We have new information about the value of prostate cancer screening in our efforts to save lives and lessen disease impact from this very prevalent cancer.
Urologists at the Cornell Medical Center in New York City have compiled new data from a very large study first reported on 12 years ago. We now know that far fewer men need to be screened to save one life from prostate cancer. Several organizations, including the United States Preventive Services Task Force and the American Cancer Society used the old data to formulate recommendations on cancer screening. Since then, the number of diagnoses of men with prostate cancer that has already spread has gone up, suggesting that a stronger effort to screen for prostate cancer may be necessary. The study recently published in the New England Journal of Medicine may be used to revise future policy recommendations.
We have all felt and seen impacts in patient access and care with the COVID-19 pandemic. Last month, a study in The Journal of the American Medical Association reported that newly identified cancers fell 46.4% on March 1 to April 18. This development may lead to cancers being detected at more advanced stages, with worse outcomes.
I recently discussed the diagnosis of prostate cancer with a local pathologist. That is the kind of physician who looks at a biopsy specimen in the lab to diagnose a cancer. Their lab has seen a significant drop in the number of prostate biopsy specimens this spring and summer, suggesting that the national trend has also occurred locally.
When discussing prostate cancer with patients, I explain frequently that there are three true facts about prostate cancer that do not necessarily reconcile themselves. First, a man who has prostate cancer will probably die of something else. The disease is so prevalent and a significant number of the cancers that we find are medium grade and slow growing and can be observed. The second statement that is true is that if a man dies of cancer in the United States, the second leading cause of that cancer death is prostate cancer. Number one is lung cancer. Prostate cancer can be slow growing and somewhat indolent in its activity, but it can also be a killer. The third statement that I explain to patients is that men who have localized prostate cancer cannot tell that they have it. There is an idea that we should be able to tell if we have a cancer in our body, but prostate cancer is definitely one of those that can sneak up on a person without any new symptoms at all.
The bottom line is that if we want to find out if we have a prostate cancer, we should go through a process of going to look for it, and that involves a visit to your physician with a PSA blood test, hopefully done every year over several years, and a digital rectal exam to actually feel the back side of the prostate. If one routinely carries this maneuver out with their main doctor, the chance of having a bad outcome from prostate cancer is markedly lessened.