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Roswell Park car show highlights debate over prostate cancer screening

Classic cars, trucks, motorcycles … and tests for prostate cancer?

That’s the formula Roswell Park Cancer Institute followed Saturday at its Cruisin’ for a Cure to promote prostate cancer awareness and screening.

This was the sixth annual car show, which has gone smoothly in the past. But now the event has become embroiled in a debate over the best way to screen for prostate cancer.

On one side of the debate are those at Roswell Park and other experts who contend the prostate-specific antigen test, aka PSA, remains one of the best ways to catch prostate disease early and help men get successful treatment, especially African-American men who have a higher incidence of the disease than white men.

On the other side are those who view screening events like the car show as contradicting the recommendations from major physician groups. Those recommendations call for men to weigh the risks and benefits with a doctor familiar with their history before deciding to take the PSA test.

“This Roswell Park event in particular caught our eye because, in the past, this institution has trotted out misinformation about prostate screening while offering prizes like free hockey tickets to men who joined their ‘Prostate Club,’ ” Joy Victory recently wrote for HealthNewsReview.org, which reviews health care journalism and marketing. “Despite getting called out for it, they’re doubling down on this misguided approach, this time with a car show event promoting a ‘cure’ for prostate cancer.”

The sharp rebuke by Victory, the deputy managing editor for the medical watchdog website, prompted Roswell Park to defend itself online and in a Buffalo News interview.

“We’re trying to engage our community,” said Dr. Willie Underwood III, a urologic oncologist and associate professor at the cancer center. “We’re not just giving people an automatic referral to Roswell Park. It’s about improving health and huge disparities.”

Men at the classic car show Saturday seemed to agree with the Roswell Park doctors, while at the same time acknowledging why some men are wary of the test. Those reasons could include fear of the results, or discomfort with the fact the blood test is sometimes administered with a digital rectal exam.

Still, men getting the test on Saturday said they thought the benefits outweighed the discomfort and hope other men would follow their lead.

“If I’m going to be around in 20 years, I’ve got to watch my health,” said Michael Bronaugh, who lives near the Medical Campus and started attending the event three years ago. “In my eyes, I’m doing something that will help me in the long run.”

Richard Miles had another motivation. His brother died of melanoma cancer when he was just 22 years old. Although Miles has been lax in screening himself over the years, he now believes early detection is the best way to ensure he lives a long life and can be there for his five grandchildren.

“I firmly believe that early detection is the best form of protection,” he said. “It’s a great program and it’s nothing to be afraid of.”

To test or not

Reaction to Cruisin’ for a Cure underscores the continuing controversy over screening.

The prostate is a walnut-size gland in men involved in the production of semen. The PSA test detects levels of an enzyme in the gland called prostate specific antigen. But the test alone can’t distinguish between the majority of slow-growing cancers that don’t pose a threat to a man’s health and the less-common potentially fatal tumors.

Prostate cancer ranks as the most common non-skin cancer in men, with an estimated 181,000 new cases and 26,120 deaths expected this year in the United States, according to the American Cancer Society. The five-year survival rate for all stages of prostate cancer increased from 68 percent to 99 percent over the past 25 years, the organization’s statistics show. But experts disagree about the influence of PSA screening in this dramatic improvement.

The test used appropriately with other measures can help detect disease early and save lives, PSA advocates say. An elevated level, however, doesn’t always mean a man has cancer. And the test often finds slow-growing cancer that doesn’t pose a risk to health. As a result, some say the test leads many men to undergo unnecessary biopsies and treatments with potentially serious side effects, including incontinence and impotence.

“Men with prostate cancer who receive treatment following a PSA screen may well believe themselves to be ‘cured’ of a horrible disease,” Victory wrote. “But ... many healthy men who are screened also will undergo unnecessary, potentially harmful biopsies due to the test’s high false-positive rate. Others will be treated for cancers so slow-growing that they would never cause a problem during the man’s lifetime. Cancer treatments can expose these men to a host of urinary and sexual side effects for no good reason.”

Victory told The News that “there is no such thing as a simple medical test. You have to examine the pros, cons and the costs.”

