UF-led council differs from feds over guidelines for routine prostate cancer screening

A University of Florida-led advisory council tasked by the state with developing guidelines for early detection of prostate cancer has released recommendations that differ from federal guidelines in the frequency of a key test for the disease and also take into account some unique characteristics of Florida’s population.

The release of the guidelines coincides with a rising incidence of prostate cancer in Florida, the number of new diagnoses within the state having increased for the fourth consecutive year. At the same time, a recent study published in Health Affairs shows that the overall rate of men in the United States receiving treatment for prostate cancer fell 42 percent from 2007 to 2012, likely reflecting a change in federal screening recommendations.

The different recommendations highlight an ongoing discussion among medical experts nationwide about the use of a critical detection test.

Since 2011, the U.S. Preventive Services Task Force, which informs federal agencies such as the Centers for Disease Control and Prevention, has recommended against routine prostate-specific, antigen-based screening for men to decrease overdiagnosis and overtreatment. The prostate-specific antigen, or PSA, blood test is the most common screening for prostate cancer. The PSA test may give false-positive or false-negative results, which could lead to unnecessary treatments that can cause a long-term impact on quality of life, according to the National Cancer Institute.

However, the Florida Prostate Cancer Advisory Council, or PCAC, recommends that Floridian men 50 years or older with an average risk of getting the disease be encouraged to get early detection testing. All African-American men in the state and those 40 years or older with close relatives who have prostate cancer should also be urged to get tested.

“The Prostate Cancer Early Detection Guidelines for Floridians are intended to be a reliable resource for all Florida men at a time when prostate cancer screening is considered by some to be controversial,” said Thomas Stringer, M.D., executive director of the PCAC and the UF Prostate Disease Center. “The controversy is related to concerns for overdiagnosis and overtreatment of prostate cancer and has resulted in an array of contradictory and confusing screening guidelines. The PCAC’s guidelines specifically addresses unique Florida subpopulations at increased prostate cancer diagnosis risk, including older and African-American men. Early diagnosis remains key to long-term cancer survivorship.”

According to the American Cancer Society, the chance of having prostate cancer rises rapidly after age 50, and the disease occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races. Both populations are present in Florida at a higher percentage than the national average, and prostate cancer is the leading cancer for men in the state.

These statistics, coupled with significant prostate cancer disparities between rural and urban populations and across ethnic and racial groups, are resulting in segments of the Floridian population being underdiagnosed or diagnosed at later stages, receiving dissimilar disease management and treatment methods and, potentially, decreasing their survival expectations, according to the PCAC website.

The Florida Legislature in 2011 directed the UF Prostate Disease Center to establish a nine-member, multi-institutional, interdisciplinary advisory body that develops and implements strategies to improve outreach and education. The council presents prostate cancer-related policy recommendations to the Florida Department of Health and other appropriate government entities, and communicates best practices to physicians involved in the care of patients with prostate cancer.

In April 2016, Florida State Surgeon General Celeste Philip, M.D., reviewed and approved the Prostate Cancer Early Detection Guidelines for Floridians, as put forth by the council. The recommendations were released shortly before the end of the year.

“Prostate cancer detection and treatment has recently come under great scrutiny with regard to which patients benefit the most from PSA screening and cancer treatment,” said Li-Ming Su, M.D., the David A. Cofrin professor of urologic oncology and chair of the department of urology in the UF College of Medicine. “The Florida Prostate Cancer Advisory Council is now working to establish guidelines to help standardize prostate cancer treatment for men in our state of Florida based upon current evidence-based best practices. The initiatives of this important organization will help ensure that practitioners around the state who follow these guidelines provide the best quality, patient-centric care especially for our unique population of aging and high-risk African-American men.”

The council will continue its work in 2017 to provide education and information to Florida men on prostate cancer risk, said Stringer, also the associate chair of the department of urology in the UF College of Medicine. The organization’s next goal is to develop statewide management guidelines for prostate cancer once the diagnosis is made.

In addition to the Prostate Cancer Early Detection Guidelines for Floridians, the Florida surgeon general recently reviewed and supported the candidate recommendations of the newest Prostate Cancer Advisory Council members, who serve either two- or four-year terms. The complete list of council members is available on the PCAC website: prostatecanceradvisorycouncil.org.

Prostate Cancer Early Detection Guidelines for Floridians (2016-Vx.y) by the Florida Prostate Cancer Advisory Council:

• Despite some of the possible shortcomings of the utilization of PSA in the detection of prostate cancer, it is the general consensus of the PCAC members that PSA has been a positive and major development in the detection and management of early prostate cancer. Many prostate cancer experts believe the utilization of PSA in early detection of prostate cancer was a major factor in the decline of prostate cancer deaths in the United States over the past twenty-plus years. Finally, in comparison to many cancer detection tests, PSA is a relatively inexpensive, widely available and low-risk blood test for the patient. PCAC feels that the patient and their health care provider should have a discussion regarding the positive and negative aspects of the PSA blood test for detection of prostate cancer.
• All Floridian men 40 years or older should be directed by their health care professional to the PCAC website to review information regarding prostate cancer, the controversies surrounding screening and the risks and benefits of early detection.
• All Floridian men 50 years of age at average risk for prostate cancer should be encouraged to undergo early detection testing after being provided with thorough information on the burden of the disease, the potential for better detection with newer tests that may decrease the rate of unnecessary biopsies and potentially better predict aggressive cancer. Men with limited life expectancy (less than 5-10 years) should be discouraged from routine prostate cancer screening.
• All Floridian African-American men and men with first- and second-degree relatives with prostate cancer 40 years or older who are at higher risk of prostate cancer should be encouraged to undergo early detection testing.
• Early detection testing should include a PSA test, or newer markers (4K, Prostate Health Index [PHI] and digital rectal examination by their health care professional.
• All Floridian men undergoing early detection evaluation should be directed to the National Comprehensive Cancer Network (NCCN) website, www.nccn.org, to follow up-to-date recommendations on early detection based on initial evaluation findings.