Navigation Links
Would sliding back to pre-PSA era cancel progress in prostate cancer?

Eliminating the PSA test to screen for prostate cancer would be taking a big step backwards and would likely result in rising numbers of men with metastatic cancer at the time of diagnosis, predicted a University of Rochester Medical Center analysis published in the journal, Cancer.

The URMC study suggests that the prostate-specific antigen (PSA) test and early detection may prevent up to 17,000 cases of metastatic prostate cancer a year. Data shows, in fact, that if age-specific pre-PSA era incidence rates were to occur in the present day, the number of men whose cancer had already spread at diagnosis would be three times greater.

"Our findings are very important in light of the recent controversy over PSA testing," said Edward M. Messing, M.D., study co-author, chair of Urology at URMC, and president of the Society of Urologic Oncology. "Yes, there are trade-offs associated with the PSA test and many factors influence the disease outcome. And yet our data are very clear: not doing the PSA test will result in many men presenting with far more advanced prostate cancer. And almost all men with metastasis at diagnosis will die from prostate cancer."

Prostate cancer usually occurs in older men, and is the second leading cause of cancer death in the male population. In 2012 an estimated 241,740 new cases will be diagnosed and 28,000 deaths will occur. Prognosis depends on whether the cancer has spread outside the prostate gland, and the degree to which the cancer cells are abnormal.

In 2011 the U.S. Preventative Services Task Force recommended against PSA screening in all men, prompting criticism from the medical community. The government panel reviewed scientific evidence and concluded that screening has little or no benefit, or that the harms of early detection outweigh the benefits. One major concern, for example, was that doctors are screening for, finding, and treating non-aggressive cancers that might have remained quiet, causing patients to needlessly suffer from serious treatment side effects such as incontinence or erectile dysfunction.

The U.S. Task Force recommendations against screening caused some confusion, and in response, a special panel of experts from the American Society of Clinical Oncology this month issued its own opinion. The ASCO panel decided that for men with a life expectancy of less than 10 years, general screening with the PSA test should be discouraged. For men with a longer life expectancy, though, it is recommended that physicians discuss with patients whether the PSA test is appropriate for them.

Messing's study looked back at the era prior to 1986, when no one was routinely screened for prostate cancer with a PSA test. To analyze the effect of screening on stage of disease at initial diagnosis, Messing and Emelian Scosyrev, Ph.D., assistant professor of Urology, reviewed data from 1983 to 2008 kept by the nation's largest cancer registry, Surveillance, Epidemiology and End-Results or SEER. They compared SEER data from the pre-PSA era (1983 to '85) to the current era of widespread PSA use (2006 to 2008), and adjusted for age, race, and geographic variations in the United States population.

Approximately 8,000 cases of prostate cancer with metastases at initial presentation occurred in the U.S. in 2008. Using a mathematical model to estimate the number of metastatic cases that would be expected to occur in 2008 in the absence of PSA screening, Scosyrev and Messing predicted the number would be 25,000.

The authors emphasized the study was observational and has some limitations. In particular it is impossible to know if the PSA test and early detection is solely responsible for the fewer cases of metastasis at diagnosis in 2008.

The potential lead-time of screening also should be considered when interpreting the study findings, Scosyrev said. For some people an earlier stage of cancer at diagnosis may not always translate into better survival. This may happen, for example, in cases when the cancer had already metastasized at the time of screening, but the metastasis remained undetected.

In general, however, the study concluded that massive screening and PSA awareness efforts during the 1990s and early 2000s resulted in substantial shifts toward earlier-stage disease and fewer cases of metastases at diagnosis.

In the United States over the most recent 20 years, Messing said, prostate cancer death rates have been reduced by close to 40%. This occurred without substantial changes in how men were treated (via surgery and radiation therapy). Other models published in the scientific literature have suggested that more than 50% of this reduction is due to early detection.


Contact: Leslie Orr
University of Rochester Medical Center

Related medicine news :

1. Expanding Access to Medicaid Would Save Lives: Study
2. NYC Ban on Super-Sized Sodas Would Cut Consumers Calories: Study
3. Reducing Ozone Limits Would Save Lives, Report States
4. Lowering the national ozone standard would significantly reduce mortality and morbidity
5. How much would our health benefit from leaving the car at home?
6. New process would make anti-malarial drug less costly
7. MSU plan would control deadly tsetse fly
8. Content Writing King Announces Cancellation Of Experimental Video Creation Process For Their Article Marketing Website
9. Tumor cells inner workings predict cancer progression
10. Infection With 2 HIV Strains Slows Disease Progression
11. Drug Widely Used to Treat MS May Not Slow Progression
Post Your Comments:
(Date:6/25/2016)... ... , ... First Choice Emergency Room , the largest network of independent ... Director of its new Mesquite-Samuell Farm facility. , “We are pleased to announce ... Dr. James M. Muzzarelli, Executive Medical Director of First Choice Emergency Room. , ...
(Date:6/25/2016)... ... 2016 , ... Conventional wisdom preaches the benefits of moderation, whether it’s a ... the bar too high can result in disappointment, perhaps even self-loathing. However, those who ... , Research from reveals that behind the tendency to set ...
(Date:6/24/2016)... ... June 24, 2016 , ... Marcy was in a crisis. Her son James, eight, was ... his family verbally and physically. , “When something upset him, he couldn’t control his emotions,” ... He would throw rocks at my other children and say he was going to kill ...
(Date:6/24/2016)... ... 24, 2016 , ... Comfort Keepers® of San Diego, CA is excited to ... Recovery® program to drive cancer patients to and from their cancer treatments. Comfort ... quality of life and ongoing independence. Getting to and from medical treatments is ...
(Date:6/24/2016)... New York, NY (PRWEB) , ... June 24, ... ... lifestyle publication Haute Living, is proud to recognize Dr. Barry M. Weintraub as ... believes that “the most beautiful women in the world, and the most handsome ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... June 23, 2016  MedSource announced today that ... e-clinical software solution of choice.  This latest decision ... value to their clients by offering a state-of-the-art ... relationship establishes nowEDC as the EDC platform of ... full-service clients.  "nowEDC has long been a preferred ...
(Date:6/23/2016)... Roche (SIX: RO, ROG; OTCQX: RHHBY) announced that it ... (procalcitonin) assay as a dedicated testing solution for people ... Roche is the first IVD company in the U.S ... assessment and management. PCT is a sepsis-specific ... blood can aid clinicians in assessing the risk of ...
(Date:6/23/2016)... -- , , , WHEN: , ... , , , LOCATION: , , , Online, with free ... EXPERT PANELISTS:  , , , Frost & Sullivan,s Global Vice President ... Industry Analyst, Divyaa Ravishankar and Unmesh Lal, Program Manager , ... is witnessing an exceptional era. Several new demand spaces, such as ...
Breaking Medicine Technology: