PSA Blood Test Saves Lives

What You Need to Know: Prostate-specific antigen (PSA) screening is controversial, but a new study shows PSA is associated with a lasting reduction in your risk of dying from prostate cancer, with an increased effect at 13 years compared with nine or 11 years.

The Study: European Randomised study of Screening for Prostate Cancer (ERSPC) is a multi center, randomized trial assessmentt of PSA testing in eight European countries for men ages 50 to 72. Data truncated at 13 years.

Results: At 13 years, the absolute risk reduction of death from prostate cancer was 0.11 per 1,000 person-years or 1.28 per 1,000 men randomized.

My Take: In this update, the ERSPC confirms a meaningful reduction in prostate cancer mortality attributable to the PSA blood test, with an even greater effect at 13 years compared to 9 and 11 years. While the use of screening PSA is controversial, this well-done study points to a PSA-linked reduction in the risk of prostate-related death. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: The Lancet, Early Online Publication, 7 August 2014.

 

 

PSA for Prostate Cancer Screening? Yes. No. Yes. Maybe.

puzzled man
 
What You Need to Know: Mortality in prostate cancer is lower in areas with frequent use of PSA testing compared with areas with little testing shows a new study. Results from the study show that prostate cancer mortality was 20 percent lower in counties with the highest incidence of prostate cancer, which indicates an early and rapid uptake of PSA testing.
 
The Evidence: The study is based on data from nation-wide, population-based registers in Sweden including the Cancer Register, The Cause of Death Register and the National Prostate Cancer Register (NPCR) of Sweden.

“Our results show that prostate cancer mortality was 20 percent lower in counties with the highest incidence of prostate cancer, indicating an early and rapid uptake of PSA testing, compared with counties with a slow and late increase in PSA testing,” says Pär Stattin, lead investigator of the study. “Since the difference in the number of men diagnosed with prostate cancer is related to how many men undergo PSA testing, we think our data shows that PSA testing and early treatment is related to a modest decrease in risk of prostate cancer death,” says Håkan Jonsson statistician and senior author of the study.

“In contrast to screening in randomized studies our data is based on unorganized, real life PSA testing. We therefore used a statistical method that excludes men that were diagnosed prior to the introduction of PSA testing since these men could not benefit from the effect of PSA testing,” continues Håkan Jonsson.

“The results in our study are very similar to those obtained in a large European randomized clinical study (ERSPC) thus confirming the effect of PSA testing on the risk of prostate cancer death. However, we have to bear in mind that the decrease in mortality is offset by overtreatment and side effects from early treatment. PSA testing sharply increases the risk of overtreatment, i.e. early treatment of cancers that would never have surfaced clinically. We also know that after surgery for prostate cancer most men have decreased erectile function and that a small group of men suffer from urinary incontinence. Our data pinpoints the need for refined methods for PSA testing and improved prostate cancer treatment strategies,” concludes dr Stattin.

My Take: The role of PSA as a screening tool remains unclear. My take is that it leads to overtreatment, but that this is more an issue of how we use the test, rather than the test itself. PSA testing is the best means that we now have available to identify those patients who have prostate cancer.  After a prostate biopsy is done, and if the biopsy identifies cancer, a patient must decide whether to treat the disease or to undergo active surveillance. To make such a decision, the patient needs to be completely informed of their disease status. So have a chat with your health care provider to see if the PSA makes sense for you. Clearly, not everyone benefits from PSA. Still, I think PSA does diminish the risk of death, especially among higher risk populations such as African American men. So don’t ignore PSA testing: Have a dialog with a valued health professional to see if it is appropriate for you. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References:

Umeå universitet. “PSA testing, early treatment decreases risk of prostate cancer death.” ScienceDaily. ScienceDaily, 10 March 2014. www.sciencedaily.com/releases/2014/03/140310090749.htm.

P. Stattin, S. Carlsson, B. Holmstrom, A. Vickers, J. Hugosson, H. Lilja, H. Jonsson. Prostate Cancer Mortality in Areas With High and Low Prostate Cancer Incidence. JNCI Journal of the National Cancer Institute, 2014; DOI: 10.1093/jnci/dju007


Prostate Cancer: Surgery and Radiation Have Similar Long-term Toxicities

Photo of linear accelerator
Linear accelerator for radiation therapy                         (Photo credit: Wikipedia)

A recent student represents the first large-scale comparison of long-term quality of life among patients treated with radical prostatectomy versus external beam radiation therapy (EBRT) for prostate cancer. Today, we turn to this important research.

