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    The return of prostate cancer: A step backward

     

    With that in mind, this June, Edward M. Schaefer, MD, PhD, and colleagues at Northwestern University published a paper showing that the number of new cases of metastatic prostate cancer increased by 72% between 2004 and 2013. Further, and most importantly, the largest increase (92%) was among men between age 55 and 69, the exact age group most likely to benefit from screening. When asked why, Dr. Schaeffer stated in a Northwestern press release, “One hypothesis is the disease has become more aggressive, regardless of the change in screening.”

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    OK, that makes sense. Of course, anything is possible. It’s also possible that I will awake tomorrow morning 8 inches taller and with bigger biceps. Sure, it’s possible and as a good scientist, Dr. Schaeffer had to mention a spontaneous change in the disease as a possibility to explain his data.

    He then continued, “The other idea is since screening guidelines have become more lax, when men do get diagnosed, it’s at a more advanced stage of disease.”

    Bingo.

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    Dr. Schaeffer is an educated urologist, and just as every urology resident is taught about how the rise in prostate cancer incidence in the ‘90s was related to the increased use of PSA, the recent decline in screening will cause an opposite effect.

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    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.

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