Has There Been an Overall Increase in High-Risk Prostate Cancer?

Dr. Bevan-Thomas talks about overall increases in high-risk prostate cancer

1743182201As part of our mission to provide the latest news in terms that patients can understand, in this video Dr. Richard Bevan-Thomas at Prostate Cancer Live talks about an interesting presentation from the 2015 Genitourinary Cancer Symposium in Orlando, FL.

The topic of this presentation was, “Early evidence of increase in higher risk prostate cancer from 2011 to 2013.”

Dr Bevan-Thomas found it very fascinating, mainly because this is one of the things that both he and his partner have seen recently: they are actually starting to see more patients come in with higher PSAs than they did in the early 2000s. For a breakdown of the findings, watch this video.

Video Transcript

Richard Bevan-Thomas MD:  Hey folks, this is Dr. Richard Bevan-Thomas at Prostate Cancer Live talking about another interesting presentation and this one was presented at 2015 Genitourinary Cancer Symposium in Orlando, so what is the topic of this presentation. 

It was very fascinating.  Early evidence of increase in higher risk prostate cancer from 2011 to 2013, so this is one of the things that I as well as my partner have seen more recently is that we are actually starting to see more patients actually come in with higher PSAs than we did certainly in the 2000s, you know 2003 to 2010 give or take, so here is how they design the study, so they actually retrospectively looked at over 87000 men in a particular database.  The database that used was the national oncology data alliance and the reason why they used is a very robust database from 2005 to 2013, so what is this mean well so when I originally read I heard of this that this is actually being presented and this was written about I thought we are starting to see higher grade prostate cancers i.e. Gleason 8, 9, or 10. 

We are seeing some of that, but this particular paper actually looked at the definition and the definition here is a PSA of greater than 10 and so what we saw in 2005 and we have discussed this on numerous different occasions is the importance of screening for prostate cancer. 

As that PSA increases, there is higher chance, number one is that the patient if they do have prostate cancer that prostate cancer is more that have increased amount and volume of the cancer, but there is always the higher that the cancer gets outside of the prostate, gets the lymph nodes, and of course becomes metastatic which is outside into the bones, so with that in mind what we are seeing and this is just only a period of 2011 and 2013 is that the proportion of men diagnosed with intermediate or higher risk prostate cancer only from PSA alone, so now we are seeing more people, more men who are being diagnosed with prostate cancer with the PSA above 10, so why is that important one we would say okay well so we are findings them just a little bit later.  It’s important in this particular thing and again they have emphasized this, but I think that there is actually one plus one does equal two in this particular thing. 

They predict that because we are not seeing men in that range where that PSA is below 10 which we started where we are seeing ever since the advent of the PSA in the late 1980s really started to 1990s more than anything else, but that being said when we started seeing and started testing for the PSAs, we were finding men really with that PSA between 4 and 10 and subsequently between 2.5 and 10 and so those were actually in the lower risk categories.  You get an intermediate risk category when that PSA gets above 10, so there is a 3% increase per year, so from 2011 to 2013 increased risk 3% per year of patients with the PSA above 10 again what is that tell us, it tells us that at least 1400 additional men may die of prostate cancer each year, so there is a correlation between when we find those men with prostate cancer, if that PSA is above 10, there is a higher mortality i.e. death rate from those patients. 

Okay, this gets a little concerning because with all of the debate about when and if we actually check PSAs on patients, if we are finding men in the later stages of prostate cancer or the more advanced where that PSA is up to, we are now going to increase the number of men that either have or will develop prostate cancer that will become metastatic and subsequently caused that men’s ultimate demands.  It is particularly important for us to stay vigilant and ensure that men continue to be tested for this.  Again in this particular presentation, they say look you are still going to talk to your doctor about this.  I agree with that you know whether you are on high risk you know if you had very significant family history, it is, however, important that you get tested. 

The takeaway from this presentation is, get tested and know your PSA.  It is important that you know what that PSA is and your risk of potentially having a focus of cancer because the lower the PSA is when we diagnose a men with prostate cancer, the better his prognosis and the better chance we can cure these men, so if you are a man and you don’t know your PSA depending on your age, but I would say over the age of 40 certainly with a family history of prostate cancer make sure that you know your PSA.  If you are in search or if you just have buddies you around that don’t know what their PSA is and they are not the same age group make sure that you spread the word.  You could save someone’s life.  I tell this to my patients all the time and I can tell you could all make a difference.  This is Dr. Richard Bevan-Thomas from Prostate Cancer Live, signing out.

Dr. Richard Bevan-Thomas
Dr. Bevan-Thomas is the Medical Director for Prostate Cancer Live. A graduate of Duke University, Rich received both a master’s degree in anatomy and his medical degree from St. Louis University School of Medicine. He completed residency training in urologic surgery at the University of Texas Houston Health Science Center and the renowned MD Anderson Cancer Center, also in Houston. In 2002, he received two top honors in his field; the Pfizer Scholar in Urology and the Gerald G. Murphy Scholar in Urology. Dr. Bevan-Thomas will remain on the leading edge of robotic surgery and cryosurgery at USMD Prostate Cancer Center and will continue offering patients the latest clinical trials in prostate cancer treatment. He continues his teaching and physician proctoring interests as well as instructing in robotic surgery.


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