To quest and test (or not to quest at all)

On The New York Times‘s “Well” blog site today. Dr. Barak Gaster takes on the complex issue of how doctors need to get better at talking to patients about the pros and cons of PSA testing. And there very definitely are pros and cons! I kid you not.

ERSPC mortality data at 13 years of follow-up published

The Lancet has just published previously reported data from the European Randomized Study of Screening for Prostate Cancer (the ERSPC trial) at 13 years of follow-up. These data were first reported earlier this year at the annual meeting of the EAU, and we commented then on the significance of these data. … READ MORE …

One size doesn’t fit all when it comes to prostate cancer risk assessment

A newly published article in the journal Cancer is probably going to drive a number of readers of this blog to distraction — and for any number of good reasons, starting with the idea that all prostate cancer screening either should be or might be discontinued (as suggested by the USPSTF). … READ MORE …

USPSTF on PSA screening … a current update …

The U.S. Preventive Services Task Force (USPSTF) has just issued its “Guide to Clinical Preventive Services” for 2014. The publication (which is available on line) includes summary information about screening for prostate cancer. … READ MORE …

Maybe this time … a real answer to the value of PSA screening?

We have frequently referred to an ongoing trial in the UK known as the ProtecT trial. That trial is comparing the effectiveness and safety of surgery, radiation therapy, active surveillance as treatments for well-characterized men diagnosed with localized prostate cancer … but there is something else important we hadn’t realized … … READ MORE …

“A plea for individualized prostate cancer screening”

For some years, Vickers, Lilja, and their associates have been arguing that baseline PSA level is able to predict long-term risk for prostate cancer, and now a new paper in European Urology seems to provide support for this argument and a practical clinical strategy for its application. … READ MORE …

Old and newer tests and risks for prostate cancer; can you avoid inappropriate biopsy?

We now have five approved tests that can (at least in theory) help a man — and his doctors — to decide whether he is at sufficient risk for clinically significant prostate cancer that he should go get a biopsy. But how good are they really? … READ MORE …

Shared and emotion-free decision-making with respect to PSA-based screening

The following is (slightly edited) report by Jeffrey J. Tomaszewski, MD, on behalf of UroToday.com, of a state-of-the-art lecture by David Penson, MD, presented at the annual meeting of the American Urological Association (AUA) in Orlando. We hope that UroToday will forgive us for this direct “theft”, but the topic is one of enormous relevance to the patient community. … READ MORE …

Evaluation of the real utility of new biomarkers for prostate cancer risk

There is a fascinating comment by Kattan scheduled for publication in a forthcoming issue of the new journal Urology Practice. It makes a truly critical point about whether any of the new biomarkers are actually adding significantly to what we know about how to assess risk for prostate cancer. … READ MORE …

New NCCN guidelines on prostate cancer are not an all-around success!

Alas, the latest revisions to the National Comprehensive Cancer Network (NCCN) guidelines on early detection of prostate cancer seem to have instigated more furore than they have clarity (although the original premise behind them may have been well intentioned). … READ MORE …

“Five golden rules” for prostate cancer screening and treatment today

In a very simple and straightforward article in European Urology, Vickers et al. have clearly laid out a series of five “golden rules” that, in their opinion, all physicians should be following today when they are testing men for risk of prostate cancer through the use of the PSA test. … READ MORE …

New prostate cancer “vaccine” in Phase II trial prior to ADT

According to a media release we saw this morning, a company called Madison Vaccines has started a Phase II clinical trial of a new form of immunotherapy for treatment of men with non-metastatic prostate cancer and rising PSA levels prior to any treatment with androgen deprivation therapy (ADT). … READ MORE …

Criteria for active surveillance are gradually improving

Being diagnosed with low-risk prostate cancer is a good reason to consider management under active surveillance (as opposed to immediate, early intervention) … but active surveillance won’t be right for every low-risk patient! … READ MORE …

Poor guidance from the AAFP, badly interpreted by the media

According to a recent recommendation from the American Academy of Family Physicians in association with the Choosing Wisely campaign. primary care physicians are being advised as follows: … READ MORE …

New prospective study supports baseline PSA testing for men in 40s

According to a newly published, prospective study in the Journal of Urology, a research team at the Mayo Clinic has confirmed prior reports (based on retrospective data) that a baseline PSA in men aged between 40 and 49 years can be used to categorize men into low and higher prostate cancer risk groups. … READ MORE …

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