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Personalized Care

May 17, 2018

Other than skin cancer, prostate cancer is the most common cancer in American men, with about one in nine being diagnosed during his lifetime. Available treatments are effective for many men, but scientists are just beginning to discover the best way to tailor care to the specific characteristics of each individual patient’s cancer.

“We physicians who treat prostate cancer are years behind breast cancer researchers in this knowledge,” said Sam S. Chang, MD, the Patricia and Rodes Hart Professor of Urologic Surgery and vice-chair of the Department of Urologic Surgery. “The ability to subcharacterize breast cancer based upon the molecular and genetic findings of each woman’s breast cancer is very, very helpful in terms of what treatment we should choose. We are just starting to scratch the surface to provide this level of individualized care with prostate cancer.”

Even PSA screening, the test that led to Orrin Ingram’s early diagnosis, is still being debated in the medical community. In 2012, the U.S. Preventive Services Task Force issued a recommendation against PSA screenings because of concerns about overtreatment, a decision that many urologists, including Chang, disagreed with.

“Dr. Dan Barocas (MD, MPH) led our efforts at Vanderbilt to demonstrate a significant downturn in men being screened and diagnosed with prostate cancer, and this contributed to an important change in 2017,” Chang said.

In December 2017, the U.S. Preventive Services Task Force updated its recommendation, ruling that the decision should be an individual one for men ages 55 to 69, made after talking with their doctor about the potential benefits and harms.

“If you look at the history of prostate cancer from the 1980s to now, there has been a significant decrease in men dying from prostate cancer,” Chang said. “We think a lot of that has to do with screening and early diagnosis. We understand that we overtreated a number of men in the past, undoubtedly, but screening has led to a significant decrease in men dying of prostate cancer. We think we are doing a better job of understanding who needs treatment, what kind of treatment that should be and when that treatment should be done.”