Is It Time To Rethink Psa Tests For Prostate Cancer

All of them were diagnosed with prostate cancer and shared their experience about the disease.
If you have been diagnosed with prostate cancer or if you are living with the side effects of prostate cancer treatment, you are not alone. Many men around the world are diagnosed with this common cancer, which affects about one in nine men. Prostate cancer is the most common non-skin cancer diagnosed in men and the second leading cause of cancer death in men, after lung cancer, with more than 1.4 million men diagnosed annually worldwide. However, is this a real disease that will eventually find someone who will live several years? Or are we just testing too many men without any real need? Screening for prostate cancer has long been a contentious issue in the debate. Should healthy men, without symptoms or a family history of prostate cancer, undergo prostate-specific antigen (PSA) testing and treatment if a tumor is found? For more than 30 years, the PSA test has been the gold standard in prostate cancer screening. This simple, widely available blood test measures how much prostate-specific antigen is present in the blood. The PSA test can detect fast-growing cancers that can spread to other parts of the body and would benefit from treatment. It can also find slow-growing cancers that are unlikely to be harmful. Some people with no symptoms of prostate cancer choose to have regular PSA tests. But PSA tests aren’t perfect. PSA levels can be elevated when cancer is not present and not elevated when cancer is present. Proponents of the routine PSA test say it is the best screening tool for detecting prostate cancer early when it is most treatable. But there are those who argue that it prompts many newly diagnosed men to seek invasive treatments that can cause many side effects, including incontinence and impotence, although up to 80% have low-risk tumors that will never be life-threatening. For them, the best option is active surveillance and watchful waiting, where doctors watch patients closely for signs that their cancer is progressing before they treat it. In active surveillance, regular monitoring may include blood tests, rectal exams, and prostate biopsies to monitor cancer progression. Cancer treatment, such as surgery or radiation, may be recommended if tests show the cancer is progressing. Official clinical guidelines for prostate cancer screening and treatment, from the various relevant clinical societies, shift back and forth, adding fuel to this debate. In the early 2000s, after two large meta-analysis studies (the European ERSPC and the US PLCO), the US Preventive Services Task Force (USPSTF) published guidelines against routine PSA testing. However, due to revisions of the leading studies and new data being published, the USPSTF removed this recommendation in 2018, while the parallel Canadian task force, for example, maintained its objection.
Similar to the world, prostate cancer is the third most common cancer disease in Israel and the most common cancer among men in Israel. In 2018, 2,713 Israeli men were diagnosed with prostate cancer and approximately 416 died from the disease. 30,278 men diagnosed with prostate cancer since 1990 live in Israel today, 10,057 of whom were diagnosed in the last five years. In international comparison, in 2020, Israel was ranked 58th in morbidity and 143rd in mortality. This huge difference between the morbidity and mortality factors and the high survival rate of 97%, may indicate that in Israel there is also a trend of over-screening. The size of the global prostate cancer treatment market is determined by the increasing number of prostate cancer numbers. The global market was valued at USD 24.9 billion in 2021 and is projected to cross USD 24.9 billion by 2030. The growth of the market can be attributed to the increasing cases of prostate cancer. Rapid technological advances in the field of oncology have led to early diagnosis of prostate cancer among patients. This factor is likely to serve as the key factor in stimulating remarkable growth opportunities in the market. There has also been a significant increase in private and public sector investment both in Israel and globally. I believe that each person needs an individualized, patient-centered approach to screening and treatment that is not addressed by one-size-fits-all screening guidelines. The treating physician should determine what is best for the patient based on the patient’s unique age, family history, health, lifestyle, race, ethnic background, and other factors. If indeed the patient has medium or high-risk cancer, early diagnosis may benefit him. Up to 35% of patients undergoing prostate radiation therapy will experience radiation side effects of rectal toxicity, such as rectal pain and bleeding, chronic diarrhea, urinary urgency & incontinence, cystitis, proctitis, and erectile dysfunction. For some of them, the side effects will be chronic and greatly affect their quality of life. Itay Barnea is the CEO of BioProtect, which produces biodegradable balloons for safe radiation therapy, and an Almeda Ventures portfolio company.

