Westminster Prostate Care

The Oct. 22 Another Voice by University of Minnesota professor Gary
Schwitzer criticized Roswell Park's prostate cancer awareness campaign for
saying too little about the controversy about PSA as a screening test.
Roswell Park developed the PSA test for prostate cancer early detection and
management. PSA has revolutionized the ability to monitor prostate cancer,
but the test has many advantages and limitations when used for early
detection. Our researchers are working to improve the PSA test to
distinguish prostate cancers that are potentially aggressive and
life-threatening from those that are clinically insignificant.

I am enmeshed in the ongoing and appropriate debate about PSA and prostate
cancer; I chair the National Comprehensive Cancer Network's Prostate Cancer
Treatment Guidelines Committee and sit on the Network's Prostate Cancer
Early Detection Guidelines Committee. Network guidelines (available at
www.NCCN.org ) are the most widely used standards for cancer care. These
guidelines are updated at least annually and provide patients access to
recommendations by panels of experts that include patient advocates,
population scientists, urologists, radiation oncologists and medical
oncologists.

I concur with Schwitzer that PSA should not be used as a screening test. We
should use PSA, and it performs best if used, for early detection of
prostate cancer in men likely to die from an undiagnosed prostate cancer.

For example, if you're young and at high risk because you're African
American or have a father or brother with the disease, do not await more
large studies. If you're older, low risk and have a normal PSA, stop getting
the test when life expectancy falls to 10 years or less.

I believe younger and healthier men benefit from having prostate cancer
diagnosed when curable so they may evaluate all options for treatment
including active surveillance. We need not return to the pre-PSA era when
most men's prostate cancers were found when they were incurable.

Men with newly diagnosed prostate cancer who come to Roswell Park are
counseled:

1. Don't panic. Prostate cancer grows slowly and is usually highly curable.

2. Don't rush into decisions. Every man and every cancer is different.

3. Get a third or fourth opinion if necessary to arrive at a decision that
makes you feel good.

Roswell Park also established a High Risk Prostate Cancer Clinic for men who
have an elevated PSA and would like a Roswell Park expert to evaluate their
results and recommend steps. Most importantly, two-thirds of men with
elevated PSA values do not have cancer. Sometimes another biopsy may be
necessary but often a simple repeat PSA, elimination of non-cancer
conditions that cause PSA elevations or careful discussion of risks and
benefits obviate the need for more biopsies.

James L. Mohler, M. D., is associate director for Translational Research;
chairman, Department of Urology; and professor of Oncology, Roswell Park
Cancer Institute.

http://www.buffalonews.com/149/story/843252.html

In addition read the blog discussion about Rosewell Park's awareness
campaign

http://prostatecancerinfolink.net/2009/10/19/medpage-slams-roswell-park-canc
er-institute And get a link to Gary Schwitzer's original public comments.

Do you think that this is the future of criticism of awareness programs?
Have we refined our message based on current evidence or does it need to be
refined?

Kathy