Today's fundamental challenge in Prostate cancer screening ...

September 2, 2012 by Dror Nir

Author: Dror Nir, PhD

The management of men with prostate cancer is becoming one of the most challenging public health issues in the Western world. It is characterized by: over-diagnosis; over-treatment; low treatment efficacy; treatment related toxicity; escalating cost; and unsustainability [Bangma et al, 2007; Esserman et al, 2009]. How come? Well, everyone accepts that most prostate cancers are clinically insignificant. It is well known that all men above 65 harbor some sort of prostate cancer. Due to the current aggressive PSA-based screening, one in six men will be diagnosed with prostate cancer. Yet, the lifetime risk of dying of prostate cancer is only 3%. The problem is that, once diagnosed with prostate cancer, there is no accurate tool to identify those men that will die of the disease (in my previous post I mentioned 1:37). Currently, screening practices for prostate cancer are relying on the very unspecific prostate-specific-antigen (PSA) bio-marker test to determine which men are at higher risk of harboring prostate cancer and therefore need a biopsy. The existing diagnostic test is a transrectal ultrasound (TRUS) guided prostate biopsy aimed at extracting representative tissue from areas where cancer usually resides. This procedure suffers from several obvious faults:

1. Since the imaging tool used (B-mode ultrasound) is poor?at detecting malignancies in the prostate, the probability of hitting a clinically significant cancer or missing a clinically insignificant cancer is subject to random error.

2. TRUS biopsy is also subjected to systematic error as it misses large parts of the prostate which might harbor cancer (e.g. apex and anterior zones). 3. TRUS guided biopsies are often unrepresentative of the true burden of cancer as either the volume or grade of cancer can be underestimated. In the last ten years I was leading the development of an innovative ultrasound-based technology, HistoScanningTM, aimed at improving the aforementioned faults;

Among the other most popular imaging modalities aimed?at better prostate cancer detection in routine use are: MRI,?Elastography, Contrast Enhanced Ultrasound etc?

In my future posts I will go into more detail on how these imaging modalities fit into routine workflow, how much they stay within budget constraints and what level of promise they bear for promoting personalized medicine. Stay tuned? Footnote: According to the final report by an advisory panel to the USA government: Doctors should no longer offer the PSA prostate cancer screening test to healthy men because they?re more likely to be harmed by the blood draw, and the chain of medical interventions that often follows than be helped;?(http://www.usatoday.com/news/health/story/2012-05-21/prostate-cancer-screening-test-harmful/55118036/1) But then; what should be offered instead?

Other posts on this Scientific Website addressing Prostate Cancer

Prostate Cancers Plunged After USPSTF Guidance, Will It Happen?Again?

http://pharmaceuticalintelligence.com/2012/07/31/prostate-cancers-plunged-after-uspstf-guidance-will-it-happen-again/

New Prostate Cancer Screening Guidelines Face a Tough Sell, Study?Suggests

http://pharmaceuticalintelligence.com/2012/05/27/new-prostate-cancer-screening-guidelines-face-a-tough-sell-study-suggests/

ROLE OF VIRAL INFECTION IN PROSTATE?CANCER

http://pharmaceuticalintelligence.com/2012/09/01/role-of-viral-infection-in-prostate-cancer/

Posted in Imaging-based Cancer Patient Management | Tagged biopsies, breast cancer, cancer, cancer grade, cancer management, Clinical trial, Conditions and Diseases, costs of procedure, environment, FDA, Food and Drug Administration, health, Health care, medicine, mortality, Mortality rate, National Institutes of Health, New England Journal of Medicine, over-treatment, Proceedings of the National Academy of Sciences of the United States of America, prostat cancer screening, PSA, research, science, screening, transrectal, TRUS, United States | 4 Comments

Source: http://pharmaceuticalintelligence.com/2012/09/02/todays-fundamental-challenge-in-prostate-cancer-screening-2/

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