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| |  New Approaches to Prostate Cancer Screening: Presented at ASCO-GU By Fred Gebhart SAN FRANCISCO -- March 7, 2010 -- Is prostate cancer screening based on evidence that it reduces mortality, or is screening based on faith that it reduces mortality? These were some of the questions addressed on March 5 at the 2010 Genitourinary Cancers Symposium (ASCO-GU). “We need to start being scientific when it comes to prostate cancer screening,” said Otis Brawley, MD, American Cancer Society (ACS), Atlanta, Georgia, speaking at the opening session. “We use PSA [prostate-specific antigen] screening because of our faith in the power of early detection. We believe, but we don’t have evidence.” What the data from multiple clinical trials show, Dr. Brawley said, is that using PSA levels to screen for prostate cancer doubles the likelihood of diagnosis from 10% to 20%. Results from the placebo arm of the Prostate Cancer Prevention Trial show that screening carries a significant risk of diagnosis and that there is clearly overdiagnosis in the US population. Screening may, at best, reduce lifetime mortality of prostate cancer by 20%. At the same time, 35% to 70% of men diagnosed with prostate cancer do not need treatment. Positive screening subjects men to a lifetime of negative outcomes from repeated biopsies, prostatectomy, radiation, chemotherapy, androgen deprivation therapy, and the associated effects on the quality of life. “PSA has not been approved in any country, including this one [the United States], for use in screening,” said Dr. Brawley. “The reason it has never been approved for screening is because it has never been shown to be effective.” The American Cancer Society made that distinction clear in a recent revision to its prostate cancer screening guidelines. The group does not recommend that men not be screened for prostate cancer, but it does not recommend the kind of broad, population-based screening that has clearly been showing to reduce mortality in colorectal cancer. Instead, ACS recommends that men discuss the potential implications of screening with their healthcare provider before any testing is done. The American Urological Association has similar recommendations on discussing options and outcomes before screening for prostate cancer. “We need to approach screening rationally,” Dr. Brawley said. “There is nothing in the guidelines to suggest that you not screen, just that you talk with patients first. Tell them what we know, tell them what we don’t know…tell them what we believe. All prostate cancer screening should be done in the context of a patient-provider relationship. There is a lot of prostate cancer screening being done in hospitals as part of a business plan.” The conference is sponsored by the American Society of Clinical Oncology (ASCO), the American Society for Therapeutic Radiation Oncology (ASTRO), and the Society of Urologic Oncology (SUO). [Presentation title: Prostate Cancer: The Past, Present, and Future]
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