Prostate Cancer Today: A 2-Minute Update for Physicians
Innovative diagnostic tools and treatments are refining management of prostate cancer, and helping clinicians and patients make better decisions.
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It’s not your father’s Oldsmobile when it comes to today’s prostate cancer diagnosis and treatment.
Innovative diagnostic tools and treatments introduced within the last six to eight years have ushered in a new era. They are refining our ability to identify which patients need biopsy, improving the quality of biopsy and assessing the biology of prostate cancer. All developments are helping clinicians and patients make more informed, better treatment decisions.
Prior to prostate-specific antigen (PSA) testing in 1987, half of men newly diagnosed with prostate cancer had incurable disease at diagnosis. Treatment was castration to remove the testosterone that fueled the cancer.
Five years after PSA was introduced, the rate of incurable prostate cancer at diagnosis dropped from 50 percent to 5 percent. PSA allowed clinicians to diagnose cancers far earlier at a curable stage. For about 20 years after PSA testing was introduced, however, physicians believed that every cancer detected had to be treated.
Over time, the medical community found that PSA screening detected a lot of low-grade cancer that did not need treatment. We also discovered that the most common reason for a worrisome PSA level in the bloodstream was noncancerous prostate enlargement.
The challenge is that PSA is prostate-specific, but not cancer-specific. The PSA test measures PSA levels in the bloodstream, but a number of benign conditions — including prostate enlargement (known as benign prostatic hyperplasia or BPH) — can raise PSA levels. It’s a major limitation in the use of PSA, leading to overdetection and overtreatment of low-grade cancers.
In 2012, the U.S. Preventive Services Task Force discouraged the use of PSA as a screening tool for prostate cancer, citing the harm it caused through overdetection and overtreatment. That decision led to a marked reduction in the number of patients screened, which led to an increase in men presenting with advanced cancer again.
The task force refined its recommendations in 2018, stating men aged 55 to 69 should make an individual decision on whether or not to be screened based on conversations with their doctors. Men 70 and older, the recommendations state, should not be screened because the harm caused by a false-positive test outweighs the benefits.
In the last six to eight years, there have been a number of important findings that opened up a new era in screening, diagnosis and management of prostate cancer:
Just as cars are evolving beyond the Oldsmobile with the introduction of hybrid and driverless technology, prostate cancer detection and treatment continues to evolve to improve the decision-making process.