No "Magic Threshold" for PSA Screening, Study Finds
Data from the National Cancer Institute's (NCI) Prostate Cancer Prevention Trial (PCPT) published last week showed that a substantial number of men enrolled in the trial as controls were found to have prostate cancer despite consistently normal screening tests over the study period. The study results were published in the May 27 New England Journal of Medicine.
"This was the first systematic study of men with prostate-specific antigen (PSA) levels from 0 to 4.0 nanograms per milliliter (ng/ml)," said study leader Dr. Ian Thompson of the University of Texas Health Science Center in San Antonio. "It shows that cancer of the prostate can be present in men with 'normal' PSAs. The main study finding was that 15 percent of men in the PCPT control arm had a positive end-of-study biopsy despite having PSA levels below 4.0 ng/ml and normal digital rectal exams (DREs) throughout the study." Clinicians often use the value of 4.0 ng/ml or greater as the trigger for further investigation. A PSA level below 4.0 is generally considered normal.
The 2,950 men in the study were from the control arm of the PCPT, a 7-year NCI-funded trial evaluating the ability of the drug finasteride to prevent prostate cancer. The men received annual prostate screening with a PSA test and a DRE. All men entered the trial at age 50 or above, had initial PSA levels of 3.0 ng/ml or less, and a normal DRE. All were asked to undergo end-of-study prostate biopsy. Read more
An Executive Commitment to Reducing the Cancer Burden
As the baby boomer generation marches toward retirement age, we face the very real prospect of an influx of patients into our health care system with a significant disease burden, including cancer, stroke, diabetes, and cardiovascular disease. Even within the existing working population, however, the disease burden is very real. Cancer, for example, is the leading cause of death in the work force today.
In addition to cancer's human toll is its very real economic toll. Cancer's price tag for the United States alone in 2003 was $180 billion, a figure that accounts for treatment costs, lost productivity, and many other factors. So it is clear that all levels of government, organizations, and corporations have a substantial stake in helping to eliminate the suffering and death due to cancer.
Last week I attended a meeting of the CEO Roundtable on Cancer, a group comprising corporate CEOs and state governors, formed in 2001 as part of the National Dialogue on Cancer forum, which is now called C-Change. At this meeting, the group, led by Vice Chairman of Pharmaceuticals for GlaxoSmithKline, Robert A. Ingram, agreed to launch an initiative that has been under development by a task force led by Gary Reedy, Worldwide Vice President of Biopharmaceutical Public Policy at Johnson & Johnson. The program will invite organizations to adhere to a "CEO Cancer Gold Standard,™" which is a list of five priority actions meant to reduce the cancer burden in the United States. Read more