Lancaster Physician Spring 2017 - 17

SPRING 2017

Prostate Cancer Prevention

screening in younger men ranging from 45
through 69. Earlier screening is recommended
for higher risk patients (African Americans;
familial or genetic history).16,17 All of the guidelines emphasize a shared decision making process
and not testing those who do not have at least
a 10- to 15-year life expectancy.

Endnotes
1 American Cancer Society, 2017 Prostate-cancer/
causes-risks-prevention/risk-factors
2 Cancer Epidemiol Biomarkers Prev 2007;16(1):63-9
3 Cornell-China-Oxford project-the-china-project-studyingthe-link-between-diet-and-disease
4 The China Study: The Most Comprehensive Study of
Nutrition Ever Conducted and the Startling Implications
for Diet, Weight Loss and Long-Term Health Campbell and
Campbell, BenBella Books; 1 edition (June 1, 2006)
5 Vitamin E and the risk of prostate cancer: the Selenium and
Vitamin E Cancer Prevention Trial (SELECT) Klein et al.
JAMA. 2011 Oct 12;306(14):1549-56.
6 Aspirin and cancer risk: a quantitative review to 2011,
Bosetti et al. Ann Oncol. 2012 Jun;23(6):1403-15
7 Associations of Circulating 25-hydroxyvitamin D with
prostate cancer diagnosis, stage and grade, Gilbert et al.
Int J Cancer. 2012 Sep 1; 131(5): 1187-1196
8 Physical activity and cancer prevention--data from
epidemiologic studies. Lee Medicine and Science in Sports and
Exercise [2003, 35(11):1823-1827]

utilized age-specific reference ranges for men
starting at age 50 for the general population and
age 40 for the high-risk patients (family history
of prostate cancer or African American).9
As men age, their prostate will enlarge and
the PSA may rise. The rate of rise is felt to be
a useful tool in following men who may be at
risk for developing prostate cancer.
In 2012, the U.S. Preventive Services
Task Force (USPSTF) recommended
against all screening for prostate cancer.
They concluded that the diagnosis and
treatment of elevated PSA levels led to an
increase in procedure complications without
a significant survival benefit.10
Controversy and confusion ensued. Other
studies reported a 29 percent decrease in mortality with PSA screening and early detection
of aggressive prostate cancer.11 As a result of
decreased screening, there has been a decrease
in prostate cancer diagnoses and also a decrease
in the detection of high-grade prostate cancer,

thus patients are presenting to doctors with
more advanced disease.12,13

So, what is best for patients?
Further studies and research will lead to refinements in testing to: 1) decrease false positive PSA
testing (negative biopsies) 2) decrease detection
of low-grade prostate cancers ('over-detection')
and 3) increase detection of high-grade prostate
cancer patients (identify those most likely to
benefit from intervention).14
PSA levels in mid-life can be predictive
for subsequent lethal prostate cancer later in
life. Risk-stratified screening on the basis of
mid-life PSA should be considered in men age
45 to 59. Men with PSA below median level
at age 60 years (< 1.0 ng/mL) are unlikely to
develop lethal disease in their lifetime (over the
next 30 years).15
The current American Urological Association
(AUA), American Cancer Society (ACS), and
National Comprehensive Cancer Network
(NCCN) recommendations all include PSA

LANCASTER

PHYSICIAN

9 Prostate-Specific Antigen (PSA) Best Practice Policy
ONCOLOGY 14(2):267-286, 2000
10 Screening for Prostate Cancer: U.S. Preventive Services
Task Force Recommendation Statement Ann Intern Med.
2012;157:120-134.
11 Quality-of-Life Effects of Prostate-Specific Antigen Screening Heijnsdijk et al. N Engl J Med 2012; 367:595-605
12 Impact of the U.S. Preventive Services Task Force
recommendations against prostate specific antigen screening
on prostate biopsy and cancer detection rates. Bhindi et al. J
Urol. 2015 May;193(5):1519-24
13 Effect of the USPSTF Grade D Recommendation
against Screening for Prostate Cancer on Incident Prostate
Cancer Diagnoses in the United States. Barocas DA et al. J
Urol. 2015 Dec;194(6):1587-93
14 Prostate Cancer Diagnosis and Risk Assessment Carroll
https://www.auanet.org/university/live-course-handout.
cfm?id...Sep 18, 2016
15 Baseline Prostate-Specific Antigen Levels in Midlife Predict
Lethal Prostate CancerPreston, M.A. et al. Journal of Clinical
Oncology 34, no. 23 (August 2016) 2705-2711.
16 EARLY DETECTION OF PROSTATE CANCER:
AUA GUIDELINE Carter, H.B. 2013 by the American
Urological Association
17 http://www.cancer.org/cancer/prostatecancer/
moreinformation/prostatecancerearlydetection/
prostate‐cancer‐early‐detection‐acs‐recommendations

https://www.auanet.org/university/live-course-handout http://www.cancer.org/cancer/prostatecancer/

Table of Contents for the Digital Edition of Lancaster Physician Spring 2017