The Cancer Conundrum: To Screen or Not to Screen?

For many cancers, the value of screening is well established. As the saying goes, “knowledge is power” and early diagnosis is usually linked with better outcomes. For prostate cancer, this topic has been more controversial. That’s because many of the tumors we discover through screening are what we call indolent tumors – prostate cancers that may never lead to symptoms or require treatment in their lifetime.

The men who are diagnosed with slow growing prostate cancers can potentially be harmed by the label, particularly if they undergo treatment and have long-term side effects as a result.

We have a number of different screening tools available to both detect the presence of prostate cancer and distinguish between the sub-types that don’t require treatment versus those that need to be treated as early as possible. One of the most common and least invasive ways to screen for prostate cancer is through Prostate Specific Antigen (PSA) testing.

PSA is a blood test that since the early 1990s has been widely used to detect prostate cancers and to follow response to treatment. This blood test is frequently incorporated as part of routine blood testing during annual physical exams for men aged 40 or older. PSA values above a “normal” threshold are associated with a greater risk of prostate cancer.

In 2012, the U.S. Preventative Health Task Force (USPSTF) recommended against routine PSA-based prostate cancer screening for healthy men, regardless of age. This recommendation was based, in large part, on results from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a large randomized trial designed and funded by the National Cancer Institute (NCI) to determine the effect of PSA screening on prostate cancer deaths in the United States. At the time, it was determined that there was no benefit to PSA testing.

Contrary to this landmark study, a new study led by Jim Hu, MD at Weill Cornell Medicine and NewYork-Presbyterian found evidence that now demonstrates that PSA testing can help reduce the number of fatal cases of prostate cancer.

DrJimHuProstateCancerScreening

Researchers from the Genitourinary Oncology Program at NewYork-Presbyterian and Weill Cornell Medicine will be presenting their findings at the 2016 American Urology Association (AUA) Meeting on Monday, May 9. They discussed their findings in this week’s New England Journal of Medicine in a letter to the editor questioning the results of the PLCO trial due to limitations in the study’s methodology.

According to this letter, more than 80% of the participants in the PLCO control group (who were not supposed to have PSA tested) reported having had PSA testing within three years of starting the trial or during the trial. Thus the trial was not truly studying men who had not been screened in contrast to those who had been screened.

Dr. Jonathan Shoag, urology resident and lead author on the article further explains, “We demonstrate that the PLCO study did not compare a group of men who received PSA screening to a group of men who were not screened, but compared men who were screened to other men who were screened, and we should therefore reconsider any decisions based on the study.”

While PSA testing isn’t perfect (PSA can rise due to other conditions aside from prostate cancer), it can be a very good screening tool when viewed as one piece of the larger puzzle of what’s going on in the body.

Stay tuned for additional blog updates on the topic. Next week, we’ll have continuing coverage on research from the 2016 AUA meeting, including updates on PSA as a prostate cancer screening tool, other ways to detect prostate cancer, and additional biomarkers that can be used to distinguish between aggressive and non-aggressive prostate cancers.

Together, this information allows us to see a clearer picture of what’s going on in the body in order to increase our cure rates and the number of people we’re able to treat effectively, while simultaneously minimizing interventions for those who don’t need them.

8 Things You Should Know About Testicular Cancer

testicular cancer awarenessIn the medical world—and especially the genitourinary (GU) world – we’re pretty comfortable having candid conversations about what’s going on below the belt. After all, the “genito” half of our name refers to diseases of the genital organs. April is testicular cancer awareness month and there’s no need for the testes to be a taboo topic. Awareness is key to early detection, so here are 8 things you should know about testicular cancer:

