The most recent lecture presentation I gave to an audience of clinicians about prostate cancer in May was titled: “Prostate Cancer: Game Over.” And yet it seems that this controversy may be far from over. Presentations at the American Urological Association in Orlando in 2014 confirm the continued ambivalence about whether/how/when we should be addressing prostate cancer screening.
No one disagrees that routine prostate-specific antigen (PSA) screening can lead to overdiagnosis: that is, identification of disease destined to have no ultimate impact on the life span or well-being of the patient. New 2014 guidelines from the National Comprehensive Cancer Network (NCCN) include a more restricted PSA level indication for biopsy (> 3.0 ng/mL), less frequent testing, and restriction of biopsy to palpable abnormalities that are “highly suspicious” rather than “minor abnormalities.” Use of PSA velocity, particularly at very low PSA levels, is now recognized to also lead to overdetection. Finally, active surveillance for low-risk disease is advocated by the NCCN.
Despite the availability of data representing more than 230,000 men from two recent randomized, controlled trials (PLCO and ERSC) that do not support the ability of PSA screening to reduce mortality, the issue continues to stimulate debate.
Source: Carroll PR, Vickers AJ. Point/Counterpoint: Early detection of prostate cancer: Do the benefits outweigh the consequences? J Natl Compr Canc Netw 2014;12:768-771.