Dr. Derek Lomas on “concerning” ACS data on prostate cancer

In this video, Derek J. Lomas, MD, PharmD, shares his reaction to the recently released data from the American Cancer Society’s Cancer Statistics, 2023 report. Lomas is a urologist at Mayo Clinic in Rochester, Minnesota.

Transcript:

It was a little concerning to see that we're seeing decreased rates of diagnosis secondary to the decreased rates of screening, that were really brought upon by the changes that the United States Preventive Services Task Force brought around in the early part of the 2010s. But what's more concerning is we're seeing an increase in advanced or late-stage diagnosis, which I've seen in my practice as well—men that weren't being screened and then subsequently we found cancer at a later stage, which is more difficult to treat. If it's regional or metastatic, it's not possible to cure at that stage. We really need to swing the pendulum back the other way, and I think we already have. The American Cancer Society screening recommendations have given some guidance on earlier screening, especially in men at risk, particularly those with family history; BRCA mutations; and African American men, who are disproportionately affected by prostate cancer. A lot of the concerns about screening and why the USPSTF went the other direction was because of the harms of overdiagnosis and the harms of treatment. Our pathway has changed quite a bit since where we were 10 or 15 years ago, where we used PSA blood testing, and rectal exam to screen for prostate cancer. If there was suspicion based on either of those, they went straight to a transrectal prostate biopsy, which itself has risks, including severe infectious complications. But this test, although it was the best we had, it was non targeted, it was random sampling of the prostate, so potentially you could miss or under diagnose, but also you would find low-risk prostate cancers that wouldn't threaten a man within their natural lifespan. Many of these men were still getting treatment, whether that's prostate removal surgery, which comes with changes to urinary and sexual function that can really affect the quality of life, or radiation therapy, which can also affect quality of life. Several things have happened over the past 15 years. Number one, there's been more emphasis on active surveillance or monitoring of indolent or non-aggressive prostate cancers, which leads to decreases in some of the harms of treatments. The other thing that has come about is a change in our diagnostic pathway. Rather than going straight to biopsy, we have other intermediate testing we can do, specifically multiparametric prostate MRI, which is good at ruling out prostate cancer, and if they are positive, that allows us to do a targeted biopsy to better improve our cancer detection. On top of that, we have biomarkers that are available now that can further inform a patient on the risk that clinically significant cancer is present. And so using all those tools, they can make the decision to go to a biopsy or, if the risk is low, omit a biopsy and potentially avoid overdiagnosis of low-risk prostate cancer.

This transcript was edited for clarity.