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What a urologist wants you to know about prostate screening

What a urologist wants you to know about prostate screening

CNN22-05-2025

EDITOR'S NOTE: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and an assistant professor at the University of Central Florida's College of Medicine.
When I learned that former President Joe Biden had not undergone prostate-specific antigen (PSA) screening since 2014—and was later diagnosed with metastatic prostate cancer—I knew there would be renewed interest and debate about prostate cancer screening guidelines.
As a urologist, I regularly discuss the complexities surrounding PSA testing with my patients. The PSA test remains valuable for early detection, but it continues to generate controversy due to its limitations. Here's what you should know about PSA screening, why medical guidelines vary and why individualized approaches are essential.
Prostate-specific antigen, or PSA, is a protein produced by the prostate. The PSA blood test measures this protein to help screen for prostate cancer. Typically, a PSA level above 4 on lab results is flagged as 'abnormal,' prompting further evaluation. However, even PSA numbers below 4 can be concerning if they're rapidly increasing. That's why PSA tests are done annually: to monitor trends over time.
Elevated PSA levels don't always mean cancer. Noncancerous conditions like an enlarged prostate, prostatitis (inflammation), recent ejaculation, stress or even strenuous activity can temporarily raise PSA. Ultimately, the PSA level is just a starting point for a deeper investigation (or conversation).
Additionally, not all prostate cancers cause elevated PSA levels. Some aggressive cancers may produce normal PSA results. Ultimately, the PSA level is a starting point for further evaluation and deeper conversations with your doctor.
The controversy around PSA testing isn't really about the test itself, but about how its results are interpreted and acted upon. Before 2012, PSA screening was routinely recommended for all men over age 50. I completed my urology training that same year, witnessing firsthand how dramatically the screening landscape changed almost overnight.
In 2012, the U.S. Preventive Services Task Force (USPSTF) recommended against routine PSA screening due to concerns of 'overdiagnosis.' The worry was that screening could detect slow-growing cancers that may never cause harm but still result in unnecessary biopsies, anxiety, and treatments—some of which caused more harm than good.
The recommendation led doctors to scale back, causing routine PSA testing to decline sharply. However, by 2018, new research and rising concerns about aggressive prostate cancers led the USPSTF to revise their recommendations again, advising men aged 55 to 69 to engage in shared decision-making with their providers.
This current stance emphasizes personalized discussions between patients and doctors, acknowledging that there's no one-size-fits-all approach to PSA testing. According to their website, the USPSTF is now working on another update, so we can expect further adjustments in the near future.
As someone who experienced this shift firsthand early in my career, I deeply appreciate how critical shared decision-making and patient involvement are in navigating these complex screening choices. These ongoing changes in recommendations have also reinforced the importance for me as a physician to stay informed, continuously adapting my practice as new research and technologies emerge.
Several organizations provide prostate cancer screening guidelines, including the USPSTF, the American Cancer Society and the American Urological Association (AUA). Each offers slightly different recommendations for both patients and health care providers. The USPSTF generally focuses on minimizing potential harm from overtreatment, while the AUA provides detailed, individualized recommendations based on clinical factors and risk profiles.
Even after practicing urology for more than a decade, I still sometimes find it challenging to navigate these subtle differences in guidelines. Although I primarily follow the AUA guidelines—my overarching professional body—I've established a balanced approach that feels comfortable for me and, I believe, best serves my patients' interests.
I start PSA testing at age 40 for men at higher risk, such as African Americans or those with a first-degree family member who has prostate cancer. For most patients, I typically initiate annual PSA screening at age 50.
It's important to know that primary care doctors perform most prostate cancer screenings. Depending on their training, clinical judgment and professional guidelines, their approach may differ slightly from my take as a urologist. This highlights the importance of clear communication among you the patient, your primary care provider and your specialists. Only through these conversations can we create personalized screening strategies that align with your health goals.
President Biden's case raises a question: Could earlier PSA screening have detected his cancer sooner, at a more treatable stage? We will never know for certain. According to current guidelines, stopping screening in one's 70s is considered appropriate. Perhaps there was a shared decision to stop testing. From a guideline perspective, nothing was necessarily done incorrectly. Still, Biden's diagnosis highlights the potential consequences of discontinuing prostate screening for an otherwise healthy older adult.
Men in the United States now have an average life expectancy of approximately 76 years, with many living healthy, active lives well into their 80s and beyond. Older guidelines based on shorter lifespans now need updating to reflect today's longer, healthier lives. I believe that decisions about prostate screening in older adults should thus focus more on individual health status rather than chronological age alone.
Changing guidelines based on longer life expectancy will require thorough research and evidence-based data. Consequently, updates to recommendations will take time. What you can do in the meantime is be proactive in your conversations with your doctors about not just prostate cancer screenings but all cancer screenings.
