September is Prostate Cancer Awareness Month.
What a year it has been. Several studies have impacted our current management and trends in evaluation and treatment of prostate cancer (CAP) this year. The use of PSA for screening has come under scrutiny by the US Preventative Health task Force (USPSTF) which caused a rift in the medical and urologic community. The concern that screening does more harm than good was put forth, and myself and urologic and oncologic colleagues have challenged this conclusion with facts that support PSA screening in men of good health from several reputable studies. Basically, PSA is a good but not perfect test, and it is helpful as a diagnostic test, but a change in the treatment discussions are needed and have already changed the playing field. More Active Surveillance (AS) for appropriate low risk tumors is where we are headed. Surgery and radiation techniques and outcomes have also improved in the last 10 years, and as a result, a reduction in prostate cancer specific mortality can be attributed PSA use, treatment improvements, and patient selection factors. We should not discard PSA testing because there is a risk of treatment complication. A return to increased prostate cancer deaths would certainly result, which would be a large step backwards for our patients.
Know your Stats. The American Urologic Association (AUA), of which I a m a member, and the NFL have continued to support prostate cancer screening for men all over the country in the month of September. A focus on higher risk groups, including men of African American descent, and those with a family history, have brought PSA screening to the forefront nationally. We need to do more to get exam and PSA testing to all men at risk, while thinking about evaluating men over 75 years of age, where the benefits of screening are less. “Prostate cancer can affect any of the men in our lives – our fathers, grandfathers, husbands, brothers, uncles, sons, friends and neighbors – but with early detection this disease is almost always curable,” said Dr. Deepak A. Kapoor, president of the Large Urology Group Practice Association and president of Advanced Urology Centers of New York. Men need to be aware in our community and come forward.
Know your Options. At Virginia Urology, we pride ourselves on offering the latest options on prostate cancer treatment options. Robotic prostatectomy has been with us for several years, and more than 10 of our physicians do this innovative procedure. Radiation therapy with IMRT and various seed implant options also bring our collaborative physicians to the forefront of prostate cancer care in Richmond. Clinical trials including HIFU and medical treatments of advanced prostate cancer have also demonstrated our commitment to innovation in prostate cancer management, which will continue as treatments evolve over the next few years. We are at a crossroads in the care of our patients, and the options that we as a group provide, do matter in the Richmond arena and beyond.
To summarize, PSA screening use is controversial, but we feel that data supports the diagnostic utility of PSA for significant prostate cancer detection which saves lives. Public awareness of PSA and prostate cancer health is relevant. Just as important, a thoughtful discourse about the treatment options from our excellent staff of MD’s will keep Virginia Urology in the prostate cancer arena in the Central Virginia region.