Drs. Robert Smith and Harmon Eyre on prostate cancer screening

ATLANTA, Georgia (CNN) -- A study in the Journal of the American Medical Association indicates that prostate cancer screening can benefit men younger than age 50, the typical age screening begins. The American Cancer Society plans to advise men who are at high risk for the disease to begin yearly screenings at age 45. Those at high risk include men with a family history of the disease and African-American men.

Dr. Harmon Eyre is chief medical officer for the ACS, and Dr. Robert Smith is director of cancer screening for the organization.

Dr. Robert Smith: Hello

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Find out more about earlier screening for prostate cancer

Dr. Harmon Eyre: Hello And thank you for having us.

Chat Moderator: How does the prostate-specific antigen (PSA) blood test aid in detecting prostate cancer?

Dr. Robert Smith: PSA is an antigen that is secreted by the prostate and it is a measure of inflammation, so it is an indication that a man may have cancer. It may also indicate other non-cancerous conditions such as prosatitis or benign prostatic hyperplasia and we look for the level of PSA as an indicator of concern that would lead us to do other tests. We can be concerned about a lower level in a young man (more) than we would in an older man, so while we use a conventional cut off of 4 nanograms/ml of PSA level and we would be more concerned about this in a 50-year-old man than a 75-year-old man.

Chat Moderator: Doctors Eyre and Smith are joining the chat via telephone from Atlanta, Georgia. CNN.com is providing a typist for them.

Question from Izekat: Dr. Smith, are there any other signs of prostate problems other than semen degradation?

Dr. Robert Smith: There are, certainly. When we test men for prostate cancer we also recommend a digital rectal exam be done where the provider can actually feel the prostate for signs of prostate cancer, which would primarily be felt as a hardening, a nodule, something that clearly is out of place, and prostate cancer is sometimes discovered because men are experiencing problems with urinating, lower back pain, and general discomfort in the lower pelvic area. These latter two things may be signs of disease that may have already progressed.

Dr. Harmon Eyre: We have learned from many years of experience that if men wait until they have symptoms of prostate cancer it is too late. Therefore, early detection is important to them, and they need to undergo these detection procedures with the annual blood PSA and annual digital rectal exam.

Question from Marc: I am 38 years old, and my father had prostate cancer at the age of 65. My doctor refuses to test me. Should I insist on getting a test?

Dr. Harmon Eyre: In general, men who have prostate cancer at age 65 who have sons would not need the sons tested at age 38, but (the sons) should be concerned and begin testing at age 45. Only (for) those who have prostate cancers in their fathers and brothers younger than age 50 would it be reasonable to begin testing at age 38.

Dr. Robert Smith: Let me add, however, that if this gentlemen were very concerned and wanted reassurance that there were no markers that would indicate that he be positive, if he would like that reassurance, he could go ahead and have the test. However, his doctor may be concerned first of all that this is a necessary medical expense and secondly, he may also be concerned about possible harms associated with treatment and therefore he could postpone testing until later.

Question from sun: What is the youngest age you've encountered with prostate cancer?

Dr. Harmon Eyre: The youngest man that I have seen with prostate cancer was 44. Prostate cancer occurs in men in their 40s, but it is uncommon.

Dr. Robert Smith: If you were to compare the numbers of prostate cancers with the numbers of breast cancers, breast cancer is a much more serious problem for women in their 40s than prostate cancer is for men.

Question from Susie-CNN: What is the rate of death from prostate cancer?

Dr. Harmon Eyre: Overall, a man in America has a 3 percent chance of dying of prostate cancer during his lifetime, and with current statistics a man has a 16 percent chance of being diagnosed with prostate cancer.

Chat Moderator: What can you tell us about this latest research about the use of PSA at earlier ages?

Dr. Harmon Eyre: The study that was reported in the journal of the American Medical Association represents an interesting hypothesis that should be further tested. (It is) based upon the fact that some men in their 40s would have higher PSA values and thereby need to be screened more often compared to the majority of men who have very low PSA values of less than 2 who could wait to be screened until they are after 50 years old.

Dr. Robert Smith: When we screen for any cancer, we are looking for a strategy that is built around how serious the disease is at a particular age, how effective our testing is, how much intervention -- early -- will make a difference in survival, and balances between the accuracy of the test and the numbers of diagnostic procedures and the cost of those procedures, both human and financial. The recent study was based on mathematical modeling. That is, the authors were exploring the range of possible scenarios and the task before us now would be to explore whether or not the model was correct for all the age groups of men to which it was targeted.

Question from greg: Those diagnostic statistics seem a little light -- otherwise why are we so concerned about prostate cancer in earlier stages?

Dr. Harmon Eyre: For men, prostate cancer is the most common cancer diagnosis and if the man does not smoke, it is the most common cause of death -- 1 out of 30 men will die of prostate cancer, which if detected early would be almost a zero chance of death if it was treated appropriately.

Dr. Robert Smith: The difference between 3.5 percent and 1 in 30 is a good example of how one statistic can sound low and the other can sound high. But it is important to keep in mind that we try to save lives in order to prevent a death that is going to occur earlier than it otherwise would. And a very simple blood test is a fairly straight-forward way to do that.

Question from greg: Is race being considered in that study? I doubt that African-American men are being diagnosed at an alarming rate.

Dr. Robert Smith: Actually, African-American men have about twice the incidence of prostate cancer as white men and the age of onset is earlier. So this kind of modeling could actually be very instructive for providing training for early detection strategies that better meet the needs of African- American men.

Chat Moderator: Are the results of this research conclusive enough for the American Cancer Society to change its guidelines for testing?

Dr. Robert Smith: No, they are not. But our guidelines are not and never have been, permanent. We evaluate new data annually, we include the world's experts in the process of evaluating the latest science, and when the consensus of opinion among these experts recommends to us that our early detection guidelines should be changed, then those changes become the new policy.

Question from gg2301: Do you think diet for a patient in remission from prostate cancer -- i.e. tomatoes, selenium -- does any good?

Dr. Harmon Eyre: We have some preliminary epidemiological evidence that diet plays an important role in prostate cancer but it is not clear yet whether diet modification after the diagnosis will change a person's outcome. It is very clear that men in America have diets that contain too much fat and too little fruits and vegetables and whole grain cereals, and improvement in diet is good for many diseases such as heart disease, cancer, diabetes and even arthritis if the weight is controlled.

Chat Moderator: Do you have any final thoughts for our audience today?

Dr. Robert Smith: This has been very interesting for us. We hope it has been interesting for your participants. But it is very important that I add that our guidelines for early detection of prostate cancer emphasize the opportunity for men age 50 and older to make an informed decision about testing. Treatment for prostate cancer may save your life, but it also carries known risks related to incontinence, and impotence. Because prostate cancers vary in their aggressiveness there may be some uncertainty about the need for treatment.

Dr. Harmon Eyre: Many of the questions for which we don't have good answers are going to be resolved through further research and all of the participants need to support our investment in research to solve the problems around prostate cancer.

Chat Moderator: Thank you, Doctors Eyre and Smith for joining us today.

Dr. Robert Smith: Thanks and good bye.

Dr. Harmon Eyre: Thank you for your interest. Good bye.

Drs. Robert Smith and Harmon Eyre joined the chat via telephone from Atlanta, Georgia. CNN.com provided a typist for them. The above is an edited transcript of the chat, which took place on Friday, September 22, 2000.

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