Prostate cancer isn't the only medical condition subject to evolving guidelines. Screening recommendations for colorectal and breast cancers have also changed recently. Colon cancer screening now generally starts at age 45 instead of 50 due to rising cases among younger adults.
Breast cancer guidelines continue to vary among organizations, but the USPSTF updated its recommendation last year to say that most women should start getting mammograms earlier. These frequent shifts reflect ongoing research and the importance of personalized, informed conversations between patients and health care providers.
Historically, an elevated PSA test led directly to a prostate biopsy, potentially causing unnecessary anxiety and sometimes overtreatment. Today, however, we have more advanced PSA-based tests that help better identify significant prostate cancers. Advanced imaging, like prostate MRI, allows us to pinpoint suspicious areas before performing a biopsy, increasing accuracy and decreasing unnecessary procedures.
Biopsy techniques have also improved, some shifting from traditional transrectal biopsies to transperineal methods, reducing infection risks. Treatments have similarly evolved, emphasizing active surveillance of low-risk cancers and minimally invasive focal therapies. These advancements have significantly reduced side effects and improved quality of life, even among older patients.
In my office, I frequently discuss PSA screening with patients who are over 70. If a patient remains active and healthy and we anticipate good life expectancy, I generally recommend that we continue regular PSA tests. However, the final decision always belongs to the patient, after we carefully weigh the pros and cons together.
If your doctor hasn't initiated this conversation yet, it's important for you to bring it up. And remember, regardless of age, promptly inform your health care provider about any new urinary symptoms or health concerns. Staying proactive gives you the best chance to maintain good health this year and next.

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A woman's heart suddenly stopped. Two passing nurses saved her life.
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A woman's heart suddenly stopped. Two passing nurses saved her life.

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While Epogen and Neupogen addresses anemia and neutropenia, no therapy has existed for the treatment of lymphopenia until ANKTIVA® –The Cancer BioShield. Landmark overall survival benefit (P-value 0.005, HR: 0.46 [0.26, 0.80]) observed in 3rd-6th line metastatic pancreatic cancer, correlated with reversal of lymphopenia. Patients with lower tumor burden and improved lymphocyte counts (ALC ≥1,000) had a median overall survival of 10.1 months, supporting earlier intervention in the disease course. CULVER CITY, Calif., June 03, 2025--(BUSINESS WIRE)--ImmunityBio, Inc. (NASDAQ: IBRX) today announced results presented at ASCO 2025 of the first known treatment for lymphopenia with ANKTIVA and CAR-NK therapy. This data supports that reversal of lymphopenia, a well-established root cause of early mortality in patients with cancer across all tumor types, correlates with significant improved survival. 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In subjects with lymphopenia rescue and a lower tumor burden (less than the median CA19-9 of 34,000 IU/mL), the median overall survival in these very advanced metastatic pancreatic cancer patients exceeded 10 months (Figure 2). These findings of improved survival in pancreatic cancer patients with lower tumor burden point to the potential of further prolonged overall survival in pancreatic cancer patients if treated in the first line or neoadjuvant stages of disease. Highlighting the importance of lymphopenia reversal, Oncologist published a peer-reviewed paper titled "Recurrent pancreatic cancer treated with N-803 and PD-L1 t-haNK followed by an EGFR-targeted nanocell drug conjugate," demonstrating that in a patient with 2nd line metastatic pancreatic cancer treated with the full Cancer BioShield platform—including ANKTIVA, CAR-NK cells (PD-L1 t-haNK), and antigen-targeting adenoviruses—remained in remission for over six years and maintains a high quality of life at the date of this release. The expanded access authorization announced yesterday enables patients across all solid tumor types who have exhausted first-line therapy including chemotherapy, radiation, or immunotherapy to receive Anktiva as a lymphocyte stimulating agent to protect the immune system from the lymphogenic adverse effects of current standards of care. The ASCO Annual Meeting 2025 materials from ImmunityBio can be found below: Association of lymphopenia rescue and CA19-9 levels with overall survival following IL-15 superagonist N-803 and PD-L1 t-haNK chemo-immunotherapy for 3rd line or greater metastatic pancreatic Text: Poster PDF: About the Cancer BioShield™ Platform The Cancer BioShield platform is a first-in-class immunotherapy strategy designed to restore immune competence by reversing lymphopenia—the loss of functional immune cells caused by cancer itself and by conventional treatments such as chemotherapy, radiation and immunotherapy. At its core is ANKTIVA® (nogapendekin alfa inbakicept-pmln), an IL-15 agonist approved for BCG-unresponsive non-muscle-invasive bladder cancer CIS with or without papillary disease, activates and proliferates natural killer (NK) cells and CD4+ and CD8+ T cells, restoring lymphocyte levels