Balanced account of PSA debate in NZ Herald

NZ HERALD: The Herald’s medical reporter, Martin Johnston, has written a balanced account on where we are with the great PSA debate. READ MORE>

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Undetectable PSA! Yep, I’ll take it, thanks

PROSTABLOG NZ:  The PSA test may get a bad rap from epidemiologists and the Ministry of Health, but so far as I’m concerned it’s a winner.

It’s a reliable post-treatment indicator of whether your prostate cancer is coming back or not, and I’ve just had my two-year test – and it remains undetectable.

That’s very good news, so far as I can discern. My reading of things prostate tells me the two-year mark is a crucial one, a time when recurrence is most likely to rear its unwelcome head.

That doesn’t mean I’m cured. There’s a long way to go before that marker, perhaps a decade.

The only thing I’m not sure about is the fact my PSA never registered much (let alone any change) prior to my diagnosis in 2008.

Does that mean post-surgery PSA tests won’t work on me either.

Nah, let’s not dwell on it.

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New UK test distinguishes prostate cancer from healthy tissue

REUTERS: British scientists say they have developed a lab test that can accurately distinguish prostate cancer from healthy tissue and other prostate conditions. READ MORE>

Researchers at a genetics and diagnostics firm Oxford Gene Technology say the set of biological signals, or biomarkers, they have identified was able to distinguish healthy tissue and benign prostate disease from prostate cancer with 90 percent accuracy in initial laboratory sample tests.

A full test for use in doctors’ clinics is likely to be at least five years off, they said, but their pilot study testing around 130 samples showed encouraging results in a disease area where more accurate diagnostic tests are sorely needed.

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The confusion about PSA testing that exists between men and their GPs

NEW PROSTATE CANCER INFOLINK: It has been well understood for some time that there is confusion among men in general and among members of the primary care community about appropriate use of PSA testing. READ MORE>

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Recent research has moved prostate screening debate along

NEW PROSTATE CANCER INFOLINK: The debate about mass screening for prostate cancer has been moved on significantly by by some recent Swedish studies, writes Mike Scott:

Is there a simple take-away from these three Swedish studies that correlates to the data from the meta-analysis of the six major screening trials? We believe that there is, and it is based on a testable premise:

• All men should get a PSA test every 5 years starting at age 40, each of which is likely to be able to project a 25-year risk for diagnosis of prostate cancer and/or clinically significant prostate cancer.
• Men who are shown to be at no significant 25-year risk based on these 5-yearly PSA tests may not need to get interim PSA tests unless there are other reasons for them to do so (based on clinical signs and symptoms, ethnicity, genetics, and other known factors).
• Men who are shown to be at significant 25-year risk based on any one of the 5-yearly PSA tests should be encouraged to monitor their PSA with care over time in consultation with a prostate cancer specialist and make appropriate clinical decisions based on their individual data.

READ MORE>

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Prostate screening misses out in Obama’s new health insurance

ASSOCIATED PRESS: Screening for prostate cancer will not be included in President Obama’s new preventive health insurance next year. READ MORE>

New health insurance policies beginning on or after September 23 must cover — without charge — preventive care that’s backed up by the best scientific evidence. Most people will see this benefit, part of the Obama administration’s health care overhaul, starting January 1.

The list includes tests strongly recommended by the US Preventive Services Task Force, an independent advisory panel that evaluates research.

Of note for men: Screening for prostate cancer isn’t included on the list because its benefits haven’t been conclusively shown by the best research, at least to the high level required by the law.

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Men with low PSA at 60 unlikely to die from prostate cancer

BRITISH MEDICAL JOURNAL: Men with a low PSA score at the age of 60 probably face little risk of dying from prostate cancer – even if they have it already, a new study claims. READ MORE>

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Auckland health group pitches prostate cancer decision aid to NZ Parliament’s inquiry

NZ DOCTOR: Harbour Health PHO told the NZ Health Select Committee yesterday [15 September] it is just weeks away from testing an electronic decision-support tool, which describes a care pathway for the assessment and management of prostate health. READ MORE>

Men and their GPs are often confused by the conflicting messages about prostate cancer, Dr Lannes Johnson (Harbour Health PHO medical director) told the committee.

“On one hand we tell GPs not to screen for prostate cancer; on the other, we say, every man has the right to testing and advice.

“The controversy has not been resolved by the evidence-based medicine approach…But sensible decisions can be made in primary care even without consensus between urologists, oncologists or epidemiologists.

“We really cannot leave things as they are.”

PROSTABLOG NZ:  Decision aids to assist men make choices about prostate cancer treatment have been around a while, but have only recently been adapted for use via the internet.

