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OPINION

Vets closer to better prostate cancer tests, treatment

By DR. LEONARD GOMELLA | Special to Stars and Stripes | Published: August 14, 2019

Veterans are a higher risk group because of their sacrifices to protect our nation. Among patients at Department of Veterans Affairs facilities, prostate cancer accounts for over 31% of all cancer diagnoses, which is no surprise if you know the prevalence — 200,000 veterans are survivors and an estimated 12,000 new patients are diagnosed annually.

Thankfully, there has been significant innovation in improving early detection of cancer. The use of advanced genomic tests is helping better determine a veteran’s risk of harboring undetected prostate cancer.

A prostate biopsy is the only way a doctor is able to diagnose prostate cancer. The procedure requires a physician to use a needle biopsy tool to remove 12 small prostate samples through the patient’s rectum. However, since less than 1% of the prostate is biopsied, there is a possibility the biopsy needle simply missed cancer cells, which happens in about 25% to 35% of biopsies. Understandably, the possibility of missed cancer is stressful for men and their doctor.

Most men will die with prostate cancer rather than of prostate cancer. Even if prostate cancer is detected, it may be best for the patient to live with the disease if it is the non-aggressive form. Active surveillance, the process of monitoring rather than treating non-aggressive cancer, may be recommended when the risks or side effects of cancer treatment (like surgery and radiation) outweigh their potential benefits.

Fortunately, the rapid evolvement of genomic testing is allowing urologists to detect cancer significantly earlier and make treatment decisions with more confidence. These tests can identify changes in DNA to confirm or rule out a suspected condition, such as cancer, or help determine a person’s risk of aggressive disease that needs to be treated right away. Precision medicine gives us — that is, both urologists and our patients — more information to make better clinical decisions.

While all of this innovation is incredible, it’s important for veterans to advocate for their health and the adoption of these tools by health systems, including the Veterans Health Administration. Some of the VHA’s biggest concerns — long wait times, cost, quality of care — can be addressed with the uptake of genomic testing. Given the significant number of veteran prostate cancer survivors, one of the biggest issues is overtreatment of non-aggressive prostate cancer. Urologists sometimes diagnose and overtreat men with slow-growing, non-aggressive cancer, which will likely never impact the patient’s daily life or health, who then undergo unnecessary treatment with unpleasant side effects.

VHA urologists now have access to better tools — there are currently many genomic tests for prostate cancer available to federal government health care providers including ConfirmMDx, SelectMDx, OncotypeDx and Prolaris.

For the second year in a row, the House Appropriations subcommittee on Military Construction, Veterans Affairs, and Related Agencies has directly encouraged the VHA to increase the use of prostate cancer biomarkers, particularly to address the common concern of false-negative biopsies, in its appropriations bill in both 2020 and 2019. This guidance from Congress opens the door for the use of precision medicine in VHA settings. Unfortunately, the widespread adoption of genomic tests in the VHA has been slow.

If prostate cancer is detected early, the five-year survival rate is nearly 100%. However, the five-year survival rate drops to 30% if the cancer has metastasized. Let’s face it — men often forget to prioritize their health, so getting fast, accurate results to drive down repeat appointments is critical to the health outcomes of thousands of veterans each year.

Urologists are unified behind one goal: to limit and ultimately eliminate the risk of death from prostate cancer by using precision medicine to identify men who are at an increased risk for developing aggressive, life-threatening forms of prostate cancer that need treatment.

For the largest integrated health care system in the U.S., change isn’t easy. However, with Congress recognizing the benefits of genomic tests and making these recommendations, we need to support the VHA in using these cost-efficient, life-saving tests. Veterans at risk of prostate cancer can be their own best advocates, and I encourage them to ask their physicians about genetic testing, no matter where they are on their prostate cancer diagnosis journey.

Dr. Leonard Gomella is the Bernard W. Godwin Jr. Professor of Prostate Cancer and Chairman of the Department of Urology at Jefferson Medical College in Philadelphia. He is also associate director for clinical affairs for the Sidney Kimmel Cancer Center at Jefferson and urology chairman for Radiation Therapy Oncology Group, serving as lead urology investigator on multiple national trials. Dr. Gomella is a paid adviser for MDxHealth.

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