Better late than never: clinical guidelines are too late to screen for prostate cancer

Men with a family history of prostate cancer may need to be screened up to 11 years before guidelines require.

Prostate Cancer Awareness

Prostate Cancer Awareness. Image Credit: funnyangel/Shutterstock.com

Insufficient data has confounded the onset of prostate cancer

Identifying the disease early remains key to treating patients successfully when addressing prostate cancer. As such, clinical guidelines for the age to start screening aim to ensure that patients are not harmed or the negatives effects are limited to a minimum when treating prostate cancer.

However, due to the lack of sufficient data and relevance of data, the age at which early screening should begin remains unclear. This poses problems for diagnosis, later treatments, and the outcome of treatment, as patients may already be progressing into later stages of cancer development. The most common risk threshold at which clinical guidelines recommend screening for prostate cancer is 50 years old, yet this may be too late for men more susceptible to developing this cancer due to family history.

To address this clinical shortcoming, a nationwide study in Sweden by Mahdi Fallah and Elham Kharazmi of the German Cancer Research Center (DKFZ) in Heidelberg, Germany, estimates the elevated risk of advanced or fatal prostate cancer among relatives of men with the disease. The study published in the open-access journal PLOS Medicine provides new data to redefine the age at which screening should begin.

Earlier detection, earlier treatment, and better outcomes

An analysis was conducted across all male residents of Sweden born since 1931 and their fathers to determine when screening should commence. Between 1958 to 2015, 88,999 out of a total of 6,343,727 men were diagnosed with advanced-stage (III or IV) prostate cancer or died from the disease.

From this data, researchers estimated the age at which men who had a first-degree biological relative, including father, brother, or son, diagnosed with prostate cancer reached the "screening risk threshold" i.e., the same level of prostate cancer risk as at the age of 50 years across the entire population.

Findings showed that men with a family history of prostate cancer reached the screening risk threshold up to 12 years before the current recommended age for screening.

This result differed across men as the threshold was reached at different ages depending on the number of direct relatives who had prostate cancer and the age that they were diagnosed. Including such factors led to a range of age differences in necessary screening, as researchers showed that men with a family history of prostate cancer reach risk thresholds anywhere from 2 to 11 years earlier than currently stated in clinical guidelines.

More personalization required in clinical guidelines

The findings of this study demonstrate the requirement for more refined and inclusive screening guidelines. Specifically, the study shows that greater personalization is needed to accommodate for elements such as family history. Including such factors would provide a better level of leading to more effective clinical treatments.

Broad, generalized, and overarching clinical guidelines that do not incorporate elements of complexity present a dangerous gap in clinical knowledge. Indeed, such a knowledge gap represents a threatening impediment for clinical diagnoses and hinders the effectiveness of healthcare.

Future research could help support these results in other populations as well as other ethnicities beyond the confines of Europe while accounting for other potential risk-related factors such as genetics, lifestyle, and further personalized measures.

The one-size-fits-all policy in medicine belongs to the past; more and more risk-adapted approaches are needed instead to optimize the use of restricted resources in health care. The team now aims to further improve such personalized approaches in screening for various other cancers, such as breast cancer."

Dr. Kharazmi

Source:
  • Xu X, Kharazmi E, Tian Y, Mukama T, Sundquist K, Sundquist J, et al. (2021) Risk of prostate cancer in relatives of prostate cancer patients in Sweden: A nationwide cohort study. PLoS Med 18(6): e1003616. https://doi.org/10.1371/journal.pmed.1003616
James Ducker

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James Ducker

James completed his bachelor in Science studying Zoology at the University of Manchester, with his undergraduate work culminating in the study of the physiological impacts of ocean warming and hypoxia on catsharks. He then pursued a Masters in Research (MRes) in Marine Biology at the University of Plymouth focusing on the urbanization of coastlines and its consequences for biodiversity.  

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