But contrary to the impression left by HealthNewsReview.org, consultations at the event Saturday emphasize that a decision to have a PSA test is a personal one that should be made after consideration with a physician, said Underwood of Roswell Park.

He also stressed that Roswell Park sees the need for programs to fit the needs of its surrounding neighborhood, where poverty remains an issue.

“When you look at Buffalo, you see huge disparities, and we believe that people at the greatest risk benefit most from getting screened earlier,” Underwood said.

The incidence of prostate cancer in African-Americans in Erie County is 43 percent higher than in whites, and the death rate 166 percent greater. As one of 45 cancer centers designated as “comprehensive” by the National Cancer Institute, Roswell Park is supposed to conduct outreach, and the cancer center is located in a part of the city heavily populated by African-Americans.

“There are a lot of men who come to an event like this who would not go see a doctor,” said Richard Satterwhite, president of the group that co-sponsored the classic car show and screening Saturday. “Men of color are at risk for prostate cancer. We want them to get checked.”

Mass screening

No groups advise routine mass PSA screening, like at health fairs. But differences in guidelines continue to stir debate among physicians and cause confusion for patients.

The U.S. Preventive Task Force in 2012 recommended against PSA screening for all men after considering the risks of unneeded treatment, although the agency is currently updating the guidelines.

The American Cancer Society recommends men talk to their doctors about the pros and cons of PSA screening if they are age 50 and at average risk for cancer and as early as at age 40 if at higher risk, such as having more than one close relative who had prostate cancer at an early age.

The American Urological Association recommends a discussion about regular screening in select high-risk men under age 55 and, otherwise, in men ages 55 to 69.

The National Comprehensive Cancer Network takes a slightly more aggressive screening stance. It recommends PSA testing in informed healthy men ages 45 to 75, and in select men after 75. Roswell Park adheres to the National Comprehensive Cancer Network recommendations for early detection, and one of Roswell Park’s experts, Dr. James Mohler, helped devise the latest version of the policy.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, said he wonders if public events, rather than one-on-one sessions with a regular doctor, can adequately take an individual’s concerns into account when deciding whether to proceed with a PSA test.

“You worry if they’re getting balanced information, if they can adequately consider a patient’s values,” he said. “We’ve been screening since 1991, and the data show it’s mainly benefitted doctors and hospitals.”

Engaging men

Roswell Park conducts the car event with Buffalo MANUP, a group that advocates for education about prostate cancer.

Satterwhite, president of the group, was just 44 when he learned he had prostate cancer after experiencing symptoms, which can be confused with other conditions. He had not yet done a PSA test because, at the time, doctors did not recommend men get one until they turned 50.

After consulting with five doctors, he had surgery.

Like Satterwhite, some MANUP members at Saturday’s event said the test could make the difference in whether men have a healthy future.

Along with an opportunity to get tested, the event gives them a chance to distribute information and raise awareness of the disease. It also may help them reach men who are not regularly seeing a doctor.

“There are certainly things men don’t want to talk about, and health is one of them,” said Rochester Davis, who was diagnosed with prostate cancer three years ago when he was 59. “It’s about communication. Getting men to open up and talk about their health, and then getting them the information they need to make decisions.”

Not counting Saturday’s event, 530 men have received a PSA test at past car shows. An unknown number of other men were either ineligible or decided against screening, officials said.

The cancer center sees the event as a chance to engage men in the community, especially African-Americans. It noted that the marketing material highlights that men receive a one-on-one consultation that outlines the limitations of PSA testing and that they must be at least 40 years old.

Moreover, cancer center officials cited the lack of consensus by experts about screening, as well as a recent study suggesting that a decline in early detection had led to an increase in advanced cases of prostate cancer. But to add to the lack of clarity on these issues, other experts, including those at the American Cancer Society, say the results of the study are flawed.

“I’m in the camp that says it makes sense to let patients make the decision about screening themselves, and our event gives them that opportunity,” said Underwood, the Roswell Park oncologist.

email: hdavis@buffnews.com

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