Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine’s Game Changer vehicles, which bring health education and free screenings for many cancer types to South Florida communities in need, are for the first time offering prostate-specific antigen (PSA) screening for prostate cancer.
“When we catch prostate cancer in the early stages, there is a 95% chance that we can cure it. But when you catch prostate cancer when it has spread beyond the prostate, there is only a 25% to 30% chance of survival at five years,” said Brandon Mahal, M.D., assistant professor of radiation oncology at Sylvester. “The PSA is the best screening test that we have in terms of being able to catch cancer early and being able to cure it.”
Black men are at especially high risk for prostate cancer, which makes PSA testing via Sylvester’s mobile units in communities like Little Haiti even more important, according to Dr. Mahal.
The PSA is a simple blood test. Men who get their PSA screenings on the Game Changer will usually have their results within 24 hours. They will not be charged for Game Changer PSA screenings, and those whose results indicate further care will be counseled and referred to locations where they will have access to care, Dr. Mahal said.
“The Sylvester Office of Outreach and Engagement team and the Game Changer program have been providing cancer prevention and screening services to the South Florida community for several years,” said Paco C. Castellon, M.P.H., M.B.A., director of Sylvester’s Community Outreach and Engagement Program. “A critical component of our program since its inception is ongoing, bidirectional engagement with our community stakeholders to understand the needs of the South Florida community. It was through this ongoing engagement with the community that we learned of the community’s interest in prostate cancer screening.
“This initiative, which is a collaboration between Sylvester Comprehensive Cancer Center, the organizations represented in the Southeast Florida Cancer Control Collaborative, and ZERO – The End of Prostate Cancer, highlights the importance of strong community-academic partnerships in addressing the needs of the community, with the objective of achieving health equity,” Castellon said.
ZERO — The End of Prostate Cancer is a national nonprofit with the mission to end prostate cancer and help those who are impacted by it.
"We are collaborating with Sylvester on the Game Changer prostate cancer screening program because it is our mission to create solutions to achieve health equity to meet the most critical needs in the community,” said Reggie Tucker Seeley, Sc.D., vice president of health equity at ZERO – The End of Prostate Cancer.” This program helps to address prostate cancer disparities by increasing awareness about prostate cancer through our education materials and resources, by providing free PSA screenings through the Game Changer vehicles, and by connecting men to Sylvester if they need follow-up care following screening.”
Sylvester’s mobile PSA screening program is one of only two in the U.S. that Dr. Mahal is aware of. The other started this year at Mount Sinai in New York City.
Sylvester has also partnered with the Southeast Florida Cancer Control Collaborative (SFCCC), a voluntary organization made up of representatives from health care provider groups, community organizations, advocacy groups, and others interested in networking and education related to cancer control in Broward, Indian River, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach, and St. Lucie counties.
“We cannot control prostate cancer in Southeast Florida without addressing the disparities that exist in its detection,” said Pascale Auguste, who leads the SFCCC Disparities Work Group. “By incorporating PSA screening on the Game Changer vehicles, Sylvester will help increase the availability of prostate cancer screening in strategically selected locations and provide culturally appropriate education, both of which are critical to addressing racial disparities in the detection of prostate cancer in Black men.”
PSA Education Is Key
Recommendations for PSA screening have changed over the years, and many don’t know if or when PSA should be done.
“Recent research has suggested that a decrease in screening for prostate cancer has resulted in an increased incidence of men being diagnosed with metastatic and incurable disease,” said Sanoj Punnen, M.D., MAS, Pap Corps Champions for Cancer Research Endowed Chair in Solid Tumor Research, associate professor and vice chair of research, Desai Sethi Urology Institute, and co-chair of the Genitourinary Site Disease Group at Sylvester. “The Game Changer will allow us to take this valuable screening test to populations that are most at risk.”
Historically there was some controversy around PSA, according to Dr. Mahal.
“In particular in 2012, the United States Preventive Services Task Force (USPSTF) came out with a recommendation against PSA screening, a grade D recommendation, because two screening trials — one that was done in the U.S. and one in Europe — came out and showed at the time that the number of men needed to screen with PSA screening to save one man’s life was over 1,000,” Dr. Mahal said.
The USPSTF opined that having to screen so many men to save one life diminished the test’s value.
“The issue with that, and what a lot of prostate cancer experts were warning the task force about, was that prostate cancer takes a long time to become a problem. They based the initial recommendation on only seven years of follow-up on PSA studies,” Dr. Mahal said.
In addition, the task force — which didn’t have prostate cancer experts on it — was concerned about overtreatment, but underestimated the number of men that can be safely observed on an active monitoring program called active surveillance, thereby avoiding overtreatment and the adverse effects related to it, according to Dr. Punnen.
The USPSTF changed its stance in 2018, after 13 years of follow-up showed that fewer than 800 men had to be screened to save one man’s life.
Today, the task force no longer recommends against PSA screening but leaves the decision to the doctor and patient, according to Dr. Mahal.
“Nearly all of the major cancer organizations, including the American Cancer Society, American Society of Clinical Oncology (ASCO), Prostate Cancer Foundation, and American Urological Association, recommend PSA screening predominately for men from ages 50 to 70 years, with the precise age range varying depending on the organization making the recommendations,” Dr. Mahal said. “These organizations also agree that higher risk men should probably start screening around age 45. So, on the Game Changer vehicles, we will be targeting high-risk men from ages 45 to 69.”
Sylvester’s Game Changer PSA program has caught the attention of the principal investigator of the STAMPEDE prostate cancer trial, Nicholas James, MBBS, FRCP, FRCR, Ph.D., professor of clinical oncology at the Institute of Cancer Research at Royal Marsden Hospital in London.
“We’re collaborating with Dr. James and colleagues to develop a point-of-care PSA test on the mobile clinic, where we would have results right away. That has never been done before and is just beginning,” said Dr. Mahal.
The Game Changer vehicle offered the prostate cancer screening service on September 10 at La Respectable Loge in Miami, and on September 13 at the Center for Haitian Studies in Miami. The Game Changer will offer the service on Friday, September 23, from 9 a.m. to 1 p.m., at a back-to-school community event in Liberty City at 6304 NW 14th Avenue, Miami, Florida 33147.