Peter Scardino, MD, chief of surgery at Memorial Sloan-Kettering Cancer, talks about the practicality of prostate cancer screening

BERKELEY, CA ( ) “Long term follow-up of the results of the good randomized trials screening for prostate cancer, especially the European trial and subsets across Europe, are showing a substantial decrease in the risk of dying among men followed for longer periods of time. In particular, the Swedish randomized trial involving 20 000 men shows greater than a 50% reduction in risk of dying after 14 years for men who were screened versus those men who were not screened in this study. There is better and better data showing the effects of screening are very powerful. Foregoing screening for prostate cancer should be taken with great caution.”

Memorial Sloan-Kettering’s prostate cancer guidelines are based on the following principles:
  • Many men with prostate cancer do not need to be treated and can be followed by active surveillance. A diagnosis of prostate cancer is information used to help make decisions, not an indication for immediate treatment.
  • Compliance with screening will increase if men are told whether they are at high, intermediate, or low risk and are informed about their need for subsequent screening.
  • There is a balance between the harms and benefits of screening. By focusing screening on men at highest risk of life-threatening prostate cancer, we can better achieve this balance.
Memorial-Sloan-Kettering doctors recommend the following screening guidelines for men expected to live at least 10 years:

“Look at what has been wrong with how we do prostate cancer screening in America. Men get a DRE and PSA starting at age 50 (or at age 45 if in a higher risk group, like African Americans or those with family history) and those tests are repeated each year. Good long-term studies of men in their 40s indicate it’s very important to get the first PSA test at age 40 or 45 because that test provides reasonable accuracy as to whether men will develop prostate cancer in their lifetimes. You don’t need to screen every year if the man has a very low PSA (below 1), instead screen every 5 years until age 60s and if the PSA is still below 1. This man’s risk for developing prostate cancer in this lifetime is very low.

The Memorial Sloan-Kettering Cancer Center Prostate Cancer Disease Management Team developed risk-adjusted prostate screening guidelines posted on the website, stating, “Men interested in the early detection of prostate cancer should be informed of their risk and be advised to consider screening according to guidelines.” The guidelines were developed at Memorial Sloan Kettering Cancer Center by James Eastham, chief, urology service; Andrew Vickers, statistician, Dept. of Epidemiology and Biostatistics; Hans Lilja, Dept, of Laboratory Medicine and Surgery and an investigator on the European Randomized Study of Prostate Cancer screening (ERSPC); and Peter Scardino, chair, Dept. of Surgery.

The MSKCC team states, “There is clear evidence that screening with a PSA test can reduce the number of deaths from prostate cancer. Many men with cancers detected by the PSA test are treated even though their cancer is not aggressive and would not become apparent during the course of their natural lives if it was not detected by screening." Dr. Scardino adds, “Better markers as well as smarter forms of the PSA test are rapidly becoming available (Prostate Health Index, 2ProPSA, and a panel of 4 markers) and are proving to be much more specific than PSA while remaining as sensitive. These new assays are currently being commercialized, and we should have access to these tests in the next year or so."

Active surveillance – “If you end up doing the biopsy for whatever reason (based on the PSA or DRE) think carefully before you recommend radical therapy for that treatment. Often you can put the patient on active surveillance and the risk that a cancer will grow and become serious over time is very low. We should always stop and think about active surveillance instead of active treatment. If we do those things, we will continue to save the lives of men while reducing the number of false-positive tests and reducing overtreatment.“

“The benefit is becoming more certain, and we can eliminate harm if we screen much smarter and much less intensively."


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Peter T. Scardino, MD, FACS
Chair, Department of Surgery; David H. Koch Chair

scardinoAs Chairman of the Department of Surgery, Dr. Scardino oversees a department widely recognized for its expertise and innovation in cancer surgery. In addition to his administrative responsibilities, he is a surgeon specializing in prostate cancer. His expertise is in early detection, prognosis, and surgical treatment of prostate cancer. Radical prostatectomy — complete removal of the prostate — can cure many men with prostate cancer. His team has developed surgical techniques to preserve urinary and sexual function after prostatectomy, and they continue to seek ways to improve quality of life for patients after treatment.

Not all prostate cancers progress in the same way. Many cancers pose little or no threat to life and health, while others grow aggressively and are resistant to treatment. He and his colleagues have pioneered the use of statistical models to predict both the natural progression of prostate cancer and how it will respond to treatment. These predictive tools (nomograms) help them tailor treatment for individual men according to the specific characteristics of their cancer. Today, nomograms are being used to help physicians and patients make medical decisions regarding a variety of other cancers as well, including pancreatic, lung, and breast cancer.

In 2001, he received an NIH grant to establish an ongoing Specialized Program of Research Excellence (SPORE) in prostate cancer at Memorial Sloan-Kettering Cancer Center. His SPORE has an ambitious research program focused on developing therapies appropriate for patients with different types of prostate cancer at different stages of development. The group hopes to achieve this by using molecular and genetic data to improve their prediction models for prostate cancer, identifying the critical mechanisms by which prostate cancer grows and spreads, and developing drugs and immunological techniques for treatment-resistant metastatic cancers.

His position at Memorial Sloan-Kettering includes appointments as head of the Prostate Cancer Program, member in the Sloan-Kettering Institute's Molecular Pharmacology and Chemistry Program; and the incumbent of the David H. Koch Chair. He is also a professor in the Department of Urology at Weill Cornell Medical College and at SUNY Downstate Medical Center.

He has written many articles and book chapters and edited the Comprehensive Textbook of Genitourinary Oncology. In 2005, with Judith Kelman, he wrote Dr. Peter Scardino's Prostate Book, a guide to prostate cancer, prostatitis, and benign prostate hyperplasia (BPH). He serves as editor-in chief of Nature Clinical Practice Urology, and is an editorial board member and reviewer for several peer-reviewed journals. He is an active member of the National Academies' Institute of Medicine and of the American Urological Association.