There has been recent debate on how to approach screening and treatment for prostate cancer. Organizations not affiliated with the American Urologic Association have made claims that limit Prostate-Specific Antigen (PSA) screening, a common screening procedure for prostate cancer that measures the level of PSA in the blood.
The U.S. Preventive Services Task Force (USPSTF), a volunteer panel of 16 doctors and disease experts in prevention and evidence-based medicine, has historically recommended against PSA-based screening for all men who do not have symptoms, but in a recent draft recommendation statement from May 2017, they have changed their recommendation to consider screening in men ages 55-69 years.1 The CDC follows the prostate cancer screening recommendations, and argues that a PSA test can find prostate cancer earlier than no screening at all. However, it’s been shown that the PSA test may have false positive or false negative results. This can mean that men without cancer may have abnormal results and get tests that are not necessary. It also means that a test might miss a cancer diagnosis in men who may need to be treated.2
B. Barckley Storey, M.D., Board Certified Urologist with Physicians Regional Medical Group sees it differently. “The problem with this argument is that it ignores a potential problem. I’m a strong believer that we should collect all the information we need, and make an educated decision on possible treatment options going forward.”
Alexandre Rosen, M.D., also a Board Certified Urologist with Physicians Regional Medical Group, adds that this argument has had negative effects. “The frequent debate in the past 5-10 years has led to patient and physician confusion as to who should be screened. The urology community strongly believes that screening for prostate cancer is important and saves lives by making an early diagnosis.”
Prostate cancer is the most common form of cancer in American men other than skin cancer. The American Cancer Society estimates prostate cancer in the United States for 2017 to reach about 161,360 total cases, and of those, about 26,730 deaths.3 Dr. Rosen recommends that PSA screening and prostate exams should begin at age 50, unless men have additional risk factors. These include being African-American or having a family history of prostate cancer. Gene mutations such as BRCA (associated with breast and ovarian cancer) may also contribute to prostate cancer. For higher-risk patients, Dr. Rosen typically starts screening men at age 40.
A relatively new tool called Focal Biopsy has become available in the last few years to urologists to help them screen and biopsy patients with suspected prostate cancer. This system allows physicians to look for potential areas of concern within the prostate using Magnetic Resonance Imaging (MRI), and if found, use a new targeting system to sample those areas of concern. Ultrasound/MRI fusion Focal Biopsy lets the urologist take a lesion seen on MRI, and guide a needle specifically to that area to biopsy. Dr. Storey points out several advantages to this system over the old way of approaching an abnormal PSA or rectal exam:
• By using MRI, it allows us to target lesions that are of higher concern, yielding much higher quality biopsies.
• It allows a method to screen patients who historically have high or unstable PSA, and who would otherwise be subjected to repeat prostate biopsies.
• This system is invaluable for the patient who has had a negative prostate biopsy, but whose PSA continues to rise. We can now look for a lesion, and target it, instead of continuously “stabbing in the dark.”
“From the feedback I received at the American Urologic Association meeting in Boston in May 2017, I would estimate a large number of studies currently being done across the country involve Focal Biopsy systems, and this is rapidly becoming a standard of care in urology,” says Dr. Storey.
Dr. Storey’s office is located in the Regional Medical Arts building at Physicians Regional – Collier Blvd, 8340 Collier Boulevard, Suite 400, Naples, and at Physicians Regional – Marco Island, 1839 San Marco Rd, Marco Island. For more information or to request an appointment, please call (239) 348-4221, or visit PhysiciansRegionalMedicalGroup.com.
Dr. Rosen’s office is located at Physicians Regional – Pine Ridge, 6101 Pine Ridge Rd, Naples. For more information or to request an appointment, call (239) 348-4221.
1 ttps://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation- statement/prostate-cancer-screening1