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.

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