Are prostate cancer cases actually on the rise?
Is it time to bring back prostate-specific antigen (PSA) screenings as a diagnostic tool for the disease?
Those questions are being debated once again after a study published last week reported significant increases in advanced prostate cancer treatments between 2004 and 2013.
The American Cancer Society and others criticized the numbers in the report.
However, some experts interviewed by Healthline said there is some legitimacy in bringing back the PSA screenings, especially with the newer diagnostic tools that have been introduced the past few years.
The U.S. Preventative Services Task Force (USPSTF) recommended against the screenings in 2012. However, the agency is in the midst of its scheduled five-year update on that recommendation.
How big an increase?
The researchers in last week’s study reported that advanced prostate cancer cases in the United States increased by 72 percent from 2004 to 2013.
The biggest increase, they reported, was in men ages 55 to 69. That age group showed a 92 percent jump.
One of the study’s co-authors, Dr. Edward Schaeffer, chairperson of urology at Northwestern University’s Feinberg School of Medicine, said the increase could be due to the disease becoming more aggressive and the decrease in PSA screenings.
Schaeffer added that since the advanced cancer cases started increasing before the 2012 USPSTF recommendation it was difficult to link the rise to the screenings.
Schaeffer did say he was a proponent of the PSA screenings.
A number of media outlets published the research findings, using words like “skyrocketing,” “soaring,” and “troubling new study” in their articles.
Many of the publications did not interview any experts outside the study for their perspective.
The critics respond
The American Cancer Society was one of the first critics to respond.
The organization posted a column on the organization’s website titled “When Skyrocketing Isn’t.”
In the column, Dr. Otis W. Brawley, the organization’s chief medical officer, said the researchers had made a “dramatic claim” that they can’t support.
Brawley noted the research was done by a group of urologists who used raw numbers instead of the more standard comparison of cases per 100,000 people.
Brawley said it’s possible that part of the reason the cases went up is because the population has increased and is aging.
He also chided the media for printing a “flawed analysis” without perspective.
“The issue of whether and how screening may affect deaths from prostate cancer in the U.S. is an incredibly important one,” said Brawley. “This study and its promotion get us no closer to the answer and, in fact, cloud the waters.”
Dr. Mark Scholz, the executive director of the Prostate Cancer Research Institute, agreed with Brawley’s opinion on the numbers.
He noted the advanced prostate cancer cases went from about 3 percent of the study group to about 5 percent. That adds up to a 72 percent increase, but it’s only a hike of 2 percentile points.
Schaeffer defended the research findings.
He told Healthline the limitations of the numbers were clearly noted in the study. He added there weren’t “per 100,000” figures available for the entire study period.
“It’s a limitation in the database,” he said.
Dr. Charles Ryan, an oncologist and professor of clinical medicine at the University of California, San Francisco, added there is a possibility that the prostate cancer case increase is tied to the decrease in PSA screenings.
However, he told Healthline more detailed research needs to be done before we jump to that conclusion.
“It’s something that we need to study more,” he said.
To screen or not to screen?
The experts interviewed by Healthline did say there is some merit in considering a return to PSA screenings.
The USPSTF recommended against the test in 2012 because many of the patients who got high numbers on the screenings underwent aggressive treatment even though many of them may not have needed it.
“It was decided the bad outweighed the good,” said Scholz.
Scholz said new technology has come out since the 2012 recommendation that makes follow-up diagnosis less painful and more accurate than the biopsies that are done with needles.
In particular, he noted multiparametric-magnetic resonance imaging (MRI), which he said can better pinpoint cancer growths and determine their seriousness.
“They redeem PSA screening,” he said.
“PSA screenings save lives,” he said.
Dr. Kristen Bibbins-Domingo, the chairperson of the USPSTF, said her agency has begun its scheduled 5-year review of PSA screenings.
She told Healthline the 2012 recommendation was based on the characteristics of the PSA screenings as well as some of the treatment afterward.
Since 2012, the diagnostic tools and available treatment for prostate cancer have improved, said Bibbins-Domingo, who is also the chairperson in medicine at the University of California, San Francisco.
Bibbins-Domingo and the other experts interviewed by Healthline also emphasized that lifestyle factors are an important preventative measure for prostate cancer.
They said the same measures recommended for a healthy heart are the same ones that can help prevent prostate cancer.
These include a well-balanced diet and exercise.
“There’s no magic to it other than that,” said Ryan.