Expert’s Corner: Mitchell Sokoloff, MD, recommends PSA screening
- Medical School
Prostate cancer continues to be the second most common cancer among men in the United States. The American Cancer Society estimates that approximately 221,000 new cases and 28,000 deaths will occur in 2015.
It also happens to be a disease about which there is a fair amount of controversy regarding screening.
The U.S. Preventive Services Task Force recommended against prostate-specific antigen (PSA)-based screening in 2012;
The American Cancer Society recommends that men be educated about “uncertainties, risks and potential benefits” of the screening and that the screening not be conducted until such conversations are had; and,
The America Urological Association offers several different guidelines and recommendations based upon health risk, age and race of patient and/or family history.
Mitchell Sokoloff, MD, chair and professor of urology, said he believes the U.S. Preventive Services Task Force recommendation against screening has “set the field back several years.”
“In that short period of time we’re now starting to see men with worse disease and less curable disease,” Dr. Sokoloff said. “So we, as urologists and as academicians, take a very, very strong stand on the importance of screening.”
Sokoloff’s concern is that with a decrease in screening there will be a subset of men overlooked who have an aggressive form of prostate cancer. He estimated that about 20 to 30 percent of men seen in his clinic with prostate cancer need treatment or they’ll die from the disease. For men who have family history and/or are of African-American decent, urologists generally recommend a PSA blood test screening and digital rectal exam be administered for men as young as 40.
Sokoloff said that in recent years the medical field has improved upon what to do if someone is diagnosed with prostate cancer. Unlike 10 to15 years ago when any diagnosis meant aggressive treatment, now doctors are able to estimate to some degree the significance of the disease and determine whether radiation and surgery are necessary or if active surveillance and observation are more appropriate.
“It’s important to identify men early on so we can stratify them to correct treatment,” Sokoloff said.
Sokoloff and Daniel Frendl, an MD/PhD student, have received a competitive grant from the American Urological Association to study how screening has changed since the U.S. Preventive Services Task Force released its recommendations, including whether there is less screening and less awareness among physicians and patients.
It’s also important that men are able to make an informed decision on whether to receive the PSA screening. Jennifer Yates, MD, assistant professor of urology and director of minimally invasive urologic surgery at UMass Memorial Medical Center, is currently conducting a questionnaire-based study to determine how primary care physicians view prostate cancer screening and how they communicate the issue to patients. Her preliminary results will be presented at the national American Urologic Association meeting in November at a high impact research session.