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Archive for the ‘Digital exams’ Category

PROSTABLOG: When can we expect a report from the NZ parliamentary inquiry into the early detection and treatment of prostate cancer, which was launched a little over a year ago?

No word on that from the committee, but perhaps two of the most powerful “words” in the debate on screening were submitted to the committee just before last Christmas (unreported in the news media, so far as I can tell).

They came from eminent pro-screening urologist Robin Smart and from the Ministry of Health’s expert panel, the NZ Guidelines Group, which has been strongly anti-screening (population-based).

Here’s a couple of quotes from Smart’s submission, which discussed the inconclusive results of the two large international screening trials published in March last year:

The conclusion is that it is now very difficult if not impossible to conduct trials of controls having no testing versus screened having PSA/DRE (PSA tests/digital rectal examinations) testing with endpoints of death or metastases in advanced countries especially the United States.

This is largely due to the international improvements in these aspects because of PSA/DRE testing and consequent reluctance of men to remain in control groups.

This in turn means that it is going to continue to be difficult for authorities and governments responsible for making decisions concerning setting up national prostate cancer screening programmes who are waiting for more information before doing so.

These decisions will have to be made largely on current information from existing trials, studies and experience…

The weight of evidence in favour of PSA/DRE testing is now irrefutable after almost two decades of international experience.

To go back to the time before PSA testing would now be unthinkable.

Of course we hope for the perfect tests, perfect treatment and continue to look for improvements. But men today need the benefit of current technology which the evidence shows is saving between a third to a half of those who would otherwise die of prostate cancer where it is applied.

In its final submission (dated the same day as Smart’s, December 16), the guidelines group gave a contrary view.

It looked at nearly 10,000 research abstracts and chose 166 it says were relevant to the brief given to it by the Ministry of Health.

Its analysis concluded that the potential harm from population-based screening outweighs benefits.

The best case scenario it could find estimated that a screening programme conducted on all men aged 50 to 74 for nine years would save about 40 lives a year (from the 600 who die from the disease in NZ each year).

Those 360 lives saved over nearly a decade had to be weighed against the following “harm” that could be done:

  • An estimated 41 men would suffer significant treatment complications for every one life saved.
  • Of the additional 1953 men per year requiring prostate cancer treatment (presumably on top of the 2500 now), 43% to 88% would have sexual dysfunction, 10% to 35% urinary dysfunction and 8% to 43% bowel dysfunction (the range depending on whose research is consulted)
  • Each year, there would be the following additional complications – 838 to 1677 cases of sexual dysfunction; 156 to 838 cases of bowel dysfunction; and 195 to 682 cases of urinary dysfunction.

Meantime, international debate on screening continues.

HERE> is a report on a pro v con panel discussion at the recent American Urological Association annual conference.

And, Mike Scott, sitemaster of the New Prostate Cancer Info-Link in the US, says he agrees with an April article in the Australian Medical Journal that said population-based screening (that is, screening of all men) cannot be sanctioned until something more accurate than the PSA test is developed. READ MORE>

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JULY 11: INDY STAR:  The blood test is no big deal, but the digital rectal exam is something many men simply refuse to do. It’s unpleasant, a cancer survivor  agrees, but he persists: “Sure, that’s a guy’s worst fear. I didn’t like it, either. But I’m alive.” READ MORE>

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JUNE 17: URO TODAY: Although major organisations disagree about the efficacy of prostate cancer screening, the PSA test and digital rectal examination continue to be utilised regularly by a majority of American men over 40. READ MORE>

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JUNE 14: PROSTABLOG NZ: Ministry of Health officials and their medical advisers have been mulling over findings from the two large randomised studies of prostate screening in the US and Europe, and the ministry is due to make an announcement on the matter soon.

The Ministry has long advised the government that population-based screening has no proven benefits in terms of preventing death from prostate cancer, a stance echoed by the NZ Cancer Society, and some researchers, as well as by governments throughout the world.

Did the two big studies (published in March) find anything that will change their minds? And meantime, what should the average NZ patient do about screening (getting a GP to do a PSA blood test and a digital examination), and what treatment choice should someone make if a diagnosis is positive?

The Harvard Medical School website has a video discussing some of the issues. SEE IT HERE>Harvard

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MAY 31: NEW PROSTATE CANCER INFO-LINK: The future of prostate cancer detection may lie in complex assays systems that can test for several markers at the same time and use the accumulated data to assess prostate cancer risk. READ MORE>

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MAY 26:  TALES FROM SERENITY NOW HOSPITAL:  How some (semi-literate) US doctors learn to perform digital examinations on patients – a bizarre tale:  “The patient (sic) recieved 100 dollars per five rectals or 20 bucks each finger. Many of these patients smelled of alcohol, had no teeth, had mental illnesses, and were addicted to IV drugs…” READ MORE>

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