When Screening for Prostate Cancer Comes Too Late

When Screening for Prostate Cancer Comes Too Late
When Screening for Prostate Cancer Comes Too Late

Summary

Late-stage diagnoses have risen and a decline in deaths has stalled.

Prostate cancer loomed over David Weigand’s family: His uncle had the disease, and his father died of it. Yet widely followed recommendations for prostate-cancer screening didn’t consider him eligible for a test.

​In 2021​, he got tested anyway at his partner Cody Green’s urging. Weigand was 53 at the time​—two years below the age when the U.S. Preventive Services Task Force says men should consider testing​ for levels of prostate-specific antigen, or PSA​. He had no symptoms.

Weigand’s PSA levels were elevated. After a biopsy, he was diagnosed with stage-four cancer that had spread to lymph nodes in his pelvis. “My prostate was completely covered in cancer," Weigand said. “The situation that I’m in was so preventable."

Screening for prostate cancer is due for a course correction—again.

Doctors have debated how often to screen men for prostate cancer for decades. Widespread screening after testing went mainstream in the 1990s led to overtreatment and damaging side effects for many men.

Doctors scaled back after the task force, which carries particular weight among family doctors and insurers, recommended against the test in 2012. About five years later, the task force said men ages 55-69 could consider it after talking with their doctors.

More patients are now getting diagnosed with prostate cancer at later stages, when it is often too late to be cured. A two-decade decline in death rates has stalled. Some doctors worry deaths could rise in coming years.

“We’re finding them with disease not contained in the prostate but also in the bones, in the lymph nodes," said Dr. James Porter, a urological surgeon in Seattle. “That’s a recent phenomenon."

The pendulum swing hits at a fundamental problem in screening for all cancers: Testing too many people leads to more invasive procedures some patients don’t need. Testing too few misses opportunities to catch cases while there is a better chance treatment will work.

Groups including the American Cancer Society are reviewing their own guidance for prostate-cancer screening. Many doctors want to better target the test, limiting screening for some men while encouraging high-risk groups including Black men or those with a strong family history to get testing earlier.

“PSA recommendations have been ping-ponging back and forth, and what’s been lost in that is the high-risk people," said Dr. Heather Cheng, director of the Prostate Cancer Genetics Clinic at Fred Hutchinson Cancer Center in Seattle. She is helping to review the American Cancer Society’s prostate-cancer screening guidelines.

Cheng and other doctors working to better calibrate screening said the risks of overdiagnosis have declined. More doctors now monitor low-risk tumors for growth before rushing a man into surgery or radiation. Better imaging tools have reduced biopsies.

The government-backed task force takes treatment advances into account when setting guidance, said Dr. Michael Silverstein, the task force’s vice chair and a professor at the Brown University School of Public Health. Low representation of Black men and other groups in clinical trials has made it difficult to assess the potential benefit from targeted screening, the task force said.

The 16-member task force, which advises primary-care doctors on how to screen for everything from anxiety to heart disease, typically reviews guidance every five years. Its last guidance was in 2018; it hasn’t started a new review.

“For prostate cancer, it’s a complicated set of evidence," Silverstein said.

Deciding whom to screen for prostate cancer is complicated by the test’s inaccuracies and the slow-moving nature of the disease. Elevated PSA levels can indicate cancer or infection, inflammation or recent vigorous exercise. Many men have been left with urinary or sexual dysfunction after surgery and radiation to remove cancer that likely wouldn’t have killed them.

Still, prostate cancer is the second-leading cause of cancer death for men in the U.S. behind lung cancer, killing more than 30,000 annually. Diagnoses of later-stage prostate cancer have increased about 5% each year since 2014.

Robert Stine of North Barrington, Ill., spent thousands of dollars in his early 50s on a slate of tests that didn’t include a PSA check. The task force recommended against it at the time. When he turned 55 in 2018, his doctor suggested he get one. Stine was diagnosed with stage-four prostate cancer. He later learned he had a genetic mutation that put him at high risk.

“I thought I covered all the bases," said Stine. “I was very surprised, and very angry."

Weigand, who lives in Dallas, underwent surgery and started a new drug in June in addition to hormone therapy. He has started a plant-based diet and is pushing through a lack of energy to exercise more and lose weight he gained on the medication.

Earlier this summer, Green proposed. They plan to get married in the spring.

“I can’t help but think how incredible it is that an easy blood test can help men catch this earlier," Weigand said. “I would not be fighting as I am for my life."

Write to Brianna Abbott at brianna.abbott@wsj.com

When Screening for Prostate Cancer Comes Too Late
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When Screening for Prostate Cancer Comes Too Late
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