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Health & Medicine for Senior Citizens

Prostate Cancer Survival Rates Improved After Introduction of PSA Screening

Growing evidence that questions U.S. Preventative Services Task Force recommendation against PSA screening in all men

Aug. 23, 2012 – The latest round in the on-going debate over the routine use of prostate specific antigen (PSA) to screen for and monitor prostate cancer is a new study that compares studies before and after the “PSA era.” The lead investigator concludes that ‘without a doubt it has played a role in extending many lives.”

The routine use of prostate specific antigen (PSA) testing for screening and monitoring prostate cancer has led to early and more sensitive detection of the disease, according to the study published in The Journal of Urology.

The report shows survival has improved for patients with newly diagnosed prostate cancer that has spread to the bones or other parts of the body and the disparity between African American and Caucasian men has been resolved.

 

Related Archive Stories

 
 

No PSA Testing May Triple Cases of Advanced Prostate Cancer, Spread

Data very clear: not doing PSA will result in many men with far more advanced prostate cancer spread to other parts of the body

July 30, 2012 - Eliminating the PSA test to screen for prostate cancer would be taking a big step backwards and would likely result in rising numbers of men with metastatic cancer at the time of diagnosis, predicted a University of Rochester Medical Center analysis published in the journal, Cancer. Read more...

Debate About Recommendation Against PSA Test for Prostate Cancer to Continue

The recommendation by U.S. Preventive Services Task Force against PSA screening for men of any age for prostate cancer stirs swirl of controversy: says special report in NCI Cancer Bulletin

By Carmen Phillips, National Cancer Institute - June 5, 2012

Four New Drugs Will Change Prostate Cancer Care, Colorado Expert Says

Hope this will lead to making prostate cancer a disease a patient is more likely to die with than from

By Garth Sundem

Feb. 16, 2012

More links to prostate cancer reports below story


 
 

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"Our analysis indicates an overall improvement in risk adjusted survival rates for non-African American and African American men. Of note is the resolution of disparity in survival between the races found in earlier studies," says lead investigator Ian M. Thompson, Jr., MD, Director of the Cancer Therapy and Research Center, a National Cancer Institute-Designated Cancer Center, and Professor in the Department of Urology at the UT Health Science Center at San Antonio, TX.

The Southwest Oncology Group, a National Cancer Institute (NCI) sponsored organization that conducts clinical trials in adult cancers, has performed a series of clinical trials over the last three decades that evaluated patient survival after androgen deprivation treatment (ADT) for prostate cancer.

Two of the trials took place before, and one took place after the introduction of PSA screening.

Recommendation to End Regular PSA Screening

In 2011, the U.S. Preventative Services Task Force recommended against PSA screening in all men, prompting criticism from the medical community. The government panel reviewed scientific evidence and concluded that screening has little or no benefit, or that the harms of early detection outweigh the benefits.

One major concern, for example, was that doctors are screening for, finding, and treating non-aggressive cancers that might have remained quiet, causing patients to needlessly suffer from serious treatment side effects such as incontinence or erectile dysfunction.

The U.S. Task Force recommendations against screening caused some confusion, and in response, a special panel of experts from the American Society of Clinical Oncology this month issued its own opinion.

The ASCO panel decided that for men with a life expectancy of less than 10 years, general screening with the PSA test should be discouraged. For men with a longer life expectancy, though, it is recommended that physicians discuss with patients whether the PSA test is appropriate for them.

"These sequential trials provide an opportunity to address the question of whether survival has improved since the advent of widespread PSA screening and follow-up testing," says Dr. Thompson.

Patient populations and eligibility criteria were comparable across the three studies, which enrolled patients from cancer centers around the country. Patients in all three trials received similar ADT treatments.

Median survival in trial S8494, which enrolled patients from 1985 to 1986, was 30 months, and median survival in trial S8894, which enrolled patients from 1989 to 1994, was 33 months. In contrast, median survival in trial S9346, which enrolled patients from 1995 to 2009, was 49 months. A 30% decreased risk of death was found in the most recent trial (S9346) from the previous trial (S8894).

The interaction of various risk factors, such as extensive versus minimal disease, older age, race, and body mass index was assessed. In S8494 the median survival for African American men was 27 months, while in S9346, the survival rate was 48 months, which is very close to that of white men.