The Australians announced in July good results with one designed for men with prostate cancer in their families. READ MORE>

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Prostate inquiry needs to be wary of way Swedish screening findings are being interpreted

PROSTABLOG NZ: The debate within medical circles about the benefits – or not – of mass screening for prostate cancer just got a little more foggy in NZ.

Parliament’s Health Select Committee inquiry into prostate cancer was due today to hear from Lannes Johnson, medical director for the Harbour Health PHO, who – if a report in last week’s NZ Doctor magazine/website is to be believed – would enthuse about the results of a “new” study just released from Sweden.

Prostablog reported (also somewhat breathlessly) on the Göteborg study back in July after it appeared in Lancet Oncology, pointing to commentary by Mike Scott at the New Prostate Cancer Infolink.

Despite the positive tone of the NZ Doctor article – the majority of whose sources depicted the study as proof that population-based screening is fully justified – Scott’s analysis does not support that.

And neither does an editorial (represented by one paragraph in the NZ Doctor article) by Cambridge University’s Prof David Neal, which appeared at the time of the Lancet Oncology report.

After rehearsing the contents of the Goteborg study, Scott had this to say:

• This study appears to show clearly that, in a screening-naïve population of men aged between 50 and 70 years of age, biannual PSA testing can lower the risk for prostate cancer-specific mortality by at least 40 percent.
• In addition, the study shows that the proportion of patients diagnosed with prostate cancer and requiring hormone therapy in the screening group (103/1,138 or 9.1 percent) was much less than half that of the patients in the control group (182/718 or 25.3 percent), implying that early detection also reduced the risk for metastatic disease.
• However … the study also shows clearly that (at 14 years of follow-up) biannual PSA screening has no impact whatsoever on the overall mortality rate in the same population.

We are therefore potentially faced with the difficult question of whether mass, population-based screening that does affect disease-specific mortality but does not affect overall mortality is justifiable based on the costs, the effort, and the potential harms to the men who are over-treated.

The single most important fact about this study, as far as The “New” Prostate Cancer InfoLink is concerned, is that it finally has provided us with a highly structured, ongoing assessment of the potential value of mass, population-based screening for prostate cancer in a previously screening-naïve population.

The study also includes full treatment information on all men diagnosed with prostate cancer over the course of the study.

This means that at last we have a real baseline against which to assess the data from all other screening studies, and we can use this baseline to recognize the inherent problems of the PLCO and ERSPC studies, which include short follow-up (to date) in both studies, variation in protocols (within the ERSPC cohorts), and data adulteration resulting from PSA testing among the “unscreened” patient cohort (in the PLCO study).

The data from the Göteborg study may still not provide a convincing rationale for mass, population-based screening based on use of the PSA test, but it certainly does set the standard for what must be expected from any new test that may come along and show promise as a true screening test for prostate cancer in the future.

The one regrettable fact about this study is that if it had included just one additional age cohort (of men born between 1945 and 1950), we might have been able to gain real insight over time into the benefits of even earlier detection for a period of up to 30 years.

A much more cautious note here, then, than these comments in NZ Doctor:

“The Government can hardly say they won’t screen for prostate cancer if the science supports it,” Dr Johnson says, referring to an ongoing Parliamentary inquiry into the early detection and treatment of prostate cancer.

Auckland urologist Robin Smart says the bottom line for him is that the study shows prostate cancer screening could prevent 300 of the 600 deaths from prostate cancer that occur every year in New Zealand. “All of the results strongly suggest that PSA screening is a really good idea,” Dr Smart says.

NZ Doctor concluded:

The results of the Göteborg trial are due to be presented to the Health Select Committee next week (today, September 15) as part of its inquiry into prostate cancer. Dr Johnson will talk about the results during a presentation by Harbour Health on PHO capability for reducing the burden of cardiovascular disease, smoking and diabetes.

Let’s hope the committee takes the time to read more widely about the study.

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Further blow against case for screening all men for prostate cancer

NEW PROSTATE CANCER INFOLINK: NZ politicians currently trying to decide what to do about prostate cancer screening (the Health Selection Committee inquiry) should read the latest analysis of the big randomised European study into PSA testing.

It suggests population-based screening is not supportable. READ MORE> and HERE>

Mike Scott at this website notes:

…it is certainly a fair question for every man of 55-74 years of age and a PSA of less than 4.0 ng/ml whether he wants to have treatment for prostate cancer based on a 553 to 1 chance that treatment will actually affect his long-term survival, and given the well-known side effects of treatment.

We do believe that these data add emphasis to the value of expectant management as a method of caring for men with low-risk prostate cancer.

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