Updates from the Prostate Screening News Front with Commentary by FirstScanTM
According to recent articles featured in the Wall Street Journal, the number of men diagnosed with prostate cancer in the U.S has significantly dropped (November 17, 2015) and there is rumor that doctors may soon be penalized for ordering the medical community’s primary early warning indicator, the Prostate Specific Antigen (PSA) blood test (November 19, 2015).
This is disconcerting because: 1) the rational for the conclusions were based upon outdated modalities, 2) facts relevant to the observations were omitted, and 3) most egregious, these conclusions could lead to a significant increase in the number of deaths by [prostate cancer.
First, the facts: Screening referred to PSA screening and not more advanced technologies. Serum PSA does not actually detect cancerous lesions; it simply serves as an indicator for physicians if their patients’ PSA level rises above 4 (ng/ml) or if the level increased since the last blood test was administered. MRI screening, a far more accurate diagnostic modality that produces images of the exact size and location of the cancerous lesion, was not used to conduct the research.
The use of PSA has dropped largely because the US Preventative Task Force recommended, in their 2008 report, that PSA not be used. Many physicians followed those recommendations. The reason that the USPTF recommended against using PSA was that their research data indicated that the biopsied tissues (from thousands of patients over years) did not correlate well with the PSA number. What was not known at the time was that the biopsy itself was deficient. At the time, PSA was validated by non-image guided biopsies, which have since been proven to be very poor themselves with less than 50% accuracy. In short, the tests were validated with an equally (if not more so) inaccurate test.
Although PSA is a great early warning indicator, it has also been known to produce misleading results, such as indicating cancer when in fact other non-cancerous pathologies such as benign hyperplasia (BPH) is at fault.
Did the decrease in population getting PSA screening replace with a better screening tool? Largely yes. A large number of independent research studies involving tens of thousands of men have been conducted since 2007 when the decline in PSA use, and cancer incidence was measured. In fact, based upon a composite summary of these independently collected and concluded statistics, the counter argument was made below.
In an accompanying editorial in The Journal of the American Medical Association (JAMA), David Penson, a urologist at Vanderbilt University, estimated that because 33,519 fewer early prostate cancers were detected and treated in 2012, 1,241 more men could ultimately die of the disease. Rather than an “all-or-nothing” approach, he called for developing ways to individualize screening, testing men at high-risk for aggressive cancers more often.
In conclusion, the American Cancer Society and the American Urological Association, in fact, recommend that doctors discuss the benefits and harms and leave the decision up to patients.
An Omaha-based MRI prostate screening clinic, FirstScan, opened this November to address this very issue and provide men with accurate and non-invasive detection options. FirstScan’s main goals have been to supply early, no risk detection and education to both physicians and patients.