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Expert Stresses Importance of PSA-Based Screening in Early-Stage Prostate Cancer

Gina Columbus
Published: Thursday, Jul 21, 2016

Scott Eggener, MD

Scott Eggener, MD

While the United States Preventative Services Task Force (USPSTF) has taken a stand against routine prostate-specific antigen (PSA) screening for prostate cancer, updated findings from the landmark Prostate, Lung, Colorectal, and Ovary (PLCO) screening trial could flip opinions, explains Scott Eggener, MD.

In the study, 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, which was reported at the 2016 American Urological Association Annual Meeting.

Controversy has surrounded PSA screening—although it has been linked to a significant decrease in mortality rates, it is also associated with overdiagnosis and overtreatment. Eggener discussed these issues in early-stage prostate cancer during the 2016 State of the Science Summit on GU and Prostate Cancer.

In an interview with OncLive during the meeting, Eggener, associate professor of Surgery, Urologic Oncology, at the University of Chicago Medicine, discusses the implications of the PLCO trial update, and shares his views on PSA-based screening and how to appropriately use it for patients with early-stage prostate cancer.

OncLive: What do oncologists need to know regarding the current landscape of early prostate cancer?

Eggener: Smart PSA-based screening can absolutely save lives. We have a problem with overdetection and overtreatment of men who are unlikely to benefit from it, so the gist of it is to identify men who have a reasonable life expectancy, are well informed, are interested in PSA screening, and can be biopsied appropriately.

However, many low-risk prostate cancers absolutely do not require treatment, and active surveillance has excellent long-term outcomes. Nevertheless, if they have an intermediate- or high-risk cancer and a reasonable life expectancy, treatment can save lives and is completely appropriate.

In addition to that, there are many novel screening biomarkers—tissue-based biomarkers with good science and data behind them, and there are advances. The upcoming—and current—challenge is how to integrate them appropriately into the standard care pathways, particularly given their typically excessive cost.

Can you shed light on some of those biomarkers?

In the screening setting, there are a lot of very strong data showing [the efficacy of] the 4Kscore, the Prostate Health Index, and the MiPS score. There’s a SelectMDx score that recently presented some data. After the diagnosis—once someone has a biopsy showing cancer—there are tissue-based biomarkers such as Prolaris, Oncotype DX, and GenomeDX.

There were some interesting findings recently presented on the PLCO trial. It seems to go against what the USPSTF was pushing for this whole time. Can you discuss that study and the findings?

It was really an ambitious, important, and landmark trial where the intent was terrific. It was in the United States. It took a large population of men and randomized them—where half of them got PSA screening, and half of them did not—and saw if screening for prostate cancer saves lives.

When the data were originally presented many years ago, it did not [indicate that screening] saves lives and everyone was taken aback. It has informed policy here and elsewhere really going against PSA screening. Well, it turns out—which has been known for a while but not to the extent as the recent data shows—90% of men in the control arm, meaning the men who were never supposed to get a PSA, either got a PSA before the trial or during the trial.

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