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Archive for the ‘Doctors' advice’ Category

RENAL & UROLOGY NEWS: A US jury has found two doctors not guilty of failing to care properly for a prostate cancer patient who died, after his wife took a case based on absence of a timely PSA test. READ MORE>

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URO TODAY: A computer-assisted phone counselling service giving advice about prostate cancer options may be more effective than discussing it with your doctor, a US medical school trial has found. READ MORE>

There was an increase in PSA knowledge, and in decisional satisfaction, a decrease in decisional conflict, and a general consistency of those decisions with the man’s values.

Among those initially who had not made a decision, 83.1% made a decision by [the] final survey with decisions equally for or against screening.

The [counselling] intervention provides realistic, unbiased and effective decision support for men facing a difficult and confusing decision.

Our intervention could potentially replace a discussion of PSA testing with the primary care provider for most men.

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NEW PROSTATE CANCER INFOLINK: For all of the academic literature and the recommendations of guideline-generating organizations on testing, diagnosis, and management of prostate cancer, urologists out in community practice may show considerable variation in their clinical practice patterns. READ MORE>

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PROSTABLOG NZ: How best to advise doctors on what they should tell their patients about prostate cancer testing is a key issue facing the Parliamentary inquiry in NZ – but they’re not alone in their deliberations.

A global debate is going on about whether men are being properly counselled, whether they should be tested, whether they should even be told about testing.

A recent report in the US Archives of Internal Medicine referred to some Australian research produced last year that asked men about their doctor-patient discussions on prostate cancer. It’s worth revisiting:

Patient knowledge, interest in being screened, and anxiety associated with considering the benefits and limitations with prostate cancer screening may all influence the manner in which patients interact with their doctor and what role is adopted during the decision-making process. READ MORE> and HERE>

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WHITIREIA journalism student CARL SUURMOND went to the Chatham Islands with the Prostate Cancer Foundation last weekend. Here’s his first report (see below for his SLIDE SHOW):

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FLYING PROSTATE TEAM: from left, Carl Suurmond, Dene Ainsworth, Daniel Marshall, David Mason, Ash Zoias, Kelvin McDonald and Joe Tapara.

PROSTABLOG NZ: The men of the Chatham Islands are a tough  breed of fishermen and farmers whose work environments have shaped their hardwearing demeanour – but it’s the women of the island who are really tough.

Without the support and encouragement of wives, partners and mothers, many of the male inhabitants of the island may not have turned up at the presentations on prostate cancer held over the weekend.

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Prostate Cancer Foundation board member Dene Ainsworth (left) and Joe Tapara.

That’s the view of Joe Tapara (Ngāti Ruanui),  cultural adviser for the Hao Te Ora o Wharekauri Trust and member of the Chatham Islands Māori Community Health.

“The wives and the partners were the reason why so many men turned up,” he said. “Without them nagging, I’m not sure how many would have bothered.”

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Dene (right) in the jump seat behind the pilots.

The weekend presentations aimed to raise awareness of prostate cancer and promote early detection, with a focus on reducing fatalities amongst Māori men.

Maori are less likely to be diagnosed early and suffer a death rate after diagnosis that is twice that of non-Māori.

The trip was funded and organised by the NZ Prostate Cancer Foundation, in conjunction with Māori Community Health and Chatham Island Health Care.

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David Mason (right) and Daniel Marshall get checked out on a boat at Port Hutt.

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ISLAND FOOD: The team is spoiled at Kaingaroa.

The team included the expertise of urologist Dave Mason and trainee urologist registrar Daniel Marshall, both from Hastings.

Otaki’s Dene Ainsworth (Te Āti Awa Iwi), a board member on the foundation, and prostate cancer survivor, shared his own experience during four well-attended presentations to several communities around the island, which is 800km off the coast of Christchurch.

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Dene speaks to one of the Chathams gatherings.

In total, 40 men out of 135 over the age of 40 – and a few women – turned out, and in small communities like Kaingaroa Harbour, Owenga and Port Hutt just about all the male population was there to have their questions and concerns answered.

The tour round the main of the Chathams group was organised by Mr Tapara, with plenty of help from other locals.

Mr Ainsworth said the weekend was a great success and the desired outcome had been achieved.

“It was a bloody awesome weekend.  I think we achieved more than we could have ever hoped for.  The reaction from the islanders was first class and they’re really keen to get us to go back and do this on a regular basis.”

