Prostate cancer screening: the ongoing debate

bloodcellsSince its adoption by the FDA in 1994, the prostate-specific antigen (PSA) test has reduced prostate cancer mortality rates by 39 percent. Despite the lives saved, whether or how the PSA test should be used for screening is at the center of an ongoing debate.

In 2012, the U.S. Preventative Services Task Force (USPSTF) recommended against the use of PSA-based screening after new studies showed that the test led to overdiagnosis and overtreatment. In 2013, the American Urological Association changed its guidelines to recommend against screening for men under the age of 55 who are at average risk of prostate cancer and for men over the age of 70 who have a life expectancy of less than 10 to 15 years. The American Cancer Society recommends that men make an informed decision with their health care provider about prostate cancer screening; it does not take a stance for or against PSA testing. The National Cancer Institute makes no formal recommendation, but presents information on its website helpful for decision making.

Is the PSA test right for you? The answer to this question varies person to person, so I recommend that you talk to your doctor about your individual risk and educate yourself about the pros and cons of testing.

Here are a few important questions to ask your doctor:

What is my risk of developing prostate cancer?
Common risk factors include: age, race/ethnicity, nationality, family history of prostate cancer, genetics, diet and smoking.

Is PSA testing appropriate for me and if so, when should I begin testing?
Your doctor may or may not recommend testing, but if you are at high risk, he/she may advise testing at a younger age.

What is the purpose of a PSA test and how is it done?
A PSA test measures the level of PSA, a protein that is produced by the prostate gland, in a man’s blood. The higher your PSA level, the more likely it is that you have prostate cancer. The test requires a blood sample that is sent to a laboratory for analysis.

What are common side effects or risks of PSA testing?
The PSA test itself doesn’t have side effects, but overdiagnosis and overtreatment are the risks that have caused the screening debate. Some tumors found through PSA testing grow so slowly that they are unlikely to threaten a man’s life. Detecting non-life-threatening tumors is called overdiagnosis, and treating those tumors is called overtreatment. Overdiagnosis and eventual overtreatment, with procedures such as biopsies, radiation and hormone therapy, can lead to unnecessary complications such as urinary incontinence, problems with bowel function, erectile dysfunction and infection. Also, one of the greatest “risks” for patients who have a high PSA test is their tendency to panic after they hear the word “cancer” and to seek aggressive treatment whether or not it’s warranted, so it is important to thoroughly consider all of your options before taking action.

As with any test, there are both benefits and harms of prostate cancer screening. An important benefit of testing includes catching the cancer before it metastasizes (grows) or becomes life-threatening.

By identifying the cancer early, less-aggressive treatment is needed and outcomes are generally better. By discussing the test with your doctor, you will know more about your options and will be less likely to make hasty decisions out of fear. I also recommend receiving a second opinion from another physician before making any decisions about treatment.

About the author
Paul G. Goetowski, M.D. (known as “Dr. G.”), is assistant professor at VCU Massey Cancer Center and the director of radiation oncology at Community Memorial Healthcenter (CMH) Cancer and Specialty Care on behalf of Massey. He has extensive experience in using radiation to treat many cancer types and noncancerous diseases.

Cancer resources now more easily accessible in Southern Virginia

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Resources and programs for the cancer community are now easier to find and access in Southern Virginia thanks to the new Cancer Resource Center of Southern Virginia (Resource Center) in Lawrenceville, which opened on May 6.

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The purpose of the Resource Center is to facilitate the availability of local, state and national cancer programs and resources to individuals living within the southern regions of the state. It will identify the specific needs and services that are of the greatest help to area residents affected by cancer through the guidance of a Cancer Task Force that it plans to develop with local cancer care providers, cancer community organizations, health district leaders and Saint Paul’s College – all in partnership with Virginia Commonwealth University Massey Cancer Center (VCU Massey).

SignThe Resource Center is supported by VCU Massey, in part through a grant from the Virginia Tobacco Indemnification and Community Revitalization Commission. Saint Paul’s College provided the physical space, housing the Resource Center in its Russell Memorial Library.

The Resource Center will act as an aggregator of cancer information for directing individuals living in southern Virginia to community cancer resources, such as identifying transportation to treatments and doctors’ appointments, financial assistance programs and help for the uninsured. It will also manage an online calendar of regional cancer events and plan cancer-related programs and activities for the community. In addition, the Resource Center will provide disease-related, site-specific education packets to cancer patients through the Cancer Task Force and local oncology practices.

OfficeThe Resource Center represents VCU Massey’s latest community outreach efforts in the Southern Virginia area. “As Virginia’s leading cancer resource, VCU Massey Cancer Center is committed to providing comprehensive cancer services to Southern Virginia in partnership with existing cancer resources and with input from the community,” says Mary Ann Hager, associate director for clinical services at VCU Massey Cancer Center.

Conference_RoomVCU Massey has long been involved in this community, providing medical oncology care in Emporia since 1988 in partnership with the Southern Virginia Regional Medical Center, as well as in South Hill since last year in partnership with Community Memorial Healthcenter (CMH). At CMH, VCU Massey will be opening the area’s first and only radiation treatment center this summer.

VCU Massey has also been leading various community outreach initiatives in the area for several years, and the Resource Center will operate in collaboration with these initiatives. For example, in partnership with VCU Massey’s Health Information & Advocacy @ Your Library (HIA) program available at library branches in Emporia, Lawrenceville, Blackstone, Crewe and Burkeville, the Resource Center will offer the public accurate, reliable and current information related to cancer prevention, detection, treatment and survivorship. It will also work in concert with VCU Massey-led efforts aimed at educating the community about the value of clinical trials research and with cancer prevention and control research studies being conducted by VCU Massey locally.

The Resource Center supports the findings of cancer needs assessments conducted in the Crater and Piedmont health districts by VCU Massey. Another assessment is currently being conducted in the Southside health district.

“Cancer patients, survivors and their loved ones are often burdened physically, mentally and economically by cancer. There are varied sources of support to help lift the burden, but they are not all easily made known,” said Hager. “Our goal in establishing the Cancer Resource Center of Southern Virginia in Lawrenceville is to serve as the connection between these helpful resources and those who need them. Many of these support services can have a positive impact on someone facing cancer.”

Dr. John R. Jones, vice president for student affairs at Saint Paul’s College, said: “The Loulie Taylor Fletcher Memorial Hospital was erected on the campus of Saint Paul’s College in 1926 to serve the health needs of the students and the community at large. Saint Paul’s College is pleased to partner with VCU Massey Cancer Center on the Cancer Resource Center of Southern Virginia. This partnership represents another major commitment to our students and community in continuing to address their health concerns and needs.”

The Resource Center is open every weekday, 11 a.m. to 2 p.m., and is also available by appointment by calling Vivian Taylor at (434) 848-6402. The reading room at the Resource Center, which offers general cancer information, is open every weekday, 9 am – 5 pm. The Resource Center is located on the lower level of the Russell Memorial Library, Saint Paul’s College, 115 College Drive, Lawrenceville, Virginia 23868.