PSA Recommendations Challenged After Analysis of PLCO Trial Data

OncLive Chairman,

Mike Hennessy

During the annual American Urological Association (AUA) meeting leaders in urology presented groundbreaking research, new clinical guidelines, and the latest advances in urologic medicine. Our coverage this month highlights the discrepancies found in the Prostate, Lung, Colorectal, and Ovary (PLCO) trial. The PLCO data were instrumental in the recommendation made by the US Preventive Services Task Force (USPSTF) against prostate-specific antigen (PSA) screening.

Investigators found a high rate of PSA testing in the control arm of the study, making any meaningful comparisons with the intervention group impossible. The trial was launched in 1993 and involved 77,000 men with an average risk of prostate cancer who were randomized to receive an annual PSA screening for 6 years and a digital rectal examination for 4 years or no screening tests. The USPSTF made its recommendation based on the PLCO data. The discrepancy will likely have a far-reaching effect on policy, so stay tuned.

In other news during the conference, the utility of the Decipher Genomic Classifier (GC) in prostate cancer was further elucidated. Two studies we highlight this month demonstrate its growing importance. In a study by Trock et al, the use of the GC in patients after they undergo radical prostatectomy (RP) can inform how further treatment should progress. The findings could affect the treatment algorithm in men who are at high to very high risk after RP by stratifying risk associated with prostate cancer-specific mortality. The GC showed a 3-fold increase in risk of death, even after adjusting for men at very high risk of prostate cancer.

In another study, the GC assay was able to predict which patients might respond to hormonal therapy, resulting in the discovery and validation of an adjuvant androgen-deprivation therapy resistance signature. This signature could potentially identify patients who may not respond well to androgen-deprivation therapy. Most importantly, it could prevent certain patients from undergoing needless morbidity and inform clinicians to try different systemic approaches. A one-size-fits-all algorithm does not always work out for the best.

There were many sessions to attend, presentations to view, and colleagues to network with during the AUA conference, but I’d like to call your attention to our OncLive® Peer Exchange this month, “Clinical Challenges in Genitourinary Cancers,” which was moderated by our editor-in-chief, Raoul Concepcion, MD. The panelists met prior to the AUA meeting to discuss the challenges that oncologists and urologists face in the genitourinary (GU) arena.

Despite the progress made in the GU field, as our understanding of the underlying biology of prostate and bladder cancer improves, and treatment protocols are refined, there still remain many scenarios in which clear cut answers are not easily identified. The panelists, Michael Cookson, MD, of the University of Oklahoma; Daniel Petrylak, MD, of Yale Comprehensive Cancer Center; David Quinn, MD, PhD, of the Keck School of Medicine at the University of Southern California; and Neal D. Shore, MD, of the Carolina Urologic Research Center, discuss 4 cases to highlight important clinical points and considerations in advanced prostate and bladder cancer. In particular, the panelists explored the emerging role of immunotherapy in bladder cancer, androgen receptor splice-variant 7 in prostate cancer, and cases involving both muscle- and non-muscle invasive bladder cancer.

These stories and more can be found in the June issue of Urologists in Cancer Care.