Miriam Hospital Experts Explain Recent Prostate Cancer Screening Recommendations

Posted Tuesday, September 04, 2012

To test or not to test? That is the question facing many men following recent recommendations from the U.S. Preventive Services Task Force against routine prostate-specific antigen (PSA) screening for prostate cancer. Experts from The Miriam Hospital say the debate has left many men confused and wondering how to defend themselves against a cancer that is expected to claim the lives of more than 28,000 men this year.

The government panel questioned whether the test improves cancer survival and determined PSA screening leads to widespread over-treatment, unnecessary procedures and complications like incontinence or impotence, which outweigh the benefits of testing. However, even with these limitations, Joseph F. Renzulli II, MD, director of the prostate surgery program at The Miriam Hospital, says the urologic community continues to recommend PSA screening in a large majority of men.

“There has been a measurable reduction in death from prostate cancer over the last three decades that can be directly correlated to the introduction of PSA as a screening tool,” Renzulli says. “Although the test is not perfect, the PSA combined with a digital rectal exam is the only way to diagnose prostate cancer. Rather than discouraging men from having a PSA test, we believe a personalized approach based on each patient’s age, medical history and other risk factors, as well a discussion about the pros and cons of screening, is the best strategy.”

Prostate cancer is the most common cancer and the second leading cause of cancer death among men. It is estimated that there will be 241,740 new diagnoses of prostate cancer in the United States in 2012. The disease is most common in men over the age of 65, and African-Americans are at increased risk. Prostate cancer is a slow-growing cancer, meaning it may not cause any noticeable symptoms until the disease has reached an advanced stage. Once prostate cancer progresses or spreads outside the prostate gland, it is usually life-threatening, which is why diagnosing the disease early while it is still confined to the prostate – and still treatable – is key to survival.

PSA tests measure blood levels of prostate-specific antigen, a protein produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer. However, there are other benign medical conditions that can cause a man’s PSA level to rise, and some men who have prostate cancer have normal PSA levels. As with the decision to screen, Renzulli says physicians and patients should make a shared decision whether to proceed with a biopsy to confirm the diagnosis.

A confirmed diagnosis of prostate cancer may not require treatment, whether its surgery, chemotherapy, radiation or hormonal therapy. Because prostate cancer is relatively slow growing, and some malignant tumors may not be life-threatening, active surveillance, or regular monitoring for cancer progression, can often be the best course of action. Again, Renzulli recommends men discuss and weigh the pros and cons of all treatment options with their physician.

“We believe the real issue is not whether prostate cancer should be diagnosed, but rather which cancers should be treated and which should be actively observed,” he says. “By selecting the appropriate patients for screening and treatment, and educating patients so they can make informed decisions about their health care, lives will be saved.”

Renzulli is also a core team member of the Genitourinary Multidisciplinary Clinic, a program of The Comprehensive Cancer Center at The Miriam and Rhode Island hospitals and the only center of its kind in the state. Dedicated entirely to the care of patients with urologic malignancies, including prostate cancer, the Center offers patients access to the combined expertise of a multidisciplinary team of specialists from all disciplines, including medical oncology, radiation oncology and surgery, whose focus is on patients with genitourinary malignancies.

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