Does Early Prostate Screening Translate into Lives Saved?

March 1, 2012

When it comes to delivering health information to patients, how it is delivered is just as important as when is it delivered. And when it comes to prostate cancer, no one knows this better than Georgetown Lombardi’s Kathryn L. Taylor, PhD, associate professor of oncology.

Trained as a clinical psychologist, Taylor and her team develop culturally-appropriate printed materials and web-based education modules to assist men with informed decision-making with regard to prostate cancer screening. By studying the effects of health information delivery methods and timing, they hope to determine whether there are any significant differences
in the choices that men make with regard to prostate screening and treatment.

“A lot of men will make a screening decision, and then if they’re diagnosed
then they will make a treatment decision,” says Taylor. “One of the things we are trying to do is have men see this as a continuum and not two separate events. If men decide to get screened then they also need to understand the events that may occur if there is an abnormal screening result.”

These events may include a biopsy and, depending on the biopsy results, will entail decisions about treatment—including understanding the risk for various side effects.

Prostate cancer is the leading cancer diagnosis among men and the second leading cause of male cancer death. However, there is not yet definitive evidence that regular prostate screening translates into reduced disease-related mortality. The absence of definitive randomized trial evidence in the U.S. has spurred debate among prostate specialists regarding the overall benefits of prostate screening.

“It is important to note that the prostate cancer screening debate refers to the question of whether to screen healthy populations of men. The issue is that when there is an abnormal screening test, we can’t always predict which cancers may grow slowly, and which require more aggressive treatment that can cause long-term side effects,” says Taylor.

Making sense of the guidelines

In 2010, the American Cancer Society (ACS) amended its recommendations with regard to prostate screening, advising that men make informed decisions about screening with their doctors based on their
individual risk levels, rather than automatically undergoing regular annual screening.

“In the U.S., most men have been screened at least once and 50 percent
of men are screened annually, which up until recently was the ACS’s recommendation,” says Taylor. “What men also need to understand before screening is that we don’t know whether one treatment for prostate cancer is better than another with regard to mortality reduction and that they all result in a significant amount of dysfunction.”

In addition to studying the effects of prostate screening and treatment information prior to decision-making for screening, Taylor is also conducting a sub-study for the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), a randomized trial that evaluates whether
regular screening for these four cancers will reduce disease-related mortality.

In their PLCO sub-study, Taylor and her group are assessing the effects of prostate cancer on men’s long-term quality of life. They conducted a case-control study that included a group of 529 men who were diagnosed as a result of that screening as well as a group of 514 men who were not diagnosed as a result of that same screening.

Five to 10 years after diagnosis, researchers interviewed both groups of men
to determine their general quality of life and their sexual, bowel and urinary symptoms. Through this analysis, researchers hope to better understand the differencesin long-term quality of life for men who have been treated for prostate cancer versus men without cancer.

One treatment option for men with ‘low-risk’ prostate cancer is called active
surveillance, in which the cancer is closely followed and only actively treated if there are signs of progression.

“We are interested in studying whether men feel it is worth avoiding treatment
side effects if they are also anxious about living with untreated cancer. On the other hand, is it worth undergoing impotence or other treatment side effects when you could have potentially avoided that?”