“It’s not surprising that the authors are finding an increase in cancer detection in younger men over the past 20 years, as PSA screening (which became widely used during the study time period) has allowed us to detect cancers earlier,” Dr. Penson told Cancer Therapy Advisor.
“The big question is whether these cancers ultimately would have caused these younger patients problems.”
While the cancer itself is certainly clinically dangerous, the risk of over detection is real and it worth considering how many patients would experience a clinical issue from their tumors if they hadn’t been detected.
Dr. Penson continued by explaining that gene sequencing is critical and that PSA testing doesn’t adequately inform clinicians on the clinical significance of a specific tumor, but new biomarkers may. Soroush Rais-Bahrami, MD, of the University of Alabama at Birmingham in Birmingham, AL, said distinguishing between low-grade and more aggressive forms of the disease may have significant clinical implications.
“As a function of early detection in this select patient population of younger men afflicted with the diagnosis, definitive treatment in appropriate patients may serve to provide longer follow-up and in turn more understanding of our treatments,” said Dr. Rais-Bahrami.
“Furthermore, in the subset who are candidates for active surveillance, early detection would allow for close monitoring and offering of definitive treatment options with curative intent without significantly compromising morbidity if applied in a timely manner without overtreating low-risk disease.”
The role of PSA screening should be seen as an entry point to diagnosis of prostate cancer in this unique population of younger men who are at risk of harboring prostate cancer at an early age (those with heightened concern due to ethnic origin, family history, or clinical suspicion).
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Patients should be counseled about prostate cancer screening, and their screening should be personalized, where young age is not considered a contraindication.
“Coupling other biomarkers including advanced imaging and genomic profiles with PSA will undoubtedly optimize detection of clinically significant cancers in this important patient population,” said Dr. Rais-Bahrami
- Salinas CA, Tsodikov A, Ishak-Howard M, Cooney KA. Prostate cancer in young men: an important clinical entity. Nat Rev Urol. 2014;11(6):317-323.
- Centers for Disease Control and Prevention. Should I Get Screened for Prostate Cancer? http://www.cdc.gov/cancer/prostate/basic_info/get-screened.htm. Updated August 25, 2014. Accessed January 9, 2015.