Too Good?

According to a new study published Sunday in the New England Journal of Medicine Evidence, a blood test to screen for prostate cancer may be better than experts initially thought, particularly among Black men.

As reported by the CDC, there’s no standard test for prostate cancer. Two of the more commonly used tests are a digital rectal exam and a blood test for prostate-specific antigen (PSA), an enzyme that is typically higher in men with prostate cancer.

The study examined how successful the blood tests were for all races, specifically Black men, by estimating how often these tests led to overdiagnosis and overtreatment. The researchers analyzed three decades of records through 2016 — the last year records were available.

The test was not only more effective than scientists originally thought, but the study determined that the net benefit is even better for Black men than for the general population.

The study found one death was prevented for every 11 to 14 men of all races diagnosed with cancer. Among Black men, the test prevented one death for every 8 to 12 men diagnosed and one death for every 5 to 9 men treated for prostate cancer.

Previous studies found that the tests prevented one death for every 23 men diagnosed, resulting in overtreatment.

Prostate cancer is pervasive, but not always in need of radical treatment. It is often slow-growing and can sometimes be controlled with lifestyle modification. Anyone that’s experienced the side effects of radical cancer treatment knows the cure can sometimes feel worse than the disease!

According to the American Society of Clinical Oncology, with the rise in testing in the late 1980s, there was a trend to treat tumors that weren’t a real threat like the ones that were. But more recently, for tumors that don’t show a risk of progression, doctors have taken more of an active monitoring approach.

The American Cancer Society states that prostate cancer is the second leading cause of cancer death in American men, behind lung cancer. As indicated by the CDC, out of every 100 American men, about 3 will get prostate cancer during their lifetime, and 2 or 3 men will die from it.

Black men have double the risk of dying from prostate cancer than the general population. They also get prostate cancer more often. But Black men have also been historically underrepresented in clinical trials that look at the success rate of tests and other diagnostic tools.

The study concludes by saying, “These data should prompt policymakers to reconsider the utility of PSA-based prostate cancer screening, particularly for Black men. The potential for overdiagnosis and overtreatment remains, although these harms may be mitigated by contemporary protocols for triaging men before biopsy and active surveillance for men with low-risk disease.”

The study was partially funded by the Bristol Myers Squibb Foundation, which develops prostate cancer drugs.

Dr. William Dahut, chief science officer for the American Cancer Society, said the findings are “very important.” He explains, “That’s not something I actually say commonly.” 

He was not involved in the research.

However, Dr. Dahut noted that a few practices are a little different now than when these records were collected. Doctors can now also screen for prostate cancer with an MRI, for example, and a cancer diagnosis does not lead to treatment as often.

This used to be called “watchful waiting,” but Dahut said it’s actually more proactive than it sounds.

Depending on a person’s risk of the cancer spreading, they may be monitored closely with regular MRIs and biopsies rather than getting treatments like surgery and radiation. And they will have an ongoing conversation with their doctor about how to manage the disease.

“This study should actually encourage more folks to be screened,” Dr. Dahut said. “These days, you have a lot more ability to make a more nuanced and thoughtful decision with your doctor about whether you will be treated or not for prostate cancer. Ultimately, what this means is, if you find the disease and you treat it appropriately, outcomes can actually be impacted in a significant and positive way.”

Not every prostate cancer is the same. That’s why serious consultation with an oncologist is critical… but that’s not even possible if we don’t know the cancer is there. This analysis of the data tells us that our tools of detection are excellent!

Men, if you’re 50 or older (45 if you’re at high risk), go get tested! It’s a simple blood test and more accurate than we’d previously realized!

Sources:

https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200031
https://www.cdc.gov/cancer/prostate/basic_info/screening
https://ascopubs.org/doi/full/10.14694/EdBook_AM.2012.32.98
https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html
https://www.cancer.gov/news-events/cancer-currents-blog/2019/prostate-cancer-death-disparities-black-men

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