Weill Cornell Medicine Urology
Weill Cornell Medicine Urology
Active surveillance, physician–patient communication may redefine role of PSA testing

Active surveillance, physician–patient communication may redefine role of PSA testing

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In a 2014 modeling study published in Cancer, Gulati and colleagues predicted that if PSA screening continued at its current rate, 710,000 to 1.1 million men would be overdiagnosed between 2013 and 2025, but that 36,000 to 57,000 prostate cancer deaths would be prevented during that period.

"That study showed that, if screenings really stopped in 2012 as recommended, it would double the number of men with metastatic disease by 2025," Stacy Loeb, MD, MSc, urologic oncologist at NYU Langone Medical Center, told HemOnc Today. "It will be several more years before we can really examine those things, but the fact that fewer men are getting tested is concerning."

Jim C. Hu, MD, MPH, professor of urologic oncology at Weill Cornell Medicine, is equally concerned. He coauthored a study — published in 2016 in JAMA Oncology — that used SEER collaborative staging analysis and produced results that appeared to contradict the findings from Jemal and colleagues.

Results showed the proportion of men aged 75 years or older diagnosed with distant metastasis increased from 6.6% in 2007 to 12% in 2013, and that the proportion of intermediate- and high-grade prostate cancers increased from 58.1% in 2007 to 72% in 2013 (P < .01). Among men aged 50 to 74 years, incidence of distant metastasis increased from 2.7% to 4%, and intermediate- to high-grade prostate cancer incidence increased from 46.3% to 56.4% (P < .01).

"It's what most of us would have predicted, although somewhat sooner," Hu said in a press release. "There was a decrease in prostate cancer metastasis and death after the advent of PSA testing. Remove the screening, and the rates of serious disease rise again."

This is an excerpt from a Healio.com HemOnc Today Cover Story. Read the full text here.

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