  1. It can develop in one or both testicles. Our bodies aren’t always exactly symmetrical and the same can be said for cancer development. Just because cancer develops in one side, it doesn’t guarantee that the other testicle will be affected.
  2. You shouldn’t feel pain. Testicular pain isn’t normal. Visit your primary care physician and inquire about getting an ultrasound to get a better picture of what’s going on. You may also need a referral to a urologist.
  3. Self-examinations are important. Make an effort to get in a regular habit and aim for once a month. The more you’re familiar with what’s normal for you, the easier it will be to spot something that isn’t right. Not all lumps and bumps mean cancer, but it is important to get them evaluated. The Movember Foundation has great resources to help you get better acquainted with your testes and recently launched an awareness campaign, #knowthynuts. Check out this guide to get started.
  4. Certain men are at increased risk. While testicular cancer can affect males of all ages, most new cases occur in men between the ages of 20-34. Other risk factors include men who were born with undescended testes (when the testes don’t move into the scrotum during development), men with Klinefelter’s syndrome (two or more X chromosomes), men with a family history of testicular cancer and men with small testes.
  5. When caught early, most testicular cancer is curable. Testicular cancer has one of the highest cure rates. We have a number of successful ways to treat testicular cancer, including surgery, radiation and chemotherapy. Seek out a specialist for evaluation if you sense something is wrong. A typical initial work up will include an ultrasound and blood tests, and then possibly a CT scan to get a better picture of what’s going on in your body from a variety of different angles.
  6. A diagnosis doesn’t mean you can’t have kids. Most men are able to successfully father children following treatment, but there are occasional situations in which prior history, cancer, or the nature of the treatment can prevent it from happening naturally. Some centers (such as ours) are able to extract sperm, which can be utilized for fertilization. Before starting treatment, ask about your options to preserve fertility, including sperm banking.
  7. It doesn’t signal an end to your sex life either. Following treatment, sexual function should be normal.
  8. Some treatments should only be performed at centers of excellence. For example, in today’s treatment era, some men only need removal of the affected testicle. These men can be spared additional surgery, radiation, and/or chemotherapy that might have been administered in the past, but they remain at risk for tumor recurrence that might be missed in less experienced hands. A type of surgery called retroperitoneal lymph node dissection (RPLND) should only be performed by someone with specialized experience in this procedure. Additionally, certain types of chemotherapy regimens are very complicated and require autologous stem cell support (bone marrow transplant) to achieve cure. We happen to offer all of these specialized approaches.

Weighty Matters: The Kidney Cancer-Obesity Connection

By Shayne Robinson, R.D., C.S.O, C.D.N

In March, we celebrate both National Nutrition Month and Kidney Cancer Awareness Month. This makes it the perfect time to talk about whether what we eat can play a role in preventing kidney cancer.

So is there a connection between diet, exercise and kidney cancer?

The World Cancer Research Fund International Continuous Update Project seeks to find out. They analyze global cancer prevention and survival research linked to diet, nutrition, physical activity and weight to determine whether certain lifestyle factors affect cancer risk. They then release reports based on the evaluation of this worldwide data.

Map Kidney Cancer Obesity
Image credit: American Institute for Cancer Research, aicr.org

When it comes to the kidneys, there is strong evidence that being overweight or obese increases the risk of developing kidney cancer. In fact, the latest findings showed that maintaining a healthy weight could prevent 24% of all kidney cancers in the United States. The report also found that there was an association between body fatness and kidney cancer, such that the more overweight people were, the greater their risk of developing kidney cancer. Being overweight or obese was assessed by body mass index (BMI), waist circumference and waist-to-hip ratio.

The good news is that this means that we can make healthy lifestyle changes to lose weight and reduce our risk of developing kidney cancer.

Wondering if you should lose weight?

See where you stack up on a BMI chart and measure your waist circumference. To measure waist circumference, place a tape measure around your waist above the tip of your hipbone. Measure your waist after exhaling. For women, a waist measurement of 31.5 inches or more indicates high risk for obesity. For men, a waist measurement of 37 inches or more indicates high risk for obesity. If your BMI is over 25 or your waist circumference is above these numbers, talk to your physician or Registered Dietitian about starting a weight loss program.

Here are 6 tips to get started with a weight loss plan:

  1. Lose pounds the healthy way. Move more and eat less. Avoid fad diets.
  2. Avoid high calorie, energy-dense beverages. This includes fruit juice, soda, sweetened coffee beverages, lemonade and sweetened tea. These beverages don’t provide the satiety you will get from eating solid foods.
  3. Eat your veggies! Cut back on energy-dense, high-calorie foods by making half your plate raw or steamed, non-starchy vegetables. These high-fiber vegetables will fill you up without weighing you down.
  4. Portion control is key. Scale back on portion sizes, except the non-starchy vegetables. Using smaller plates can help.
  5. Get movin’ — Increase your physical activity. For some people, this may mean starting by walking to the mailbox and back. Aim for 30 minutes of physical activity a day. If you can’t do 30 minutes, start small and increase as your fitness improves.
  6. See a professional. Nothing replaces the individualized counseling you will receive from working with a registered dietitian (RD). To see a dietitian at the NewYork-Presbyterian Outpatient Nutrition Practice call (212) 746-0838. A physician referral is required.