Recent Information on Prostate Cancer Screening and Active Surveillance.

The National Cancer Institute (NCI) is the largest of the numerous institutes comprising the National Institutes of Health (NIH) in Bethesda and Frederick, Maryland. The NCI publishes a monthly cancer bulletin focused on all types of cancer. The current special issue (NCI Cancer Bulletin, Vol. 9, November 27th, 2012) is specifically devoted to cancer screening. Screening is an important part of the effort to reduce the number of lives lost to cancer. A tremendous amount of research is currently focused on improving the effectiveness and efficiency of cancer screening.  Some studies suggest that about one-third of screen-detected localized breast cancers and up to 70 percent of localized prostate cancers are overdiagnosed. As more has been learned about the benefits and harms of PSA screening for prostate cancer, organizations have begun to recommend against routine screening. Screening is a personal decision that, according to most experts, a man should make in consultation with his doctor, after he has been informed in detail about the potential benefits and harms. An infographic published in the latest NCI Cancer Bulletin depicts the benefits and harms of PSA screening for prostate cancer. The estimates appeared in the U.S. Preventive Services Task Force Recommendation Statement, published July 17 in the Annals of Internal Medicine. The estimates were based on 13- and 11-year follow-up data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial and the European Randomized Study of Screening for Prostate Cancer.  According to the two trials, the best evidence of possible benefit of PSA screening is in men aged 55 to 69.

If prostate cancer is diagnosed, active surveillance is recommended by the National Comprehensive Cancer Network as a first-line option for older men at very low or low risk of developing advanced prostate cancer. Findings from the Johns Hopkins active surveillance program — the largest and longest-running in the world — provide important insights. It should be noted that Johns Hopkins Urology has been consistently rated #1 in the annual U.S. News and World Report survey and review.  “In one promising development, researchers were able to identify risk factors present at diagnosis and the first surveillance biopsy that were associated with disease progression and to use that information to restratify men into new risk categories. This strategy will make it possible for doctors to predict earlier and more accurately the likelihood that the prostate cancer will progress after a man enters the surveillance program. Even when a cancer appears to be low risk, there is always a chance that it will grow and become more aggressive. One challenge is to determine the mathematical likelihood of that happening. To that end, researchers at Hopkins have been using a mathematical formula that helps predict which men in the active surveillance program will need treatment. Called the Prostate Health Index, or PHI, this mathematical equation takes into account PSA, percent-free PSA, and proPSA (a variant of PSA that increases in men with prostate cancer).” This and other valuable information can be obtained by subscribing on-line to the Johns Hopkins Prostate Disorders Health Alerts written by Drs. Jacek Mostwin and H. Ballentine Carter.  The most recent issue was published on November 22, 2012. On a personal note, I personally have interacted with Dr. Mostwin for the past seventeen years and recommend him most highly. Dr. Carter is also highly esteemed.

An Example and a Purpose For Anyone with Prostate Cancer.

Chapel dated from 1100 A.D., Brunlanes, Larvik, Norway; Photo: BJ Gabrielsen

At some point in life, all of us will be diagnosed with a serious and perhaps life-threatening medical condition. How will we react in such a situation? Could such an unwanted circumstance have a deeper purpose? A difficult diagnosis and illness can be viewed as either a mirror or a window.  A dark adversity can represent a mirror in which we see ourselves and then are overcome with self-pity.  Alternatively, a difficult time as this can be a window through which we can see the world around us filled with people who are walking a similar pathway as ourselves. An important purpose for which God can use our specific condition is found in the Bible in 2 Corinthians 1:3-4 which states: “All praise to God, the Father of our Lord Jesus Christ. God is our merciful Father and the source of all comfort. He comforts us in all our troubles so that we can comfort others. When they are troubled, we will be able to give them the same comfort God has given us.”  Our condition can serve as a major purpose in ministering to others experiencing similar situations.  A man whose wife was dying of cancer has shared his thoughts* based on Psalm 55.  As he witnessed the fourth member in a family of four facing a battle with cancer, he was strongly reminded of Jesus’ experience and prayer in the Garden of Gethsemane just prior to his crucifixion. Jesus had been betrayed by Judas, denied by Peter and forsaken by all His disciples. Jesus’ response was to cast His burden on God the Father thus serving as an example for us all when we are distressed or when we are helping to comfort others.

The starting point for all of us including Jesus is to pray that our suffering be removed and that we be delivered of our condition. Jesus prays in Matthew 26:39, “He went a little farther and fell on His face, and prayed saying, ‘O My Father, if it is possible, let this cup pass from Me; nevertheless, not as I will, but as You will.”   After praying for deliverance, Jesus’ second prayer was for acceptance when He prayed in verse 42, “O My Father, if this cup cannot pass away from Me unless I drink it, Your will be done.” For me personally, this is the most difficult prayer to pray yet it is the prayer that God wants to hear above all others as it demonstrates our complete faith and trust in God’s overall plan for our lives and the events therein. The third level of Jesus’ prayer (and ours hopefully) is one of glorification. Jesus desired that God’s grace would be seen in Him and that His Father would be glorified. In John 12:27-28, Jesus prays “Now my soul is troubled and what shall I say? ‘Father, save Me from this hour?’ But for this purpose I came to this hour, Father, glorify Your name.” The beauty of Jesus’ prayers is that they not only reveal His divine nature but His human nature as well. He is fully capable of truly “feeling our pain.” We too can cast our burdens on the Lord and in the process help others to do so as well. May our deepest desire be that God’s grace would be seen in us, that we share with others the comfort which we ourselves have received, and that God would be glorified in our stressful times and in our reaction to them.”

* Adapted from “When You Feel Like Running Away: Psalm 55” by Roy Clark.  © 2008 RBC Ministries.