Dr. Thompson notes that African American men had poorer results in the earlier studies despite receiving treatment in a carefully overseen clinical trial.

"When we evaluated ZIP code summary information regarding income and education, there was no shift in socioeconomic status over time. We hypothesize that this improvement is based on greater awareness of prostate cancer and improved health seeking behavior in African American men."

However, African American men have a two- to three-fold greater incidence of newly diagnosed metastatic prostate cancer compared to white men, which contributes to a similarly increased mortality rate.

"A greater effort is needed to eliminate disparities in prostate cancer," he says.

Dr. Thompson concludes, "While not all of these welcome improvements can be attributed strictly to PSA testing, without a doubt it has played a role in extending many lives."

>> About PSA Testing at National Cancer Institute


Links to More on Prostate Cancer in SeniorJournal.com

Researchers Find Possibility of Heart Disease Causing Prostate Cancer

Duke researchers find evidence linking prostate cancer and coronary artery disease - Feb. 8, 2012

Why Observing Prostate Cancer Gaining Ground On Surgery: NIH Panel Says Not Cancer

‘Some think these tumors should be rebranded as something else, such as idle tumors’

By Richard Knox, NPR’s Shots blog - Dec. 9, 2011

Delay of Treatment for Low-Risk Prostate Cancer Gets Nod from NIH Panel

Recommends active monitoring but details of strategies not determined, Dec. 8, 2011

Cardiovascular Deaths Not Linked with ADT for Prostate Cancer but Lower All- Death Risk May Be

Study should be 'generally reassuring' to most men with unfavorable-risk prostate cancer considering ADT, because it was associated with improved survival  - Dec. 7, 2011

Prostate Cancer Patients Considering Suicide May Find Help in New Concept

Patients who have these negative thoughts before surgery are more likely to have a lower perceived quality of life 3 months afterwards

Oct. 31, 2011

Influential Panel Giving Thumbs Down To Routine PSA Test for Prostate Cancer

See links to other comments and reports on this recommendation

By Scott Hensley, NPR News, Oct. 10, 2011

New Models Predict Likelihood of Erectile Function Return After Prostate Cancer Treatment

Problem still there but it helps men make better informed decisions with realistic expectations - watch video report

Sept. 20, 2011

New Surgery-Free Treatment for Enlarged Prostate Avoids Sexual Dysfunction

Prostatic artery embolization as effective as popular TURP surgical method; more than half of senior men have enlarged prostate; also silodosin a new treatment for prostatitis

May 18, 2011

Ten Ways to Improve Communications, Make Better Decisions About Your Cancer Care

Michigan researchers outline how to improve communication about the risk

Sept. 20, 2011

Concern Is Growing That the Elderly Get Too Many Medical Tests; Little Benefit

Growing skepticism about widespread, routine screening for cancer and other ailments of people in their 70s, 80s and 90s

By Sandra G. Boodman, Kaiser Health News

Sept. 13, 2011

Prostate Cancer Patients Live Much Longer with Hormone Therapy Added to Radiation

Larger graphs of prostate cancer cases and deaths 1987-2007 below story

ADT therapy works well with intermediate grade cancer, not so well with low grade; only two grades tested in this trial

July 15, 2011

Medicare Bites Bullet to Cover Expensive Provenge, Prostate Cancer Drug for Bad Cases

CMS also to continue expensive breast cancer drug, Avastin; Sipuleucel-T activates immune system to defend against prostate cancer; first approved autologus cellular immunotherapy

July 1, 2011

Cancer Death Rates Continue Decline That Began in Early 1930s Says Cancer Society

Cancer Statistics 2011 shows among men the reduction in lung, prostate, and colorectal cancers is nearly 80% of decline; among women, almost 60% of decrease in breast and colorectal - see chances of seniors getting cancer - June 17, 2011

Drug Approved to Treat Nail Fungus Found to Delay Chemo in Advanced Prostate Cancer

Itraconzole slows prostate cancer progression but has potential of serious side effects - June 3, 2011

Rising PSA Levels May Sometimes Lead to Negative Biopsies But Usually Means Cancer

News study shows nearly 70 percent with rising PSA eventually get prostate cancer - May 18, 2011

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