In an effort to provide our patients and their families with the best possible care, all patients
treated at the Florida Center for Prostate Care are closely monitored by our dedicated team and tracked in our computerized
database. In addition, all seed implants are carefully analyzed for quality assurance.
strive to offer our patients the newest and most innovative cancer treatments available by participating in both national
and regional research trials. This includes participation with:
National Cancer Institute
Radiation Therapy Oncology Group
Numerous Pharmaceutical Companies
Screening for Prostate Cancer
US Preventive Services Task Force Recommendation Statement
In the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 13%, and the lifetime risk of dying of prostate cancer is 2.5%. The median age of death from prostate cancer is 80 years. Many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease. African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared with other men.
To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on prostate-specific antigen (PSA)–based screening for prostate cancer.
The USPSTF reviewed the evidence on the benefits and harms of PSA-based screening for prostate cancer and subsequent treatment of screen-detected prostate cancer. The USPSTF also commissioned a review of existing decision analysis models and the overdiagnosis rate of PSA-based screening. The reviews also examined the benefits and harms of PSA-based screening in patient subpopulations at higher risk of prostate cancer, including older men, African American men, and men with a family history of prostate cancer.
Adequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened. Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened. Potential harms of screening include frequent false-positive results and psychological harms. Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence, and 2 in 3 men will experience long-term erectile dysfunction. Adequate evidence shows that the harms of screening in men older than 70 years are at least moderate and greater than in younger men because of increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment. The USPSTF concludes with moderate certainty that the net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small for some men. How each man weighs specific benefits and harms will determine whether the overall net benefit is small. The USPSTF concludes with moderate certainty that the potential benefits of PSA-based screening for prostate cancer in men 70 years and older do not outweigh the expected harms.
Conclusions & Recommendations
For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. (C recommendation) The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. (D recommendation)
Association Between Treatment at a High-Volume Facility and Improved Survival for Radiation-Treated Men With High-Risk Prostate Cancer
Yu-Wei Chen, MD, MS, Brandon A. Mahal, MD, Vinayak Muralidhar, MSc, Michelle Nezolosky, BA, Clair J. Beard, MD, Robert B. Den, MD, Felix Y. Feng, MD, Karen E. Hoffman, MD, MPH, MHSc, Neil E. Martin, MD, MPH, Peter F. Orio, DO, MS, Paul L. Nguyen, MD
Although the association between higher hospital volume and improved outcomes has been well-documented in surgery, there is little data about whether this effect exists for radiation-treated patients. We investigated whether treatment at a radiation facility that treats a high volume of prostate cancer patients is associated with improved survival for men with high-risk prostate cancer.
Methods and Materials
We used the National Cancer Database (NCDB) to identity patients diagnosed with prostate cancer from 2004 to 2006. The radiation case volume (RCV) of each hospital was based on its number of radiation-treated prostate cancer patients. We used propensity-score based analysis to compare the overall survival (OS) of high-risk prostate cancer patients in high versus low RCV hospitals. Primary endpoint is overall survival. Covariates adjusted for were tumor characteristics, sociodemographic factors, radiation type, and use of androgen deprivation therapy (ADT).
A total of 19,565 radiation-treated high-risk patients were identified. Median follow-up was 81.0 months (range: 1-108 months). When RCV was coded as a continuous variable, each increment of 100 radiation-managed patients was associated with improved OS (adjusted hazard ratio [AHR]: 0.97; 95% confidence interval [CI]: 0.95-0.98; P<.0001) after adjusting for known confounders. For illustrative purposes, when RCV was dichotomized at the 80th percentile (43 patients/year), high RCV was associated with improved OS (7-year overall survival 76% vs 74%, log-rank test P=.0005; AHR: 0.91, 95% CI: 0.86-0.96, P=.0005). This association remained significant when RCV was dichotomized at 75th (37 patients/year), 90th (60 patients/year), and 95th (84 patients/year) percentiles but not the 50th (19 patients/year).
Our results suggest that treatment at centers with higher prostate cancer radiation case volume is associated with improved OS for radiation-treated men with high-risk prostate cancer.
Terk M, Vargas C, Cesaretti J, Swartz D, Blasser M , Vashi A, Kasraeian
A, Koziol J, Kiley K. Excellent Long-Term Outcomes with Prostate Brachytherapy in Young Men Less Than 55 Years Old.
Brachytherapy. 2013; 12 (2), Suppl 1, S12
Swartz D, Vargas C, Terk M, Vashi A. Salvage Palladium
Brachytherapy for Local Failure after Initial External Radiotherapy for Prostate Cancer. Oral Presentation. American
Urological Association - Annual Meeting. May 5, 2013
Kerns S, Stock R, Stone N, Blacksburg
S, Rath L, Vega A, Fachal L, Gómez-Caamaño A, De Ruysscher D, Lammering G, Parliament M, Blackshaw M, Sia M,
Cesaretti J, Terk M, Hixson R, Rosenstein B, Ostrer H. Genome-wide association study identifies
a region on chromosome 11q14.3 associated with late rectal bleeding following radiation therapy for prostate cancer.
Radiotherapy and Oncology (in press 2013)
Burri R, Ng J, Horowitz D, Cesaretti J, Terk M,
Kao J, Thompson D , Stephens T, Chao KS, Brenner D, Shuryak I . Rectal balloons and the risk of secondary rectal
cancer after combined modality prostate radiation. World Congress of Brachytherapy 2012, Barcelona, Spain, May 10-12,
Burri R, Ng J, Horowitz D, Cesaretti J, Kao J, Thompson D, Stephens T, Chao KS, Brenner D, Shuryak I. Rectal
Balloons and the Risk of Secondary Rectal Malignancy After IMRT for Prostate Cancer. ASTRO 2012, Boston, October
Burri R, Ng J, Horowitz D, Cesaretti J, Kao J, Thompson D, Stephens T, Chao KS, Brenner D, Shuryak
I. Rectal balloons and secondary rectal cancer risk after 3D-conformal radiation for prostate cancer. ESTRO
31, 2012, Barcelona, Spain, May 9-13, 2012