Pictured: Professor of Family Medicine and Public Health Sciences Jinping Xu, M.D.
Prostate cancer is the most commonly diagnosed non-skin cancer in men, with most cases detected by a blood test that measures prostate-specific antigen, or PSA, said physician and Wayne State University Professor of Family Medicine and Public Health Sciences Jinping Xu, M.D., M.S., F.A.A.C.P.
Ninety percent of PSA screen-detected prostate cancers are localized; more than half are low-risk, small-volume tumors unlikely to become life-threatening. Aggressive treatments like surgery or radiation may provide little survival benefit for such tumors while putting men at risk of substantial adverse effects, including impotence, urinary incontinence and bowel problems, Dr. Xu added. However, the majority of the men, including African-Americans in particular, receive aggressive therapy instead of active surveillance. She wants to find out why.
Dr. Xu was awarded a one-year, $56,000 award from the DMC Foundation to launch "Radiation Oncologists' Treatment Recommendations for Low-Risk Prostate Cancer," a survey of radiation oncologists in Michigan and Georgia. The physicians will share their views and experiences using active surveillance instead of radiation therapy for the management of patients newly diagnosed with low-risk prostate cancer.
Dr. Xu's most recent work in Detroit, couple with other published papers, found that a physician's recommendation, specifically that of an urologist or radiation oncologist, has the largest influence on a patient's treatment choice. The results should give physicians a more complete understanding of the major driving forces behind patient-driven treatment decisions and active surveillance adoption.
The data may also serve as a foundation for the design and implementation of culturally-sensitive targeted interventions to decrease overtreatment, improve quality of life and reduce racial disparities in prostate cancer outcomes. The survey results will be "particularly relevant to black men who are traditionally more likely to choose radiation therapy, and who have a disproportionally large burden of prostate cancer compared to white men," she said.
AS appears to be safe and effective, and has been included in practice guidelines as an appropriate - sometimes preferred - initial strategy for low-risk LPC.
"Decreasing overtreatment and its associated morbidity in men with low-risk localized prostate cancer is a critically important public health issue given the large number of men affected and the high risk for adverse outcomes. Active surveillance offers the opportunity to delay or avoid curative treatment and associated side effects unless the cancer progresses," she added.
The researchers will survey all practicing radiation oncologists from the same geographic areas as patients of an ongoing study from the National Cancer Institute's Surveillance, Epidemiology and End Results Program, pathologist reports and local professional societies.
Her team is also surveying men and their urologists to uncover the determinants of treatment decisions in men with newly diagnosed low-risk LPC using a six-year grant from the American Cancer Society.
"I am thrilled to have this funding from DMC Foundation that enable us to better understand the perspective and role that radiation oncologists play in the selection of active surveillance option for men who are newly diagnosed with low-risk prostate cancer," Dr. Xu said. "These physicians were not included in our original ACS-funded study of prostate cancer patients and their urologists. By adding the perspective of radiation oncologists, we can have a more complete picture of the influences in the selection of treatment options."
Dr. Xu's co-investigators include the Department of Oncology Division of Radiation Oncology's Steven Miller, M.D.; the Department of Oncology's Cathryn Bock, Ph.D.; the Department of Family Medicine and Public Health Sciences James Janisse, Ph.D.; and Kendra Schwartz, M.D.; and Michael Goodman, M.D., from Emory University in Atlanta.
The DMC Foundation is dedicated to promoting the well-being of people in the metropolitan Detroit area through the support of health-related research, education and community benefit activities. Formerly known as the Health & Wellness Foundation, it was created in 2010 to receive part of the charitable assets transferred from the Detroit Medical Center following its sale to the company that became part of Tenet Healthcare Corp. in October 2013. The DMC Foundation affiliated with the Community Foundation for Southeast Michigan that same year.