Dr Gellhaus on the Significance of Prostate Cancer Awareness Month

“Prostate cancer is...such an important disease because of how common it is. We want to make sure we’re diagnosing the right people, and [that] we’re treating the right people and not overdoing [treatment] and causing the burden of repeated unnecessary steps and unnecessary diagnosis and evaluation alongside treatment."

Paul Gellhaus, MD, a urologic oncologist, medical director of Robotic Surgery, and an associate clinical professor in the Department of Surgery at City of Hope Cancer Center Phoenix, discussed the value of prostate cancer screening in the context of Prostate Cancer Awareness Month, which is observed annually in September.

Prostate cancer represents one of the most common malignancies among men, with data indicating that approximately 1 in 6 to 1 in 8 men will develop the disease during their lifetime, Gellhaus began. Because of its high prevalence, prostate cancer affects individual patients, as well as their families and caregivers, he stated. Given this widespread burden, the establishment of accurate, evidence-based strategies for diagnosis and management remains essential, he said. The clinical challenge lies in balancing the early identification of clinically significant disease and avoiding unnecessary interventions that may expose patients to additional burdens, both physical and psychological, associated with overdiagnosis and overtreatment, he emphasized.

Screening for prostate cancer has been a controversial issue, according to Gellhaus. Guidelines have historically varied, often shifting between supporting and discouraging screening, which has created considerable uncertainty for both patients and physicians, he reported. Primary care providers in particular often experience challenges in interpreting and applying these evolving recommendations, especially given their already demanding clinical responsibilities, he explained.

The use of prostate-specific antigen (PSA) testing has been central to the screening debate, Gellhaus noted. Although concerns have been raised regarding unnecessary testing and follow-up procedures, declining use of PSA screening has coincided with an observed increase in patients presenting with advanced-stage disease, he continued. This trend underscores one of the limitations of reducing screening efforts, as the absence of early detection frequently results in disease progression to stages that are more difficult to manage effectively, he added.

A significant barrier to optimal screening has been the spread of misinformation regarding the utility of PSA testing and prostate cancer screening in general, Gellhaus contextualized. Recent advances in diagnostic technologies, however, have improved the accuracy of cancer detection and provided oncologists with better tools to distinguish patients who are most likely to benefit from intervention, he highlighted. These developments have enhanced detection and improved risk stratification, allowing oncologists to better determine which patients require active treatment and which may be safely monitored, he concluded.