Prostate Cancer Screening & Early Detection

Transcript:E. David Crawford, MD: This is an exciting time in prostate cancer. When we looked at early disease, a correction was needed. You gave us a way forward starting with family practice guys. You should screen. You shouldn’t give it away. You’ve talked to family practice doctors. Most of them believe there probably is a benefit for early detection.

Matt Rosenberg, MD: There was a wonderful study that we did last year, where we were asking our primary care colleagues about their thoughts on prostate-cancer screening. And, we took a couple of things out of it. One was this mass confusion. No one really knew what to do. They were looking at guidelines. They didn’t even understand the guidelines, necessarily, and there are so many, I don’t blame them. But, what I found very reassuring—and this was a study with 153 primary care providers—they knew that there were aggressive tumors and there were indolent tumors. And they unanimously said, “If we had a way of differentiating those, we would do that.”

E. David Crawford, MD: It’s amazing how many primary care doctors I see who check their own PSAs. You have a great talk where you give that. The US Preventive Services Task Force says don’t check PSAs, and then you have the annual history and physical of the President of the United States, his PSA was like 0.71. So, he had his checked and he wasn’t even in that high, over 65.

Matt Rosenberg, MD: Right.

E. David Crawford, MD: I think that you’re right, and so the take-home message is—and you and I published a paper on this, you have done a lot of work on this—that in the heart of hearts, most family practice doctors think that there is a value for early detection in the right person, but we were doing a lot of overdiagnosis and overtreatment. And you had said, a PSA of greater than 1.5 is a danger zone. What you do, it’s like when you get an abnormal blood sugar, you go to the A1C. In this area, you do a couple of new tests, the blood test and the urine test, to try to identify aggressive prostate cancers. That’s a way forward so we don’t have all this advanced disease that’s coming around. Dan, I think you did a nice job of talking about all these new agents. We talked about shared care and how you can’t do it by yourself. It’s a team. It’s the team that wins, and that’s what the shared care is. It’s not just radiation oncologists, medical oncologists, and oncologists. Embrace this family practice.

Finally, I want to thank both of you for being here. Matt is a unique person in more than one way. He actually is trained in urology in Boston, and he is a family practice doctor, so he has both sides of the fence. There aren’t many medical oncologists in the world like Dan Petrylak. He is one of the top. The issue is we don’t have enough Dan Petrylaks around, and so we have medical oncologists who don’t know that much about prostate cancer. They’ve got other important tumors to take care of: breast cancer, lung cancer, and hopefully, something in pancreatic cancer. And so, that’s why what you’re seeing here is people who know a lot about prostate cancer, but out in the community, there’s the family practice guy, somewhere in South Dakota, who’s working with the urologist and the medical oncologist. The team is different. You’ve got to work together. I want to thank both of you for sharing all this information. I think that we’ve got a good foundation to work on. It’s the future. We have, actually, studies that we didn’t go into from Europe and Sweden, that looked at shared care improving the survival rate of patients, and that, and many other things, have been shown in multidisciplinary clinics. The idea is that you need a team captain, but that varies who the team captain is. You need a team.

Daniel P. Petrylak, MD: Absolutely.

E. David Crawford, MD: Any last comments you guys want to make?

Daniel P. Petrylak, MD: No. Again, I think communication is the key, and stay away from e-mail. Use the telephone. I think that’s a lot better.

Matt Rosenberg, MD: It is. It is. Let’s go back to our origins here, and let’s commit to communicating because, at the end of the day, it improves patient care.

E. David Crawford, MD: Right. Thank you.

Daniel P. Petrylak, MD: Thank you.

Transcript Edited for Clarity