The PSA Screening Debate and Active Surveillance
When the American Urological Association convened a panel to help men and their doctors make decisions about prostate cancer screening, it chose to lead it the Hopkins urologist whose ongoing, pioneering work on PSA screening has shaped much of the debate: H. Ballentine Carter, M.D.
"There is a lot of confusion because there are so many opinions," says Carter. "Views on PSA -based screening for prostate cancer vary widely – from a 'one-size-fits-all' approach that recommends starting when men turn 40, to a recommendation not to use the test at all." Opinions on treating prostate cancer are no less disparate, ranging from "treating all cancers to treating hardly any of them," Carter adds. The panel's interpretation of the evidence was that men between the ages of 55 and 69 are those most likely to benefit from screening, and that a man should only be screened after hearing about both the benefits and harms. "The major harm of screening is that a substantial minority of men, depending on age, will be diagnosed with a cancer that would never have caused harm," says Carter. "If treated, these men risk the side effects of treatment without the benefit in terms of extending life."
" The major harm of screening is
that a substantial minority of men,
depending on age, will be diagnosed with
a cancer that would never have caused harm.
But who can safely avoid treatment?"
The other approach is not to treat every man diagnosed with prostate cancer. "But who can safely avoid treatment?" Carter began working to answer this question 16 years ago when he developed the Active Surveillance Program for prostate cancer at Hopkins. Now the careful collection of data from men in the program is paying off: In 2012 and 2013, a number of studies based on the Johns Hopkins experience with surveillance and surgery were carried out to learn more about the safety of surveillance. The big question these studies sought to answer: Which men can avoid treatment without compromising their chance of a cure?