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Mr Mason and his colleague were there to address medical concerns and provide advice.

“I think the turnout has been amazing,” said Dave Mason.  “Each place that we’ve been to, the guys have come out and talked about things in different ways and brought up different concerns.

“There was a good bit of interest and a good spread of age groups.”

Mr Marshall said the men were not shy about asking questions.

“From talking to them afterwards it seems they’ve got a lot out of it.  They certainly haven’t been shy in asking questions and finding out what they want to know, which is what it’s all about.

“Seeing the island, seeing the style of life here, the way everyone gets on so well in the community here – it’s been brilliant.”

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The waterfont at Waitangi, the main settlement.

The weekend came about through a serendipitous meeting between Dene Ainsworth and Joe Tapara at the first-ever Māori men’s health conference, Tane Ora, held in Blenheim earlier this year.

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MAORI TV: Kelvin McMcdonald (left) & Ash Zoias.

Dene spoke about prostate cancer in a presentation at the conference and was heard by Joe Tapara.

The two talked about men’s health and prostate cancer and Joe told Dene that his presentation was needed on the Chatham Islands.

“I agreed that Chatham Islands men should have the same access and opportunity to these sorts of presentations as ‘mainland’ New Zealanders,” said Dene.

The trip, which was funded by the Prostate Cancer Foundation, was filmed by a crew from Maori Television, which will show it on its top current affairs programme, Native Affairs.

VIEW THE CHATHAM ISLANDS TRIP SLIDESHOW HERE

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WALL STREET JOURNAL: A new study raises the question of whether patients facing prostate screening and their health-care professionals are engaging in shared decision making, and what such a collaboration should look like. READ MORE>

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DOMINION POST: In this personal account, a Lower Hutt man recalls the dire effects on his life of an enlarged prostate – and how he finally got it fixed.

When prostate rules it’s not OK

…was too late. I was in trouble again – this time on an island miles from a hospital. I returned in some discomfort to the company and tried to act as if everything was OK. We left soon after. When we got to the cottage I sat on the toilet until I got…read more…

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mohPROSTABLOG NZ: Maori and Pacific people living in NZ suffer big disparities in the way cancer is detected and treated, and how well they survive it. READ MORE>

This has been known for some time, but the problem is newly highlighted in the Ministry of Health-funded cancer guidelines for GPs that have just been released.

For example, it reminds us that as many as 17% of Maori cancer cases and 6% of deaths are never reported.

It also points out that health statistics tend to be five years old before they are published, which suggests that in the rapidly changing detection/treatment environment for prostate cancer, decision-making on how best to screen and treat is seriously hampered by lack of knowledge.

While the overall, 174-page report, avoids discussion of population-based screening, it does touch on the issue in the ethnicity section:

Cormack et al. noted that national screening programme data have identified that equitable screening for breast and cervical cancer has not been achieved for Mäori women.

However, BreastScreen South Limited’s results (70% of eligible Mäori women screened in 2005) suggest that the inclusion of focused efforts and leadership are the key to achieving equity in screening.

The report analyses available data on ethnic disparities in cancer detection and treatment, and makes a number of suggestions, including more “cultural competence” training for health workers.

For the full report, CLICK HERE>

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JULY 31: URO TODAY: What’s the most accurate way your specialist can predict your fate when you first learn you have prostate cancer? Using something called a nomogram, according to latest analysis. READ MORE>

Researchers at the University of Montreal Health Center reviewed tools available to clinicians involved in treatment decisions in newly diagnosed prostate cancer and examined their accuracy to provide individual life expectancy.

“…nomograms provide the most accurate health-adjusted life expectancy prognostication,” they conclude.

What’s a nomogram?

It’s a calculation that gives an estimate – in this case, of life expectancy – after known information is fed into it.

The Memorial Sloan Kettering Cancer Center in the US has one for prostate cancer on its website. Anyone who knows the results of PSA, biopsy and Gleason grade can use it: CLICK HERE>

Here’s an example:

Nomogram

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JULY 23: CANCER RESEARCH UK.COM:  A new edition of the Prostate Cancer Risk Management Programme has been produced to help British GPs give men clear and balanced information about testing for prostate cancer. The second edition of the information pack is designed to assist GPs when responding to patient queries about prostate specific antigen testing. READ MORE>

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