Dear Dr. LeBlanc,
Thank you for your reply earlier this fall and for providing the linked documents. On page 7 of the NYS Comprehensive Cancer Control Plan, prostate cancer is listed as the #1 diagnosed solid tumor malignancy in New York State men and the #2 cause of death. The lack of a universally accepted screening tool should not be the basis to exclude a malignancy of that potential source of morbidity and mortality from a public awareness campaign. As you well know, the USPSTF based their 2012 recommendations regarding PSA-based prostate cancer screening on two largely flawed studies (PLCO and ERSPC) which were underpowered and poorly controlled. Death from prostate cancer dropped 50% since the advent of PSA testing and still technology and knowledge advance. PSA testing has become more refined and and the focus is to identify the risk of clinically significant cancers (i.e. Gleason grade group 2 or higher) not just simply the task of finding ‘any’ prostate cancer. As such, urologists work to stratify patients for their risk of significant prostate cancer using familial and genetic tools (e.g. BRCA2, p10 deletions), PSA isoform panels such as the 4K score and Prostate Health Inventory (PHI), and, when indicated, multiparametric MRI of the prostate, the first imaging approach that reliably identifies clinically signficant foci of prostate cancer that may merit targeted biopsy. No assessment of prostate cancer risk, however, can be performed unless patients and stake holders have access to adequate and available information, including PSA testing, and as such would benefit from the kind of coordinated, multisystem effort such as the Department of Health can undertake. The lack of any such effort, especially for high risk portions of the state, may be doing a disservice to those men who are currently unaware of their potential for having life threatening prostate cancer. We ask that the Department of Health reconsider their including prostate cancer and current practice guidelines regarding its risk assessment in the NYS Prevention Agenda.
John Phillips, MD, FACS
Professor, Department of Urology, New York Medical College Program Director, Westchester Medical Center President, New York State Urological Society