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PROSTABLOG NZ: Exact meaning of the word “encourage” will be pivotal  in the continuing New Zealand saga on how best to prevent prostate cancer.

“We will be encouraging men to go to their GPs to discuss optionsincluding whether or not they should have a PSA test,” says the chairman of Parliament’s inquiry into prostate cancer, Paul Hutchison, in today’s Dominion Post newspaper (see below).

In the same story, his statement is welcomed by Prostate Cancer Foundation of NZ president Mark von Dadelszen: “…we would certainly applaud that move.”

What they both mean by the term “encourage” is about to become the focus of a debate that has churned around in global prostate cancer politics since PSA testing became commonly available in the early 1990s.

First question: how does “encouraging” men to be tested differ from a national screening programme (which Hutchison signals will be rejected in the inquiry report due in a matter of weeks)?

A national screening programme presumably involves the Ministry of Health spending millions promoting tests to the general populace, as it does with breast and cervical cancers.

Such programmes “encourage” people to get along to their doctor and have the tests.

How will men be encouraged? Not with a lot of advertising, it seems.

So how, exactly?

By training barbers to spread the word to their clients, as has been tried in the US?

By sending doctors into communities to talk about risks and options, as the Foundation did last year when it flew a team to the Chathams?

By leaving it to the Foundation to publicise the disease and urge men to act, as happens now?

Whatever approach the Health Select Committee is about to recommend, it needs to deal with a mammoth in the waiting rooms – the Ministry of Health instruction to GPs that they must not raise the topic of PSA and rectal examination until the patient does or unless they spot symptoms obviously related to what is often a symptomless disease.

This is the real crux of the dilemma the Select Committee has presumably been wrangling with since its first public hearings in September, 2009.

What instruction will it recommend the Government give to the Ministry, whose staff and advisers  adamantly oppose any widening of the availability of PSA testing?

Up to now, men have been the subject of a mild but just as deadly form of Russian roulette when it comes to being diagnosed.

Take my own case.

Over the past 30 years, I’ve been under the care of four GPs. The first never mentioned prostate cancer (to be fair, I was under 50); the second (mid 1990s) refused to consider PSA tests because to him they were unproven; the third insisted on it without my bidding; and my current one responded readily to my request for tests (saying Ministry instructions forbade him raising the matter unless I spoke up first!).

Anecdotal evidence suggests the Ministry’s obfuscation is becoming increasingly irrelevant – for some people, anyway.

The Foundation’s awareness campaigns have been effective, if I judge by the number of male acquaintances now being diagnosed early and successfully treated.

However, I suspect there are dangerous class factors at play here.

Me and my mates are okay because we have been blessed by education, higher socio-economic status, media awareness and access to health provision.

I fear for those who don’t. The Ministry’s stubbornness condemns them to an uncertain fate.

National prostate screening rejected

Dominion Post April 2, 2011

A PARLIAMENTARY inquiry into prostate cancer screening will not be recommending a national screening programme despite pressure from cancer survivors to do so.

The Prostate Cancer Foundation has backed the committee’s approach, but a former patient says the decision is disappointing.

Health select committee chairman Paul Hutchison said the inquiry, which has been running since May 2009, was not due to report back for another few weeks, but when it did, it would not advocate screening.

There was still controversy over whether blood tests for prostate-specific antigens led to fewer prostate cancer deaths, he said.

Heightened levels of prostate specific antigen – PSA – can indicate the presence of prostate cancer. However, early detection can result in aggressive and unpleasant treatment of tumours that would never have grown or created ill-health.

The inquiry has heard from a huge number of prostate cancer survivors, many of whom asked for a screening programme for all men aged 50 and older.

Dr Hutchison could not go into detail about the committee’s findings but said there were two main conclusions.

‘‘We will not be recommending a PSA screening programme. However, we will be encouraging men to go to their GPs to discuss options … including whether or not they should have a PSA test.

‘‘Those are the two points that are loud and clear.’’

Prostate Cancer Foundation president Mark von Dadelszen said the organisation did not support a national screening programme because of ‘‘issues’’ with the PSA test.

‘What it does advocate is that men should be encouraged to have screening tests . . . we would certainly applaud that move.’’

Napier farmer Duncan McLean, who has just got the all-clear five years after being diagnosed with prostate cancer, said encouragement was good but the committee should recommend a full screening programme.

Mr McLean, 57, had his prostate gland removed in 2006 after several years of increasingly high PSA readings, followed by a biopsy that confirmed the cancer.

‘‘PSA testing is essential. I’m alive today because of it. It’s really disappointing they’re not [recommending screening].’’

