Even as the appropriateness of routine prostate-specific antigen-based (PSA-based) screening is being called into question by some experts, a significant proportion of patients and physicians reportedly remain loyal to this and other controversial cancer screening protocols. Meanwhile, for men who -- through whatever means -- are diagnosed as having early-stage, low-risk prostate cancer, investigators are looking to identify the best management strategies.
According to a recent study(archinte.ama-assn.org) in the Annals of Internal Medicine, "a high percentage of older adults continue to be screened in the face of ambiguity of recommendations" for prostate and other types of cancer. Such screening practices fly in the face of evidence-based clinical guidelines developed by the U.S. Preventive Services Task Force (USPSTF) and the AAFP, although other groups differ in their views on screening.
"Despite USPSTF guidelines recommending against routine screening for breast, cervical, colorectal and prostate cancer at the age of 75 years (65 years for cervical cancer), over 50 percent of physicians are continuing to recommend these screening tests in older men and women," the researchers noted. "Interestingly, these high recommendation rates continue in the group 80 years or older for colorectal (54 percent), breast (50 percent) and prostate (53 percent)."
- A recent study found that older patients, including men ages 75 and older, continue to receive prostate-specific antigen-based and other cancer screenings at a high rate, regardless of evidence-based clinical guideline recommendations to the contrary.
- Meanwhile, a panel convened by the Agency for Healthcare Research and Quality examined the role of active surveillance in men with low-risk prostate cancer.
- The panel concluded that no clear standard exists regarding which monitoring strategies are most likely to optimize patient outcomes and recommended further research to determine the best protocols for managing low-risk disease.
The authors of the study, which was based on results from the National Health Interview Surveys for 2005 and 2008, also indicated that patients' recollection of having received a physician recommendation for screening was a significant predictor of screening behavior.
"This finding reinforces the critical role for health care providers to make informed screening decision(s) for older adults," said the authors.
Meanwhile, a new evidence report(effectivehealthcare.ahrq.gov) from the Agency for Healthcare Research and Quality (AHRQ) examines the role of active surveillance in men with low-risk prostate cancer.
According to Patricia Ganz, M.D., who chaired the panel that produced the report, prostate cancer affects some 30 percent to 40 percent of men older than 50.
"Some of these men will benefit from immediate treatment, others will benefit from observation," she said in an NIH news release(www.nih.gov). The problem panel members identified, however, is that no clear standard exists regarding which monitoring strategies are most likely to optimize patient outcomes.
The two alternatives to immediate treatment -- active surveillance and watchful waiting -- differ in that the former observes with an intent to cure, a process that involves proactive patient follow-up in which blood samples, digital rectal exams and repeat prostate biopsies are conducted on a regular schedule, and curative treatment is initiated if the cancer progresses. Watchful waiting, on the other hand, is more passive and seeks to alleviate symptoms only if they develop.
"It's clear that many men would benefit from delaying treatment, but there is no consensus on what constitutes observational strategies and what criteria should be used to determine when treatment might ultimately be needed among closely monitored men," said Ganz. "We need to standardize definitions, group patients by their risks, and conduct additional research to determine the best protocols for managing low-risk disease."
In addition, the panel recommended, strong consideration should be given to removing "the anxiety-provoking term 'cancer'" for this condition because of the favorable prognosis that often accompanies low-risk prostate cancer.