The Importance of Prostate Cancer Screening

Prostate cancer screening with prostate-specific antigen (PSA) and digital rectal exams should be a shared decision beginning at age 45-55 years old and drugs such as apalutamide and enzalutamide therapy are effective at slowing the spread of the disease, according to research presented at the 2019 HOPA Annual Conference by Lisa M. Holle, PharmD, BCOP, FHOPA, an Associate Clinical Professor at UConn School of Pharmacy and an Associate Professor at UConn School of Medicine.

Each year, approximately 165,000 people will be diagnosed with prostate cancer, making it the second most common cause of cancer death among men, claiming the lives of approximately 29,430 patients in the US annually. The five-year life expectancy for prostate cancer is promising is the disease is localized (99%) but drops perceptibly if the cancer metastasizes (30%). Most people diagnosed with prostate cancer have an elevated or increased level of prostate-specific antigen (PSA). Although only 5% of patients present with metastatic prostate cancer, that number is increasing as PSA screening decreases.

For patients who have discussed the risks and benefits of prostate cancer screening with their physician and decides to undergo screening plus a digital rectal exam, the National Comprehensive Cancer Network (NCCN) guidelines supports that decision. However, they advocate screening in health individuals, and according to their guidelines “testing after 75 years of age should be done only in the very healthy men with little or no comorbidity (especially if they have never undergone PSA testing) to detect the small number of aggressive cancers that pose a significant risk if left undetected until signs or symptoms develop. Widespread screening in this population would substantially increase rates of over-detection and is not recommended.”

Prostate cancer may take the form of nonmetastatic hormone-refractory prostate cancer, now understood to be castration-resistant cancer (progression of the disease despite castration). In treating this form of cancer, studies suggest the use of the drugs apalutamide and enzalutamide can delay time to metastases. Moreover, for newly diagnosed prostate cancer patients with metastatic disease who are hormone sensitive, the use of docetaxel and abiraterone are effective, but should be based on both the disease characteristics as well as patient preferences.

Dr. Holle wrote in a presentation conclusion slide that “tumor or gene mutations are likely to drive treatment choices in the future, but routine use is currently limited to those with high microsatellite instability or deficient mismatch repair gene.”