Dr. Lau on Controversies Surrounding Prostate Cancer Screening

Clayton S. Lau, MD, director, Urologic Oncology, director, Robotic Surgery, Prostate Cancer Surgery, interim chair of Urology, City of Hope, discusses the controversies surrounding prostate cancer screening. Lau spoke on this in an interview during the 2016 OncLive State of the Science Summit on GU Cancer.

Today, prostate cancer is one of the most commonly diagnosed cancers, according to Lau, adding that it is the most common solid malignancy among men. Statistics show that 1 in 6 men are diagnosed with prostate cancer. During the State of the Science Summit, Lau also educated attendees on more information about prostate cancer itself, as well as the evaluation and treatment of it.

There has been quite a bit of controversy about prostate cancer, especially with screening, he adds. There are recent studies that have been published, as well as a new guideline on screening, to help guide physicians with treatment decisions. The controversy, however, surrounds prostate-specific antigen (PSA), which is a biomarker that, in more cases than not, detects early-stage prostate cancer.

However, the problem with PSA-based screening is that it can be associated with overtreatment of prostate cancer, especially in low-grade, low-volume, or indolent disease. This overtreatment can also create a negative impact on quality of life, as many patients are likely unnecessarily treated. Therefore, even though the oncology community did see a decrease in cancer-related deaths with PSA-based screening, there was also an increase in costs and in patients who have treatment-related side effects.

In the landmark Prostate, Lung, Colorectal, and Ovary (PLCO) screening trial, results showed that 80% of the control group reported at least 1 PSA test during the trial. Additionally, more than half had PSA assessments within the year prior to enrollment, and 70% reported having a PSA test in the 2 years prior to joining the control group of the trial. A high rate of PSA testing in the control arm suggests that meaningful comparisons with the intervention group could be impossible, according to the new analysis of the PLCO data.

Now, patients with low-grade prostate cancer can often be monitored with active surveillance versus active treatment.