When It Hurts to Say I Told You So: Advanced Prostate Cancer Cases on the Rise

emperorDiagnose a patient's prostate cancer in its earliest stages and you have a great chance of curing it. Starting in the early 1990's, that was the philosophy behind Prostate Specific Antigen (PSA) blood testing in men. It wasn't a perfect test, and many men with increased PSA proved not to have cancer when their prostates were biopsies. Some other men underwent heavy duty treatment such as prostatectomy or radiation for prostate cancers that were SO small and bland they probably would never have spread. Despite the drawbacks, the death rates from prostate cancer dropped in men who were being screened.

As I have written about before. some scientific panels, as well as CMS, the federal agency that oversees Medicare, took a dim view of PSA screening, and the number of men being screened decreased. Some men were never tested, others were still getting tested, but maybe a few years later or a little less frequently than they had been in the past. As a busy prostate pathologist this delay in testing worried me, and I never missed an opportunity to tell the men I knew to have PSA testing. I told women to nag the men they love. And I never failed to have my PSA tested as part of my annual physical

My worries soon began to become reality. My colleagues and I, examining biopsies under the microscope, began to see more cases of aggressive looking (higher Gleason Grade) prostate cancer than we had in years past.  This was what is called anecdotal findings; it was our impression, but we did not do a statistical study or a publish a peer reviewed scientific paper to state our claim and have it verified (or debunked) by other pathologists around the country.  But we wondered, was there a correlation between what we were seeing and the amount of spread of cancer in the men being diagnosed?

We now have the beginning of an answer. A study published this week from my alma mater, Northwestern University, confirms that a higher number of men are once again being diagnosed with advanced prostate cancer. By the time of diagnosis, their cancer has spread to bones or lung, making cure much more unlikely. The window of catching a small, treatable, tumor has passed. The authors do not claim this is entirely due to lack of PSA screening, but to quote the lead author, Dr. Edward Shaeffer, “If I were a patient, I would want to be vigilant. I firmly believe that PSA screening and rectal exams save lives.”

PSA isn't perfect. We hope someday to have a better test. And, very importantly, any man diagnosed with prostate cancer needs to have a long discussion with his urologist about the best way to manage his disease. But mammas, don't let your babies grow up to be victims. Tell them PSA's save lives.

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