Results of a study from Northwestern University shows the number of new cases of metastatic prostate cancer (cancer that spreads to other parts of the body) increased 72 percent between 2004 and 2013. Doctors at CHI Memorial are seeing the same trend with the number of metastatic prostate cancer increasing.
In 2008, the U.S.
Preventive Services Task Force (USPSTF) scaled back its PSA screening recommendations, and in 2012, recommended against the screening altogether. The task force cited the number of false positive results that led to unnecessary treatment.
Jeffrey Mullins, M.D., urologist, CHI Memorial Chattanooga Urology Associates says urologists have feared the controversial recommendation against PSA screening by the USPTF in 2008 would lead to more men presenting with incurable prostate cancer. “Despite flaws in methodology, the present study shows early evidence the incidence of metastatic prostate cancer may be on the rise. The bottom line is PSA screening saves lives, and men should seriously discuss the risks and benefits of PSA screening with their doctor," says Dr. Mullins
Lee Jackson, M.D., urologist, CHI Memorial Robotics for Prostate Cancer, is alarmed by the rise in metastatic prostate cancer cases and says the change in PSA (prostate-specific antigen) screening recommendation is a contributing factor to the increase in metastatic cases. “The number of men dying from prostate cancer dropped after the PSA screening was introduced about 20 years ago,” says Dr. Jackson. “Now we’re seeing a connection between not screening and the discovery of prostate cancer in a more advanced stage.”
Dr. Jackson says a variety of factors like age, race, and family history need to be considered when determining when and how often a man receives a PSA screening. If there are no risk factors present, he recommends men get a PSA screening for a baseline level during the annual physical exam at age 40. If the result indicates a low risk for prostate cancer, the man should begin annual screenings between the ages of 50-55. “Prostate cancer is only curable if it is diagnosed early. Early prostate cancer is silent. It doesn’t produce symptoms,” explains Dr. Jackson. “The only way to detect prostate cancer early to look for it with screening.”
To address the issue of over-diagnosis, Dr. Jackson uses MRI to help determine if a man needs treatment for prostate cancer. “We used to send a man with an elevated PSA for a biopsy, but an elevated PSA does not automatically mean he has cancer. Now, we use MRI to determine if a biopsy is needed. If the MRI shows something suspicious, the man has a targeted biopsy on that specific area of concern so we get more accurate results and can better determine if treatment is needed or if we just need to actively monitor,” explains Dr. Jackson.
The USPSTF updates its screening recommendations every five years. The PSA screening recommendation will be updated in 2017. “The results of this study should serve as a warning sign to policy makers and doctors that the recommendation against screening should to be reversed,” says Dr. Mullins. “Because prostate cancer is typically asymptomatic, the only way to catch it is with a PSA, or blood, test. We have to be able to catch the aggressive cancer that needs treatment and leave the ones that aren’t aggressive alone.” Both Dr. Mullins and Dr. Jackson are hopeful the recommendation against screening is reversed. “In order to find the ones who need to be treated, you have to screen. Failure to diagnose is worse,” they agreed.
CHI Memorial Robotics for Prostate Cancer is located at 725 Glenwood Drive, Suite 790, Chattanooga, TN 37404. For more information, or to schedule an appointment with Dr. Jackson, call (423) 495-3068.
CHI Memorial Chattanooga Urology Associates is located at 725 Glenwood Drive, Suite 780, Chattanooga, TN 37404. For more information, or to schedule an appointment, call (423) 697-0072.