The Pennsylvania General Assembly passed Act 66 of 2015 and created the Prostate Cancer Task Force (PCTF) to assess the impact of prostate cancer – the most common cancer diagnosed among Pennsylvania men and the third most common cause of cancer-related death among the state’s male residents. The 15-member task force was charged with searching for actionable ideas to improve care and research in the state.
For more than a year, the PCTF has been collaborating on an extensive report that was recently published by the Pennsylvania Department of Health. As a urologist at UPMC, I was asked to chair the screening and treatment sections of the report.
If you are looking for a topic that will immediately polarize medical professionals, bring up prostate cancer screenings and treatment methods. Prepare yourself for the fisticuffs. Some doctors champion early screening with lab tests (PSA testing), while others decry PSA testing as an unnecessary and potentially harmful expense. Eliciting nuance between the two views is often hard to find.
Large published studies in 2008 cast serious concern over the utility of early screening for prostate cancer. Then in 2012, the U.S. Preventative Task Force recommended against PSA screenings for prostate cancer. As a result, the diagnosis of prostate cancer in the Commonwealth has plummeted. The small rise in prostate cancer metastases also is a real potential concern if this trend continues.
The PCTF explored the impact – both positive and negative – of this change in rates of diagnosis and formed some important recommendations.
- First, the PCTF supports PSA screenings of healthy men 50 to 70 years old in the context of informed consent with their physicians.
- Second, the task force emphasizes the role of non-treatment (or active surveillance) of low-risk prostate cancer. This might be the most salient point developed in the report. The urging of the PCTF for patients with low-risk prostate cancer to not seek active treatment is critical, and challenging. Important advice about the exciting new role of multi-parametric MRIs was cited, making active surveillance more palatable and a completely safe option.
Other important recommendations abound, including augmenting the collection of cancer data, teaching people about the concept of survivorship, requiring insurance carriers to pay for PSA testing and post-treatment conditions, and promoting public funding for prostate cancer initiatives.
Of course, the power of the report is in the follow-up. To that end, the PCTF set up reporting and funding goals that will hopefully bring some muscle and action to its thoughtful message..
Dr. Benjamin Davies is an associate professor of urology at the University of Pittsburgh School of Medicine and chief of urology at UPMC Shadyside.