diagnosed with advanced cancer (Stage IV) when he was only 44, six years before the guidelines for routine prostate cancer screenings start at age 50. I asked him what he thought about PSA screening protocols, and early detection of prostate cancer in general.

“The state of affairs for early detection on cancer are sad,” Bryce told me. “At least most women know about mammograms. How many 40 year old guys even know what a PSA test is? I sure didn’t.”

The Prostate Cancer Foundation recently posted a Research News brief on the rise in the diagnosis of metastatic prostate cancer, and re-emphasized the importance of regular PSA screening and DREs for men over 50.

So what’s a guy who wants to be smart about prostate cancer to do? I’d personally recommend getting screened at 50, and using a shared decision making approach with your doctor to talk through the what-ifs on the screening results. I’d also strongly recommend getting your genome sequenced if your screening leads to a biopsy, and a diagnosis of prostate cancer.

The National Cancer Institute has a great PSA Fact Sheet for you to learn more about the screening process, and the American Cancer Society has a meaty set of resources on what prostate cancer detection and treatment involve.

In short: get screened. If you get a diagnosis, get sequenced. Learn more about that at Cure Forward.


 

Casey Quinlan Precision Medicine Advocate

Casey Quinlan Precision Medicine Advocate

Casey Quinlan covered her share of medical stories as a TV news field producer, then got a breast cancer diagnosis five days before Christmas in 2007. She used her research, communication, and comedy skills to navigate treatment, and wrote “Cancer for Christmas: Making the Most of a Daunting Gift” about managing medical care, and the importance of health literate self-advocacy.Her speaking calendar for 2016 includes Academy Health’s National Health Policy Conference, the 7th Patient Engagement, Education and Adherence Summit, the ePharma Summit, the Genetic Alliance’s Building Trustworthiness in PCORnet meeting, and Health Datapalooza.