Study: Dr. Matthew Resnick and colleagues used data from the Prostate Cancer Outcomes Study, a population-based cohort of patients whose prostate cancer had been treated in the mid 1990s and who had been prospectively followed for 15 years. The goal? To compare urinary, bowel, and sexual function after prostatectomy or radiation therapy for localized prostate cancer. Included were 1,655 men between the ages of 55 and 74. Of these 1,164 had surgery and 491 had radiation therapy. Researchers examined functional status at baseline and again at 2, 5, and 15 years after diagnosis. Full results may be found in the New England Journal of Medicine 2013;368:436-334.

Results:

Pro-radiation: Patients who had surgery were more likely to not be able to control their urine (urinary incontinence) compared to radiation therapy (at 2 years: over 6x more likely; at 5 years, over 5x more likely. By 15 years, however, there were no differences between radiation therapy and surgery in terms of urinary incontinence. Surgery also led to more impotence at 2 years (3.5x more likely) and 5 years (2x more likely), but the treatment groups were similar by 15 years. By 15 years, the impotence chance was around 80% if you started out with good function, and nearly 90% if you did not!

Pro-surgery: Patients undergoing prostatectomy were less likely to have bowel urgency at 2 years (radiation therapy 2.5x more likely to cause it) and 5 years (double the risk with radiation therapy). The % that dropped bowel function was about 10% for radiation, and 5% for surgery by 15 years.

My take: Give that the median survival following treatment for prostate cancer approaches 14 years, it is important to look at long-term quality of life among men living with a diagnosis of prostate cancer. This study hints at potential compromises in quality of life with either radiation therapy or surgery. However, it is not a randomized trial, and the study loses power over time as the number of men followed shrinks (for example, due to death from other causes). At 15 years, there were no significant relative differences in disease-specific functional outcomes comparing surgery versus radiation therapy. Still, caveat emptor: Men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up. If you are contemplating treatment for low-risk prostate cancer, ask carefully about side effects. And ask if you might be a candidate for active surveillance. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Coming Soon for iPad:  Understand Colon Cancer in 60 Minutes; Understand Diet & Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes, and Understand Breast Cancer in 60 Minutes. All can be found at the Apple Ibooks store. Thank you.

Food Supplement Linked to Lower PSA in Prostate Cancer

broccoli
Broccoli (Photo credit: Wikipedia)

A commercially available food supplement that contains pomegranate, broccoli, green tea, and tumeric significantly lowers prorate-specific antigen (PSA) levels (compared with a placebo) among patients with prostate cancer. The study results were presented at the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO). The polyphenol-rich supplement, known as Pomi-T sold out within hours.

The study: Double-blind, placebo-controlled randomized trial. The study enrolled 203 men (average age, 74 years) who had sustained a recurrence (as defined by PSA) of their cancer following treatment with surgery or radiation therapy. The men were randomized to receive either the supplement three times per day for 6 months, or the supplement.

Results: At 6 months, the median increase in PSA was 64% lower in the supplement group (15% versus 78.5%). Not surprisingly, more men proceeded to treatment in the placebo group. In the supplement group, 7.4% went on to treatment, compared to 26% in the supplement group.

Supplement downsides: More men experienced non-significant bloating or diarrhea, but 15% had beneficial effects such as better digestion and improvement in urination.

The science: In the lab, polyphenols reduce cell proliferation, block blood vessel growth, mage cells more sticky to one another (less likely to break loose and travel), and promote cell suicide (apoptosis). These agents have no hormonal effects.

Bottom line: While more data is needed regarding this particular supplement, it adds to growing evidence that lifestyle matters: A balanced diet (including cruciferous vegetables may avoidance of obesity, physical activity may all reduce the risk of prostate cancer. I’m Dr Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. And have a great day!

Gene test predicts prostate cancer outcomes

Image

A slew of information is pouring out of the American Society for Clinical Oncology (ASCO) Annual Meeting this week. Now we have results from the Prolaris test, launched in 2010. The test is designed to measure the activity of cell cycle progression (CCP) genes in prostate cancer biopsy samples, and was evaluated for its ability to predict either death from prostate cancer, or a risk in the PSA (biochemical recurrence) in 5 company-sponsored trials. The studies included a multivariate analysis (accounting for variables such as grade and PSA). Overall, the CCP score was a highly significant predictor of outcome in all studies. In other words, the test appears to discriminate who is at high risk for progression of cancer. Exactly how we will use this test is being developed, but it may be especially useful for patients with low-grade, low-risk cancers. The Prolaris test for prostate cancer is predictive of a patient’s response to therapy. Still, we don’t have firm risk cutoffs to steer decisions toward a different treatment. Other tests are emerging, too, including the just-launched Oncotype DX test (Genomics Health). I’m Dr Michael Hunter.

Caveat emptor: This information is general only, and should not be construed as medical advise for an individual. Please check with you valued health care provider to determining optimal management for you.