Researchers discover decline in prostate most cancers screening, early detection

The US Preventive Services Task Force (USPSTF) in 2008 had recommended that men with average prostate cancer risk not be put through routine Prostate Specific Antigen (PSA) screening test as many prostate malignant lesions grow slowly, not requiring treatment. But for a few men, hearing a diagnosis of cancer and doing nothing but monitoring it is too hard, leading to treatment that may be unnecessary, he said.

A big question remains: Did that shift have any effect on death rates from prostate cancer, the most common non-skin cancer in US men?

In the cancer society study, diagnosis of early-stage prostate cancer increased slightly from 2005 to 2008, but dropped after that, most sharply from 498 cases per 100,000 men in 2011 to 416 cases per 100,000 in 2012 – a 16 percent decline.

But many professional organizations, including the American Urologic Association and the American Cancer Society, continue to advocate for various levels of PSA screening, depending on age.

Use of a blood test to detect prostate cancer fell after a USA government-back panel advised against using it, researchers found.

Also, the percentage of men who reported PSA screening in the previous year fell from 41 percent in 2008 to 31 percent in 2013.

Dr. Diamandis has collected semen samples from 100 men with confirmed prostate cancer and 100 men who do not have the disease.

But others welcome the trend, saying it will save many men from unnecessary suffering.

“We don’t know how this will all play out”, said Penson, who wrote an editorial published with the studies.

Dr. Richard Kahnoski, an urologist with Spectrum Health, said his office is participating in a new first-of-its-kind clinical trial focusing on high risk prostate cancer patients.

It’s been clear for many years that there’s a “much greater chance that a PSA test would lead to preventable misery such as impotence or incontinence, compared to any chance of having one’s life saved”, says Dr. Howard Brody, a professor of medical humanities at the University of Texas Medical Branch in Galveston, wrote in an email. “Some will think that this is a good thing, as fewer men will be subjected to the harms of overtreatment, while others may be concerned with its potentially catastrophic consequences, with more men presenting with advanced, metastatic prostate cancer”.

That group also says screening every other year should be an option, and advises against screening for men over 70 or those with a less than 10-to-15 year life expectancy.

The debate over PSA testing has been roiling medicine for years. “We need tools to distinguish which prostate cancers require aggressive treatment and which don’t”.

That raises the possibility that a single PSA measurement at a relatively young age could help doctors figure out when and how often to do further testing, according to Penson.

According to the study’s findings, the authors found substantial cost differences at 5 years, with costs ranging from $7,298 for active surveillance to $23,565 for intensity-modulated radiation therapy.

The decrease in cancer diagnosis doesn’t mean the disease disappeared; in a few men it’s there but just isn’t being detected.

“I do hope physicians are talking to their patients and letting the patient decide whether or not to be screened”, Brawley said. But many and perhaps most of those cancers are so slow-growing they pose no threat to a man’s health or life.

The cancer society says screening should be offered to men starting at age 50 who are expected to live at least 10 years and have been informed about risks and benefits.

Men could die with prostate cancer, not of it.