Who should get screened?

Efforts to increase screening are important, as a leading medical journal predicted this month that prostate cancer cases worldwide will increase by millions. In what seemed like an insufficient recommended response, the authors suggested that these mobile screening units, sometimes called “man vans,” could help curb the estimated rise in prostate cancer cases, which are projected to double by 2040.

The new report In the diary The lancet They said black men should be targeted for a simple blood test called a PSA test starting at age 45, and other populations could be targeted from ages 50 to 69. The tests should be done in conjunction with educational and outreach programs, the authors wrote, but they also said these types of mobile exams are a possible tool for more and more communities with limited access to health care.

A simple blood test is the first step in detecting the disease in its early stages, when it is most treatable. The test, called a PSA test, looks for a protein called prostate-specific antigen that can be produced by cancerous and non-cancerous tissue in the prostate, which is a gland that plays a role in men’s hormonal, reproductive and urinary functions.

The problem is that the PSA test alone can’t always distinguish the types of prostate cancer that are very dangerous from the types that men may be able to live with all their lives and never have any problems. And once people hear the word “cancer,” they often seek treatment that some experts say is not necessary and carries risks such as impotence and infertility.

TO paper published last year in a leading British medical journal concluded that PSA testing “remains highly controversial because it is unclear whether the benefits of reduced mortality from prostate cancer outweigh the harms of overdiagnosis and overtreatment.”

“Don’t get a PSA test or a biopsy unless you feel comfortable hearing that you have cancer and not treating it,” said Andrew Vickers, PhD, lead author of the British paper and a biostatistician at Memorial Sloan Kettering Cancer Center. In New York.

This is because many doctors will recommend approaches such as active surveillance, observation, or watchful waiting for prostate cancers that do not cause symptoms, are small, have not spread outside the prostate, and are likely to grow very slowly.

The current PSA testing recommendation in the US is for men ages 55 to 69 to talk to their doctor about the benefits and risks of having a PSA test. But Mahal and his co-authors of the new recommendations in The lancet They argue that it is worth strongly recommending screening in high-risk groups such as black men.

He called the current recommendation in the U.S. “not a very strong statement,” noting that a series of changes to it in recent years can be difficult for primary care providers to follow. He website Because the task force making the recommendations says more changes are being considered, including perhaps changes based on age, race, ethnicity or family history.

“Cancer screening recommendations are made around benefits to the population, not individuals,” explained Erin Kobetz, PhD, MPH, professor of medicine and public health sciences at the University of Miami. “It’s a strategy for public health management, so sometimes these recommendations change because yes, there may be benefits to doing a certain test for a high-risk individual or for a certain group of high-risk people, but supporting it for all individuals within a given group of people. The age range may create more problems than the solution is intended to solve. The PSA is one of them.”

Current figures suggest that 1 in 8 men in the US will get prostate cancer, which is the second leading cause of cancer death in men, behind lung cancer.

The possible changes being considered by the influential U.S. Preventive Services Task Force indicate that, once again, the task force may be trying to strike a more refined balance between the harms and potential outcomes of testing. PSA to save lives.

Precision medicine meets PSA screening

A cancer screening at one of Miami’s mobile units is usually a walk-in. The vehicles are meant to attract attention and are decorated in bright colors by a famous Miami artist. The artwork can be a conversation piece in itself.

The mobile cancer screening and education vehicles operated by the University of Miami Sylvester Comprehensive Cancer Center are called “Game Changing Vehicles” or GCVs. Community health worker teams speak English, Haitian Creole and Spanish. Team members generally come from the same communities they serve and all have the quality of being natural helpers.