title: “Is It Time To Rethink Psa Tests For Prostate Cancer Klmat” ShowToc: true date: “2022-12-13” author: “Morris Smith”

All of them were diagnosed with prostate cancer and shared their experience about the disease.
If you have been diagnosed with prostate cancer or if you are living with the side effects of prostate cancer treatment, you are not alone. Many men around the world are diagnosed with this common cancer, which affects about one in nine men. Prostate cancer is the most common non-skin cancer diagnosed in men and the second leading cause of cancer death in men, after lung cancer, with more than 1.4 million men diagnosed annually worldwide. However, is this a real disease that will eventually find someone who will live several years? Or are we just testing too many men without any real need? Screening for prostate cancer has long been a contentious issue in the debate. Should healthy men, without symptoms or a family history of prostate cancer, undergo prostate-specific antigen (PSA) testing and treatment if a tumor is found? For more than 30 years, the PSA test has been the gold standard in prostate cancer screening. This simple, widely available blood test measures how much prostate-specific antigen is present in the blood. The PSA test can detect fast-growing cancers that can spread to other parts of the body and would benefit from treatment. It can also find slow-growing cancers that are unlikely to be harmful. Some people with no symptoms of prostate cancer choose to have regular PSA tests. But PSA tests aren’t perfect. PSA levels can be elevated when cancer is not present and not elevated when cancer is present. Proponents of the routine PSA test say it is the best screening tool for detecting prostate cancer early when it is most treatable. But there are those who argue that it prompts many newly diagnosed men to seek invasive treatments that can cause many side effects, including incontinence and impotence, although up to 80% have low-risk tumors that will never be life-threatening. For them, the best option is active surveillance and watchful waiting, where doctors watch patients closely for signs that their cancer is progressing before they treat it. In active surveillance, regular monitoring may include blood tests, rectal exams, and prostate biopsies to monitor cancer progression. Cancer treatment, such as surgery or radiation, may be recommended if tests show the cancer is progressing. Official clinical guidelines for prostate cancer screening and treatment, from the various relevant clinical societies, shift back and forth, adding fuel to this debate. In the early 2000s, after two large meta-analysis studies (the European ERSPC and the US PLCO), the US Preventive Services Task Force (USPSTF) published guidelines against routine PSA testing. However, due to revisions of the leading studies and new data being published, the USPSTF removed this recommendation in 2018, while the parallel Canadian task force, for example, maintained its objection.
Similar to the world, prostate cancer is the third most common cancer disease in Israel and the most common cancer among men in Israel. In 2018, 2,713 Israeli men were diagnosed with prostate cancer and approximately 416 died from the disease. 30,278 men diagnosed with prostate cancer since 1990 live in Israel today, 10,057 of whom were diagnosed in the last five years. In international comparison, in 2020, Israel was ranked 58th in morbidity and 143rd in mortality. This huge difference between the morbidity and mortality factors and the high survival rate of 97%, may indicate that in Israel there is also a trend of over-screening. The size of the global prostate cancer treatment market is determined by the increasing number of prostate cancer numbers. The global market was valued at USD 24.9 billion in 2021 and is projected to cross USD 24.9 billion by 2030. The growth of the market can be attributed to the increasing cases of prostate cancer. Rapid technological advances in the field of oncology have led to early diagnosis of prostate cancer among patients. This factor is likely to serve as the key factor in stimulating remarkable growth opportunities in the market. There has also been a significant increase in private and public sector investment both in Israel and globally. I believe that each person needs an individualized, patient-centered approach to screening and treatment that is not addressed by one-size-fits-all screening guidelines. The treating physician should determine what is best for the patient based on the patient’s unique age, family history, health, lifestyle, race, ethnic background, and other factors. If indeed the patient has medium or high-risk cancer, early diagnosis may benefit him. Up to 35% of patients undergoing prostate radiation therapy will experience radiation side effects of rectal toxicity, such as rectal pain and bleeding, chronic diarrhea, urinary urgency & incontinence, cystitis, proctitis, and erectile dysfunction. For some of them, the side effects will be chronic and greatly affect their quality of life. Itay Barnea is the CEO of BioProtect, which produces biodegradable balloons for safe radiation therapy, and an Almeda Ventures portfolio company.