Prostate Cancer Update

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Prostate Cancer Update

• Ned Calonge, MD, MPH

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Current recommendations

• USPSTF The U.S. Preventive Services Task Force
  (USPSTF) concludes that the evidence is
  insufficient to recommend for or against routine
  screening for prostate cancer using prostate
  specific antigen (PSA) testing or digital rectal
  examination (DRE).

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Current recommendations

• Rationale The USPSTF found good evidence that
  PSA screening can detect early-stage prostate
  cancer but mixed and inconclusive evidence that
  early detection improves health outcomes.
• Screening is associated with important harms,
  including frequent false-positive results and
  unnecessary anxiety, biopsies, and potential
  complications of treatment of some cancers that
  may never have affected a patient's health.
• The USPSTF concludes that evidence is
  insufficient to determine whether the benefits
  outweigh the harms for a screened population.

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Current recommendations

• ACS Both the prostate-specific antigen (PSA)
  blood test and digital rectal examination (DRE)
  should be offered annually, beginning at age 50,
  to men who have at least a 10-year life
  expectancy.
• Men at high risk (African-American men and men
  with a strong family of one or more first-degree
  relatives father, brothers diagnosed before age
  65) should begin testing at age 45.
• Men at even higher risk, due to multiple
  first-degree relatives affected at an early age,
  could begin testing at age 40. Depending on the
  results of this initial test, no further testing
  might be needed until age 45.

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Current recommendations

• Information should be provided to all men about
  what is known and what is uncertain about the
  benefits, limitations, and harms of early
  detection and treatment of prostate cancer so
  that they can make an informed decision about
  testing.
• Men who ask their doctor to make the decision on
  their behalf should be tested. Discouraging
  testing is not appropriate. Also, not offering
  testing is not appropriate.

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Current status of research

• The evidence gap still remains regarding the
  health benefits of screening
• Older men, African Americans, and men with a
  family history of prostate cancer are at
  increased risk, however, the research gaps are
  the same for these groups
• There are new PSA strategies to improve screening
  test utilities for aggressive cancers involving
  the change in PSA levels over time however,
  there is no evidence that these new strategies
  improve health outcomes

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Current status of research

• There are two ongoing trials, which should be
  completed soon, that should help address the
  evidence gaps for screening
• The U.S. Prostate, Lung, Colorectal and Ovarian
  Cancer Screening Trial (PLCO)
• The European Study of Screening for Prostate
  Cancer (ERSPC)
• There are two treatment trials that should
  provide better evidence on treatment options for
  screening detected cancers
• U.S. Prostate Observation Versus Intervention
  Trial (PIVOT)
• U.K. Prostate Cancer for Testing and Treatment
  (ProtecT) study

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Current status in Colorado

• Prostate cancer awareness is the current CDPHE
  goal, in order to provide men with information
  about
• Prostate cancer
• Potential benefits of screening
• Potential risks of screening
• Lack of evidence of net health benefit
• Options for screening and treatment

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Current Status in Colorado

• There are important health disparities in
  Colorado (as seen nationwide) with Black African
  Americans having about a 13 higher incidence but
  twice the mortality rate of whites
• Latinos have both a lower incidence rate and a
  lower mortality rate

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Current status in Colorado

• CDPHE will continue to look for opportunities to
  educate men, especially African Americans, about
  prostate cancer and prostate cancer screening
• Advocating for screening should await good
  evidence that this leads to improved health
  outcomes that exceed the harms of screening,
  diagnosis and treatment