New prostate cancer research revisits early screening conversation

Men in their 40s and 50s encouraged to reevaluate their prevention strategy

New research out of the U.S. adds additional support for early prostate cancer screening of men in their 40s and 50s, leading some advocates to hope that it may persuade reluctant physicians to reconsider their positions.

The Northwestern Medicine research showed that the number of new cases of metastatic prostate cancer climbed 72 percent in the past decade from 2004 to 2013. The report considers whether a recent trend of fewer men being screened may be contributing to the rise, or whether the disease has become more aggressive, or both.

Opposing positions about prostate cancer detection and prevention in Canada has led to inconsistent medical guidelines, which in turn has led to men getting different treatment recommendations across the country.

Cases rose 92% among men aged 55 to 69 in the last decade

As reported by Northwestern Medicine, the largest increase in new cases was among U.S. men 55 to 69 years old, which rose 92 percent in the past decade. This rise is particularly troubling, the authors said, because men in this age group are believed to benefit most from prostate cancer screening and early treatment.

Dr. Edward Schaeffer, the senior study author and chair of urology at Northwestern Medicine said that one hypothesis is the disease has become more aggressive, regardless of the change in screening. The other hypothesis is since screening guidelines have become more lax, when men do get diagnosed, it’s at a more advanced stage of disease.

Early screening is something Medcan Chief Medical Officer Dr. James Aw and Dr. Rajiv K Singal, Director, Medcan Urology and specialist in Urology at Toronto East General, have been promoting for years.

Early detection saves lives

In his article on PSA tests in a National Post in 2011, Dr. Aw argued that early detection saves lives.

“The PSA test is by no means perfect. However, it does form an important component in an ongoing and developing series of algorithms designed to predict whether a given male will develop prostate cancer, and whether that cancer will be a dangerously aggressive form of the disease. Early detection of the aggressive forms of prostate cancer in younger males (aged 65 or less) saves lives,” wrote Dr. Aw.

He encourages men in their 40s and 50s to speak with their physicians about the best screening options for them.

“We can’t simply abandon an entire generation of men waiting for something better to come along. Those men that are destined to be harmed by prostate cancer must be found and offered a chance at cure,” says Dr. Singal.

As Dr. Singal has written on his site and elsewhere, until there is a better tool that is widely available, he believes the PSA is the best thing that we have.

“While we have some knowledge about clear risk factors such as family history and ethnicity, in my experience the large majority of men that have presented with meaningful disease have had no clear or prior risk factor,” Dr. Singal wrote in a 2013 posting.

One of his most popular pieces “My GP Just Doesn’t Believe in PSA” helps male patients navigate the medical system when family physicians who are reluctant to recommend a screening.

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