Quest Spring 2015 : Page 1

A Publication of Dr. William J. Catalona Q uest Spring 2015 • Volume 23, Number 1 and the Urological Research Foundation ©Dan Oldfield The Consequences of a Decline in PSA Testing F rom 1992-2011, there was a 47% decrease in prostate cancer mortality. Yet, the 2009 and 2012 recommendations from the U.S. Preventive Services Task Force (USPSTF) discouraged the use of PSA testing to screen men for prostate cancer. Now, current research is examining the impact of a decline in PSA testing in the period after the USPSTF statement was released. this trend could translate to 14,000 additional higher-risk prostate cancer diagnoses in 2014 as compared to 2011. They also predicted that at least 1,400 additional men might die from Today’s actions will affect the future. prostate cancer each year. This estimation took into account 10-year their analysis as new registration data prostate cancer survival rates, which are become available. about 95% for low-risk, 75-90% for Early diagnosis is key for a cure intermediate-risk and 60-80% for high-The best chances of survival occur Increased rates of higher-risk risk cancer. when prostate cancer is caught while it prostate cancer Researchers defined higher-risk is still localized within the prostate. A A study presented disease as prostate recent Canadian study raised concerns at the 2015 cancer with a blood Given the rise in intermediate-that lack of testing after the USPSTF Genitourinary Cancers PSA level greater than and high-risk prostate cancers recommendations could lead to missing Symposium in 10, which indicates seen in our analysis during this the window for early diagnosis. 1 Orlando, Florida found either intermediate-Researchers conducted a time series that the rates of or high-risk prostate timeframe, men who are at analysis of prostate biopsies performed intermediate-and cancer. increased risk for prostate cancer, at the University Health Network from high-risk prostate The study was especially those with a family 2008 to 2013. They saw a decrease in cancer are rising ledbyDr.TimothyE. the number of biopsies performed after among men in the U.S. history of prostate cancer, should Schultheiss, PhD, of the USPSTF recommendations were Researchers consider talking with their doctor Radiation Physics at released. The median number of analyzed 87,562 men City of Hope in about PSA screening. biopsies per month decreased by 39%, diagnosed with Duarte, California. He – Dr. Timothy E. Schultheiss while the median number of men prostate cancer said, “Our study is undergoing first-time biopsies decreased between January 2005 and June 2013. the first to measure the changes in by 44%. From 2005 to 2011, the proportion of prostate cancer presentation in the ( Continued on page 2.) men with prostate cancer and PSA period following the U.S. greater than 10 decreased gradually. Preventive Services Task Force’s However, between 2011 and 2013 they PSA screening UEST is a free publication dedicated found a nearly 6% increase in higher-recommendations.” to educating the public about the risk cases. The authors emphasized latest issues in prostate cancer. Please Based on 233,000 new prostate that the findings must be cancer cases predicted in 2014 in the consider supporting the URF and Q UEST . confirmed through further U.S., the study authors estimated that research. They plan to update Q

The Consequences of a Decline in PSA Testing

From 1992-2011, there was a 47% decrease in prostate cancer mortality. Yet, the 2009 and 2012 recommendations from the U.S. Preventive Services Task Force (USPSTF) discouraged the use of PSA testing to screen men for prostate cancer. Now, current research is examining the impact of a decline in PSA testing in the period after the USPSTF statement was released.

Increased rates of higher-risk prostate cancer
A study presented at the 2015 Genitourinary Cancers Symposium in Orlando, Florida found that the rates of intermediate- and high-risk prostate cancer are rising among men in the U.S.

Researchers analyzed 87,562 men diagnosed with prostate cancer between January 2005 and June 2013. From 2005 to 2011, the proportion of men with prostate cancer and PSA greater than 10 decreased gradually. However, between 2011 and 2013 they found a nearly 6% increase in higher-risk cases.

Based on 233,000 new prostate cancer cases predicted in 2014 in the U.S., the study authors estimated that this trend could translate to 14,000 additional higher-risk prostate cancer diagnoses in 2014 as compared to 2011. They also predicted that at least 1,400 additional men might die from prostate cancer each year. This estimation took into account 10-year prostate cancer survival rates, which are about 95% for low-risk, 75-90% for intermediate-risk and 60-80% for highrisk cancer.

Researchers defined higher-risk disease as prostate cancer with a blood PSA level greater than 10, which indicates either intermediateor high-risk prostate cancer.

The study was led by Dr. Timothy E. Schultheiss, PhD, of Radiation Physics at City of Hope in Duarte, California. He said, “Our study is the first to measure the changes in prostate cancer presentation in the period following the U.S. Preventive Services Task Force’s PSA screening recommendations.”

The authors emphasized that the findings must be confirmed through further research. They plan to update their analysis as new registration data become available.

Early diagnosis is key for a cure
The best chances of survival occur when prostate cancer is caught while it is still localized within the prostate. A recent Canadian study raised concerns that lack of testing after the USPSTF recommendations could lead to missing the window for early diagnosis.

Researchers conducted a time series analysis of prostate biopsies performed at the University Health Network from 2008 to 2013. They saw a decrease in the number of biopsies performed after the USPSTF recommendations were released. The median number of biopsies per month decreased by 39%, while the median number of men undergoing first-time biopsies decreased by 44%.

The study authors said the sudden 43% decrease in the detection rate of Gleason 7-10 prostate cancers was “concerning.” There was also a decrease in the median number of lowrisk prostate cancers detected per month, by 35%.

Support for PSA testing programs
An examination of data from the Göteborg screening study found that organized screening programs for prostate cancer were more effective than opportunistic testing.

In the study, 10,000 randomly selected men were invited for PSA testing every 2 years, with prostate biopsy recommended for men with a PSA =2.5 ng/ml. The control group of 10,000 additional men was exposed to increased opportunistic PSA screening over time.

After 18 years, organized screening resulted in a 42% relative reduction in prostate cancer death. To prevent one prostate cancer death in the organized screening group, 139 men needed to be invited for screening and 13 men needed to be diagnosed. In the control group, 493 men needed to be invited for screening and 23 diagnosed in order to prevent one prostate cancer death.

Organized screening reduced prostate cancer mortality but was associated with overdiagnosis. However, opportunistic PSA testing had little—if any—effect on prostate cancer mortality, but resulted in more overdiagnosis. Almost twice the number of men in the control group needed to be diagnosed in order to prevent one death from prostate cancer.

Statistical modeling shows potential increase in prostate cancer death
Eliminating screening eliminates overdiagnosis, but by 2025 there could be twice as many metastatic cases of prostate cancer and a 13-20% increase in preventable prostate cancer deaths.

Statistical models predicted that continuing recent screening rates will overdiagnose 710,000-1,120,000 men but will avoid 36,000-57,000 prostate cancer deaths from 2013-2025. Discontinuing screening for men older than 70 years would eliminate 64-66% of overdiagnoses but would fail to prevent 36-39% of avoidable prostate cancer deaths.

Dr. Catalona’s Opinion
There is a price to be paid for not doing PSA testing. We have learned from the cancer statistics in the United States and from randomized clinical trials in Europe that PSA testing can cut the prostate cancer death rate nearly in half. The strategy for success is to detect the prostate cancer early, when it is curable. If doctors and patients do not work together to ensure appropriate PSA testing and treatment in an organized and routine fashion, there will be more unnecessary suffering and death from incurable prostate cancer in the near future.

Read the full article at http://epubs.democratprinting.com/article/The+Consequences+of+a+Decline+in+PSA+Testing/1973543/252850/article.html.

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