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Prostate Cancer Screening: Early Diagnosis Delivers Best Outcomes

Prostate cancer represents about 27% of all cancers in men, and is the second deadliest form of cancer. Last year, an estimated 26,000 men died of prostate cancer.

The American Cancer Society’s estimates for prostate cancer in the United States for 2017 include:

  • about 161,360 new cases of prostate cancer.
  • about 26,730 deaths from prostate cancer.
  • about 1 man in 7 will be diagnosed with prostate cancer during his lifetime.
  • Prostate cancer develops mainly in older men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is 66.

(Read more at the American Cancer Society).

African-Americans at Higher Risk
According to the Prostate Cancer Foundation: “African-American men are the group – out of all men in the world – hardest hit by prostate cancer…[and] are 1.6 times more likely to get prostate cancer, and more than twice as likely to die from it.”

An article at Wiley’s Newsroom pointed out:

“a new study indicating that higher prostate cancer death rates among black men in the U.S. may be due to a higher risk of developing preclinical prostate cancer, and a higher risk of that cancer progressing more quickly to advanced stages. The investigators estimated that 30 percent to 43 percent of black men develop preclinical prostate cancer—prostate cancer that is not symptomatic—by age 85, a risk that is 28 percent to 56 percent higher than that among men of any race.”

This further highlights the need for prostate cancer screening among at-risk populations.

The PSA Test
The Prostate-Specific Antigen (PSA) test measures the level of PSA in a man’s blood. Because the PSA biomarker is only expressed in prostate tissue, it can aid in the early diagnosis of prostate cancer.

PSA Testing: Controversy…or Just Confusion?
The confusion surrounding the use of PSA testing — when to screen and when not to screen — continues because prostate tumors may be very slow-growing (in general, about two-thirds of prostate tumors are categorized as slow-growing), and require only monitoring.

It is important to understand that the controversy around PSA screening is not about the PSA test, but rather about when or whether to treat based on the test result.

Since the FDA approval of the PSA test in 1994, the age-adjusted mortality rates for prostate cancer in the U.S. have declined 50%. (In that time period, mortality due to prostate cancer has declined more than mortality for any other type of cancer.

The value of PSA screening in terms of early detection of prostate cancer and reducing related morbidity, mortality, and cost is well established, when implemented in combination with passive surveillance.

Revised USPSTF Prostate Cancer Screening Standards
In April, the U.S. Preventative Services Task Force (USPSTF) released new draft guidelines for PSA prostate cancer screening – bringing it more in-line with American Urological Association and American Cancer Society recommendations.  (Read more on the draft recommendations at https://screeningforprostatecancer.org.)

The 2017 draft recommendations are based on new findings tracking PSA testing in clinical trials. From an April 11, 2017 NBCNews.com article (Men Should Ask About Prostate Cancer Test, Panel Advises – 4/11/17) comes this:

“After following patients for a longer period of time, it was shown that for every 1,000 men screened, one to two lives were saved. “We are more confident about the benefits of screening,” said Bibbins-Domingo. “We now think, on balance, there is a small benefit.”

PSA – 15 Minute Results
Testing confusion aside, two of the benefits of the PSA test are the ease of testing and rapidity of results. Patients – tested in a doctor’s office during a visit – can receive the results in 15 minutes.

This can potentially eliminate the need for a follow-up visit to review results – and allow the doctor and patient to develop a follow-on plan of action – if any is needed – during the initial visit.

Sekisui Diagnostics recently sponsored a webcast at Clinical Lab Products on this topic: Critical Thinking for Early Diagnosis of Prostate Cancer. It is available, on-demand free (Duration: 1 hour, 5 minutes). The webcast – moderated by Steve Halasey, chief editor of Clinical Lab Products. – explores:

  • The current controversy surrounding screening and diagnosis of prostate cancer.
  • The importance of digital rectal examination.
  • Optimizing the clinical application of PSA testing.

Point-of-Care Testing & the Fight Against Antibiotic Resistance

A paper published in 2015 – Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection – discussed the frightening scope of the problem with antibiotics today:

“Antimicrobial resistance is a global problem and is being addressed through national strategies to improve diagnostics, develop new antimicrobials and promote antimicrobial stewardship.”

It’s not a surprise that antimicrobial resistance (AMR) – the ability of a microbe to withstand drugs previously used against them – is an issue fast reaching crisis proportions. Resistant microbes are difficult to treat – especially with few new drugs in the arsenal….or in pharma’s pipeline. In fact, the World Health Organization had pointed out the challenges back in 2014:

“This serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistance is now a major threat to public health.”

According to the CDC, every year more than 2 million Americans become infected with antibiotic resistant bacteria – resulting in at least 23,000 deaths. The problem is global: the UK government estimates that more than 25,000 deaths occur in the EU every year due to drug resistant infections.

It’s a crisis being driven by two principal developments (or lack thereof):

  1. Over-prescribing antibiotics
  2. The scarcity of new classes of antibiotic drugs 

Trade Association Engagement
The UK Department of Health’s Five Year Antimicrobial Resistance Strategy calls on industry and trade associations to contribute to the work of tackling AMR. In keeping with this, BIVDA (British In vitro Diagnostics Association) has established an AMR working party which meets quarterly and includes representatives from more than 40 different IVD companies. Sekisui Diagnostics is one of the participating companies.

Pharmacy Strategy
A July 2016 paper in the Journal of Antimicrobial Chemotherapy, “A Feasibility Service Evaluation of Screening and Treatment of Group A Streptococcal Pharyngitis in Community Pharmacies,”concluded:

“it is feasible to deliver a community pharmacy-based screening and treatment service using point-of-care testing, and that this type of service has the potential to support the antimicrobial resistance agenda.”

To drive this idea forward, Sekisui Diagnostics’ distribution partner in the U.K. – Una Health – in collaboration with pharmacy sector consultants Connect-2-Pharma have engaged in a variety of awareness campaigns. These campaigns aim to create awareness among the community pharmacy segment, and drive adoption of Rapid Testing using OSOM rapid tests (principally for Strep-A, and Influenza) within the community pharmacy setting.

The Diagnostic Solution – Promoting “Less is More”
Diagnostics are a critical counterpart to ongoing drug R&D, which alone will not be able to eradicate AMR.

Point-of-care testing is one of the most powerful tools available today in the fight against AMR. Every single use, rapid, disposable test can enable better decision-making at the point-of-prescription, and prevent the unnecessary or erroneous use of an antibiotic.

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