Improved early detection of prostate cancer would ideally involve a noninvasive test that allows clinicians to distinguish aggressive cancers from relatively indolent ones. This distinction is especially important given that relatively few men who undergo screening are destined to die of prostate cancer.
For those undergoing screening for the presence of previously undiagnosed prostate cancer, the major challenge for new tests is to avoid the overdetection of indolent cancers that limits the clinical utility of the prostate-specific antigen (PSA) test.
The benefit-to-risk trade-offs associated with PSA screening are highly sensitive to patient preference, underscoring the importance of ensuring that men have the opportunity to decide for themselves whether they wish to have their individual risk for suffering and death from prostate cancer assessed through PSA screening.
Of course we should offer active surveillance to African-American men with localized prostate cancer! We simply need to do it selectively and in a smarter way—and we need to be aware of some of the potential pitfalls.
Active surveillance seems to be generally safe, yet African-American men tend to have more aggressive prostate cancers. Thus, it is imperative that we learn the characteristics and outcomes of African-American men considering surveillance.
Nancy Dawson, MD discusses PSA dynamics: the significance of PSA levels and PSA doubling time—the marker which currently provides the most information—and their usefulness in predicting metastatic disease and in counseling patients on their prognosis.