During the first session of PHEN’s 2025 Prostate Cancer Disparity Summit, numerous medical experts came together to participate in the What Is Needed Today to Meet the Early Detection of Prostate Cancer Challenge panel discussion. PHEN President Thomas Farrington introduced the panel, which included:
- J. Jacques Carter, MD, MPH, Primary Care Physician, Harvard Medical School
- Keith Crawford, MD, PhD, Director of Clinical Trials and Patient Education, PHEN
- Bettina F. Drake, PhD, MPH, Michael F. Neidorff Professor, Division of Public Health Sciences, Washington University School of Medicine
- Marc B. Garnick, MD, Gorman Brothers Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
- Leslie Deane, MD, FACS, MS, Professor & Chief, Howard University Hospital
- Waseem Hussain, MD, Primary Care Physician, Luminis Health
Awareness and early detection of prostate cancer are crucial. There are significant gaps in care from primary care doctors, especially regarding PSA tests. Outdated guidelines from the US Preventive Services Task Force affect screening recommendations. The discussion highlights the importance of age-adjusted PSA levels, medications for prevention, and the role of primary care physicians. Recommendations include early screening for black men starting at age 40 and the need for regular prostate examinations.
Prostate cancer testing is “one of the most complicated issues in medicine that oncologists face on a day-to-day basis,” explained Dr. Garnick. “The taskforce has had the most important and widely used guidelines. [However,] the NCCN guidelines are much more detailed [and] very often used by medical oncologists. I’m very discouraged that 2018 was the last year that the taskforce provided recommendations.”
“When the narrative is that those 55 and over have a PSA test until age 69, that is doing our country a disservice. [Yet,] a PSA test, frankly has a very high false positive rate,” stated Dr. Hussain. “We don’t want our patients to get that false positive. The testing has to get better.”
Dr. Hussain explained that prostate cancer testing has improved in recent years, as patients are now recommended to have an MRI if they receive an abnormal PSA test result instead of immediately undergoing a biopsy. If the MRI shows a problem, then patients undergo a biopsy to receive a final diagnosis.
“We need to really set the expectation that the default position is not to do a biopsy [first], but there are other intervals in between,” said Dr. Deane. “So, when we do a biopsy, the chance of finding something is much higher. Check biomarkers and MRI lesions. If these values are low, then you do not need to do a biopsy. I think some of these practices can halt overdiagnosis.”
“I believe insurers use the task force guidelines for screening,” Dr. Drake described. “Even medical school students are taught the task force’s system of grading for all types of cancer screening.”
Dr. Drake mentioned the importance of rethinking how the healthcare system trains future healthcare providers in terms of using cancer screenings.
