The objective of this work in writing is to examine the clinical problem of prostate cancer and to identify solutions proposed by journal authors to address this problem. The Google Scholar database will be searched for journal articles reporting on this issue.
Prostate cancer is reported to be a disease that is “highly heterogeneous,” and one which presently nearly 250,000 men in the United States are newly diagnosed each year (Silberstein, Pal, Lewis, & Sator, 2013, p.1). There are approximately 30,000 men who die from this disease each year with around 2.7% of males in the U.S. expected to die with prostate cancer at some point in their life (Silberstein et al., 2013). A clinical problem related to prostate cancer is that there is a question among authorities and practitioners of whether elderly men and men, in general, should be screened for prostate cancer. Since elderly men are at an increased risk of prostate cancer, the confusion, and disagreement about whether elderly men should undergo screening for prostate cancer is problematic.
Lee and Amling (2014) reported that there are clinical factors upon which physicians can base their predictions about the potential outcomes for those with prostate cancer. However, the research, which has proliferated, has yielded a great many “additional potential prognostic factors” (Silberstein et al., 2013, p. 1). There is a problem with comprehending the significance of these factors. This is confounding, since as reported by Silberstein, et al. (2013), overtreatment of prostate cancer results in the creation of a burden that is unnecessary for so many patients. It is reported that this is especially witnessed when considering the many other diseases that are presenting as comorbidities in patients who are elderly (Silberstein et al., 2013).
Masaoka, Hidemi, Yokomizo, Eto, and Matsuo (2017) reported that overtreatment occurs in “super-elderly men with localized prostate cancer” (p.1). The reason stated that elderly men are being overtreated is due to their age, other health problems, and the fact that elderly men who have prostate cancer often die with other problems rather than prostate cancer. It is recommended that observation is much preferred and reasonable, since overtreatment, or treatment that is unnecessary results in medical costs that are increased. Additionally, it is reported that overtreatment often has outcomes “such as urinary, erectile, and bowel toxicity (Masaoka et al., 2017, p.1).
According to Rooboi (2017), PSA screening for prostate cancer has been under fire for quite some time. Specifically, reported is that while the PSA’s use in screening was acknowledged in various guidelines during the 1990s, “with more data becoming available on steeply increasing PCA detection rates, related over treatment, and questionable benefit of screening, the medical societies changed their views and adapted their guidelines” (Rooboi, 2017, p.1). Carroll (2018) reported that the United States Preventive Services Task Force rated PSA screening with a ‘D’ in 2012 and stated that screening for early detection of prostate cancer should be discouraged by physicians. However, according to Carroll (2018), the ‘D’ grading for screening for prostate cancer appears to be formulated upon the basis of an interpretation that was not correct.
This is especially true in light of the findings and supporting clinical evidence for prostate screening that focused instead on over-detection as well as over-treatment. However, most recently, it was reported by Carroll (2018) that the Task Force had stated a recommendation while, changing the grading to C for prostate cancer screening, that men who are 55 to 69 should have prostate cancer screening upon the basis of a well-informed decision. However, it is reported by Carroll (2018), that the Task Force, left the grade at ‘D’ for screening men who are 70 years of age or older for prostate cancer, because of the risks associated with screening. However, an individualized approach to prostate screening for men over 70 years of age is recommended (Carroll, 2018; Rooboi, 2017). Rooboi (2017) noted that the USPSTF stated a recommendation against the use of PSA screening. The guidelines issued by the USPSTF also included methods focused on the reduction of harm, as well as offering advice regarding at which age testing should stop. These guidelines are focused on ensuring that men are “fully informed about the potential benefits and harms” (Rooboi, 2017, p.1). Also, the guidelines set out that the PSA screening should be utilized only as a starting point and should be followed-up with other intervals of screenings and testing.
Heidenreich et al. (2014) reported that the findings in research do not support the use of PCA screening for all men. A PLCCO screening trial was conducted and reported findings that there were 50 deaths in the group that received screening. There were only 44 deaths reported in the control group. Since the mortality related to prostate cancer occurring between the two groups was not significantly different, PCA screening is reported not to be recommended (Heidenreich et al., 2014).
There is a general lack of agreement about prostate screening for elderly men or men in general. The disagreement is not only because of the risks associated with screening but since screening for prostate cancer is not significant in reducing prostate cancer deaths. It is clear that each case should be individualized based on the overall health of the individual who is elderly. Specifically, at issue is whether men have the presence of other diseases, the likelihood if prostate cancer is diagnosed and then successfully treated, if whether the elderly individual will survive long enough for the burden of treatment to be worthwhile.
Carroll, P.R. (2018). USPTF prostate cancer screening recommendations – A step in the right direction. JAMA Surg. Doi:10.1001/jamasurg.2018.1283
Heidenreich, A., Bastian, P.J., Bellmunt, J., Bolla, M., Joniau, S.,…Mottet, N. (2013). EAU guidelines on prostate cancer: Part I: Screening, diagnosis and local treatment with Curative Intent. European Urology, 65(1). Doi: https://doi.org/10.1016/j.eururo.2013.09.046
Masaoka, H., Ito, H., Yokomizo, A., Eto, M., & Matsuo, K. (2017). Potential overtreatment among men 80 years and older with localized prostate cancer in Japan. Cancer Science, 108(8). Doi: 10.1111/cas.13293.
Rooboi, M.J. (2018). Screening for prostate cancer: Are organized screening programs necessary? Translational Andrology and Urology, Feb;7(1). Doi: 10.21037/tau.2017.12.10
Silberstein, J.L., Pal, S.K., Lewis, B., & Sartor, O. (2013). Current clinical challenges in prostate cancer. Translational Andrology and Urology, 2(3). Doi: 10.3978/j.issn.2223-4683.2013.09.03