Making Sense of Prostate Cancer Screening

Lee Richstone, MD
Manish Vira, MD

This past week, it was hard to escape hearing news regarding the US Preventive Services Task Force (USPSTF) upcoming release of recommendations regarding prostate cancer screening and prostate-specific antigen (PSA) testing. Once again, millions of men and their loved ones are left to sort out the conflicting messages and try to make an informed decision regarding prostate cancer screening.

For more than two decades, annual PSA testing of men aged 50 or older in combination with digital rectal examination (DRE) has been the standard screening approach for the early detection of prostate cancer. It is the most common cancer diagnosis in men with an estimated 250,000 new cases in 2011. Despite the perception in the media that prostate cancer is not dangerous, it is the third leading cause of cancer death in men, causing more than 30,000 deaths annually. While many men may die of their prostate cancer, the majority of others will go on to live long lives and die of other causes--even if their prostate cancer is never treated.

Herein is the dilemma.

Prostate cancer has two faces: one a killer and the other a virtually harmless “disease,” that nevertheless affects patients with all of the anxiety that accompanies the diagnosis of “cancer.” PSA testing as a screening test fulfills its requirements, i.e. it is inexpensive, easy to perform (simple blood test), and most importantly, detects prostate cancer at an early stage when it is potentially curable. Full Post - to Detail View

Common Prostate Medications Linked to Increased Cancer Risk

Manish Vira, MD

Another wrench is thrown into the prostate cancer prevention, screening, and treatment conundrum.

The US Food and Drug Administration (FDA) recently released a Drug Safety Communication regarding a common class of medications called 5 alpha reductase inhibitors (5-ARI) known as finasteride and dutasteride. Two large randomized, placebo-controlled trials in which a combined 27,113 men were randomized to receive either 5-ARI or placebo to reduce the incidence of prostate cancer showed a 25 percent reduction in the incidence of prostate cancer, but also revealed a higher incidence of high-grade cancers in the cohort of men on the study drug. As a result, the FDA revised the labeling of these medications to warn of the “increased risk of being diagnosed with a more serious form of prostate cancer.”

The FDA communication further advises that:

  • 5-ARIs are not approved for the prevention of prostate cancer
  • 5-ARIs may increase the risk of high-grade prostate cancer
  • Prior to initiating therapy with 5-ARIs, healthcare professionals should perform appropriate evaluation to rule out other urological conditions, including prostate cancer, that might mimic benign prostatic hyperplasia.

It is important to understand that the FDA continues to endorse the use of 5-ARIs in the indicated treatment of men with an enlarged prostate and lower urinary tract symptoms. These medications have a proven benefit in reducing prostate volume and reducing the risk of acute urinary retention or surgery related to prostatic hypertrophy. Second, among patients being treated with 5-ARIs for prostate cancer prevention, the risk of being diagnosed with high grade cancer is very low. Full Post - to Detail View