critical for immunosurveillance, immunogenic cell death, and long-term tumor control. The platform employs a multi-modal approach: In-vivo stimulation: Subcutaneous administration of ANKTIVA expands NK and T cells, boosting anti-tumor immunity. Ex-vivo targeted cytotoxicity: Off-the-shelf PD-L1 t-haNK CAR-NK cells are engineered to target and eliminate PD-L1–expressing tumor cells and immunosuppressive neutrophils (myeloid-derived suppressor cells), enhancing anti-tumor specificity and reducing immune evasion. Memory Cytokine-Enriched Natural Killer (M-ceNK) cell therapy: M-ceNK cells are developed via cytokine activation and expansion of autologous and allogeneic NK cells collected through apheresis, potentially providing long-term immune memory and sustained cytotoxic capacity. Together, these components offer a comprehensive, novel, immune-restoring therapeutic platform aimed at not only expanding effector immune cells but also overcoming tumor-mediated immune suppression to support long-term disease control. The platform's effectiveness can be tracked through universally utilized, simple complete blood count (CBC): increases in absolute lymphocyte count (ALC) reflect ANKTIVA's lymphocyte-stimulating activity, while reductions in the neutrophil-to-lymphocyte ratio (NLR) demonstrate PD-L1 t-haNK's immunosuppressive neutrophil targeting. Low ALC and high NLR levels are laboratory measurements that have been extensively reported as predictive biomarkers of poor prognosis with early mortality across all tumor types5,6. The data presented by ImmunityBio for the first time demonstrates that improving ALC and NLR correlates with significant enhanced overall survival and clinical benefit. About Lymphopenia and Absolute Lymphocyte Count (ALC) Lymphopenia—the loss of key immune cells such as NK, CD4+, and CD8+ T cells—is a common side effect of chemotherapy1, radiation2,3, and some immunotherapies4. Unlike anemia and neutropenia, which have FDA-approved treatments like EPO and Neupogen, no therapy previously existed to treat this immune cell depletion. Lymphopenia weakens the immune system, increases infection risk, and is linked to early death across many cancer types5. Low Absolute Lymphocyte Count (ALC) is a recognized poor prognostic marker. ANKTIVA® is the first approved therapy to restore lymphocyte levels by activating and expanding NK and T cells—without increasing immunosuppressive T regulatory cells7. More information on lymphopenia could be found on Twitter/X @DrPatSoonShiong articles here: References: Ray-Coquard I, et al. Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Cancer Res. 2009 Jul 1;69(13):5383-91. doi: 10.1158/ Epub 2009 Jun 23. PMID: 19549917; PMCID: PMC2775079. Chen D, et al. Absolute Lymphocyte Count Predicts Abscopal Responses and Outcomes in Patients Receiving Combined Immunotherapy and Radiation Therapy: Analysis of 3 Phase 1/2 Trials. Int J Radiat Oncol Biol Phys. 2020 Sep 1;108(1):196-203. doi: 10.1016/ Epub 2020 Feb 7. Pike LRG, et al. The Impact of Radiation Therapy on Lymphocyte Count and Survival in Metastatic Cancer Patients Receiving PD-1 Immune Checkpoint Inhibitors. Int J Radiat Oncol Biol Phys. 2019 Jan 1;103(1):142-151. doi: 10.1016/ Epub 2018 Sep 15. PMID: 30227198. Lee, Y.J., et al. Peripheral lymphocyte count as a surrogate marker of immune checkpoint inhibitor therapy outcomes in patients with non-small-cell lung cancer. Sci Rep 12, 626 (2022). Ménétrier-Caux C., et al. Lymphopenia in Cancer Patients and its Effects on Response to Immunotherapy: an opportunity for combination with Cytokines? J Immunother Cancer. 2019 Mar 28;7(1):85. doi: 10.1186/s40425-019-0549-5. PMID: 30922400; PMCID: PMC6437964. Templeton AJ, et al. Prognostic role of neutrophil-to-lymphocyte (NLR) ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014 May 29;106(6):dju124. doi: 10.1093/jnci/dju124. PMID: 24875653. FDA ANKTIVA Label, April 2024 - About ImmunityBio ImmunityBio is a vertically-integrated biotechnology company developing next-generation therapies and vaccines that bolster the natural immune system to defeat cancers and infectious diseases. The Company's range of immunotherapy and cell therapy platforms, alone and together, act to drive and sustain an immune response with the goal of creating durable and safe protection against disease. Designated an FDA Breakthrough Therapy, ANKTIVA is the first FDA-approved immunotherapy for non-muscle invasive bladder cancer CIS that activates natural killer cells, T cells, and memory T cells for a long-duration response. The Company is applying its science and platforms to treating cancers, including the development of potential cancer vaccines, as well as developing immunotherapies and cell therapies that we believe sharply reduce or eliminate the need for standard high-dose chemotherapy. These platforms and their associated product candidates are designed to be more effective, accessible, and easily administered than current standards of care in oncology and infectious diseases. For more information, visit (Founder's Vision) and connect with us on X (Twitter), Facebook, LinkedIn, and Instagram. Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, such as statements regarding clinical trial data and potential results and implications to be drawn therefrom, the expectation that the EAP described herein will enable access to ANKTIVA for patients across all solid tumor types who have exhausted first-line therapy including chemo, radiation or immunotherapy, the RMAT designation as previously reported and potential results therefrom and regulatory submissions in connection therewith, the belief that ALC levels and NLR levels obtained from a CBC are predictors of clinical benefit and outcomes relating to overall survival, the belief that improving ALC levels and NLR levels correlates with enhanced overall survival and clinical benefit, the belief that reversal of lymphopenia correlates with improved survival, clinical trial and expanded access program enrollment, data and potential results to be drawn therefrom, anticipated components of ImmunityBio's Cancer BioShield platform, the development of therapeutics for cancer and infectious diseases, potential benefits to patients, potential treatment outcomes for patients, the described mechanism of action and results and contributions therefrom, potential future uses and applications of ANKTIVA alone or in combination with other therapeutic agents for the prevention or reversal of lymphopenia, potential future uses and applications of ANKTIVA alone or in combination with other therapeutic agents across multiple tumor types and indications and for potential applications beyond oncology, potential regulatory pathways and the regulatory review process and timing thereof, the application of the Company's science and platforms to treat cancers or develop cancer vaccines, immunotherapies and cell therapies that has the potential to change the paradigm in cancer care, and ImmunityBio's approved product and investigational agents as compared to existing treatment options, among others. Statements in this press release that are not statements of historical fact are considered forward-looking statements, which are usually identified by the use of words such as "anticipates," "believes," "continues," "goal," "could," "estimates," "scheduled," "expects," "intends," "may," "plans," "potential," "predicts," "indicate," "projects," "is," "seeks," "should," "will," "strategy," and variations of such words or similar expressions. Statements of past performance, efforts, or results of our preclinical and clinical trials, about which inferences or assumptions may be made, can also be forward-looking statements and are not indicative of future performance or results. Forward-looking statements are neither forecasts, promises nor guarantees, and are based on the current beliefs of ImmunityBio's management as well as assumptions made by and information currently available to ImmunityBio. Such information may be limited or incomplete, and ImmunityBio's statements should not be read to indicate that it has conducted a thorough inquiry into, or review of, all potentially available relevant information. Such statements reflect the current views of ImmunityBio with respect to future events and are subject to known and unknown risks, including business, regulatory, economic and competitive risks, uncertainties, contingencies and assumptions about ImmunityBio, including, without limitation, (i) risks and uncertainties regarding the FDA regulatory submission, filing and review process and the timing thereof, (ii) whether the RMAT designation will lead to an accelerated review or approval, of which there can be no assurance, (iii) risks and uncertainties regarding commercial launch execution, success and timing, (iv) risks and uncertainties regarding participation and enrollment and potential results from the expanded access clinical investigation program described herein, (v) whether clinical trials will result in registrational pathways and the risks, (vi) whether clinical trial data will be accepted by regulatory agencies, (vii) the ability of ImmunityBio to continue its planned preclinical and clinical development of its development programs through itself and/or its investigators, and the timing and success of any such continued preclinical and clinical development, patient enrollment and planned regulatory submissions, (viii) potential delays in product availability and regulatory approvals, (ix) ImmunityBio's ability to retain and hire key personnel, (x) ImmunityBio's ability to obtain additional financing to fund its operations and complete the development and commercialization of its various product candidates, (xi) potential product shortages or manufacturing disruptions that may impact the availability and timing of product, (xii) ImmunityBio's ability to successfully commercialize its approved product and product candidates, (xiii) ImmunityBio's ability to scale its manufacturing and commercial supply operations for its approved product and future approved products, and (xiv) ImmunityBio's ability to obtain, maintain, protect, and enforce patent protection and other proprietary rights for its product candidates and technologies. More details about these and other risks that may impact ImmunityBio's business are described under the heading "Risk Factors" in the Company's Form 10-K filed with the U.S. Securities and Exchange Commission (SEC) on March 3, 2025, and the Company's Form 10-Q filed with the SEC on May 12, 2025, and in subsequent filings made by ImmunityBio with the SEC, which are available on the SEC's website at ImmunityBio cautions you not to place undue reliance on any forward-looking statements, which speak only as of the date hereof. View source version on Contacts ImmunityBio Contacts: Investors Hemanth Ramaprakash, PhD, MBA ImmunityBio, Inc. +1 Media Sarah Singleton ImmunityBio, Inc. +1 Sign in to access your portfolio

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