Fears about over-treatment were ‘‘bollocks’’, he said. ‘‘You don’t leap in and go under the surgeon’s knife – I was monitored for three years before I had surgery.’’

International research on the matter is split, with several largescale studies under way.

The results of a 20-year Swedish study, published yesterday in the British Medical Journal, found screening did not significantly reduce prostate cancer deaths but the risk of overdetection and unnecessary treatment was considerable.

However, another Swedish study found death from prostate cancer more than halved among men who were screened.

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NURSE.COM: The motto, “Use it or lose it,” is spot on for prostate cancer patients recovering from surgery. READ MORE>

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URO TODAY: The surge in adoption of robotic-assisted radical prostatectomy – across the United States in particular – has put “open” surgeons on the defensive. READ MORE>

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AMERICAN JOURNAL OF MEDICINE: To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered. READ MORE> (but you need to pay $US30 to get access to the full text).

URO TODAY: The need for this aprioristic rethinking is manifest, very eminently, in the fresh recommendations about screening for breast cancer, issued by the US Preventive Services Task Force, and in the public uproar provoked by these. READ MORE>

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BLOOMBERG BUSINESSWEEK: A wave of new immunotherapy drugs may help turn some lethal cancers into manageable chronic diseases. READ MORE>

Beginning on June 4, at the American Society of Clinical Oncology conference, the world’s biggest gathering of cancer doctors and drug and biotech companies will show how medicines now being developed will provoke the immune system to kill cancer cells.

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NEW PROSTATE CANCER INFO-LINK: Transperineal, template-guided mapping biopsies can find prostate cancer where more traditional 8- or 12-core transrectal ultrasound (TRUS)-guided biopsies often don’t, new research confirms – but is this really an advantage? READ MORE>

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NEW PROSTATE CANCER INFOLINK: The media and marketing arms of some prostate cancer organisations need to be reined in by the facts, with over-promotion of screening a real risk. READ MORE>

Roswell Park Cancer Institute really is one of the best cancer care centers in the nation, but some people in their health education and communication departments need to sit down and look carefully at the available data and make sure that their media partners are not over-promising on what they are promoting.

FOOTNOTE: Prostablog spent about 10 minutes on the Roswell Park Cancer Institute website trying to find out where it is in the US, but it was a fruitless quest. The website is as dysfunctional as…well, you know what. It may be in Buffalo, New York, but don’t quote us. Another case of the media department failing in its role…

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URO TODAY: Medical professionals should pay more attention to the emotional burden felt by prostate cancer patients, because their stress and strains during the time before treatment have a rather more emotional than physical character. READ MORE>

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movember

PROSTABLOG NZ: Moustaches or blue paint? What works best when it comes to helping prostate cancer patients?

This may be a dilemma for NZ’s generous public as two Australian-based organisations go up against one another in annual Kiwi campaigns to get attention – and money – for the world’s most devious killer of men.

Marketing company (MWC Media) has just completed Blue September, which has just run for the second time here.

Seemingly unique to NZ and Australia, Blue September uses celebrities, blue paint on faces, clever branding, media events and photo-ops to raise the profile of the Prostate Cancer Foundation of NZ, a bunch of mostly volunteer prostate cancer survivors and their families.

The other is charitable organisation  Movember. It hooked up with the Foundation in 2006 and in two years raised more than $2 million for the foundation’s coffers.

But in 2008 it switched its benevolent aim to the Cancer Society of NZ and the Mental Health Foundation.

Also big in Australia, the US, Canada and the UK, Movember is in the process of launching once again for next month.

This week, it got national press and web attention with the announcement of a survey it had done on how poorly men look after their health (no details of the sample size, who did the survey, etc, were released, going by the media reports).

Movember began as the 2003 brainwave of four Aussie blokes and has since grown into a global operation which raises funds for the US Prostate Cancer Foundation, the Prostate Cancer Charity in Britain, and the Cancer Council in Australia.

Australia and NZ seem to be the only countries where there are two prostate awareness campaigns running closely together (separated by October).

Who raises what, who gets the money and what’s it spent on?

This writer knows the answers so far as the NZ Prostate Cancer Foundation is concerned (I was a board member for a couple of month).

They were published here in August, when we provided an account of the foundation’s annual results released at its annual meeting in late July.

What about the Cancer Society of NZ, the 50% beneficiary of Movember (it’s unclear how the Mental Health Foundation got into the act, but we have asked Movember. There has been a delay because earlier this month its NZ website was not working)?

Some questions were put to Dalton Kelly, the Cancer Society’s CEO, who readily provided detailed answers today.

Here’s what we asked, and here’s what he said:

Hello Jim – thank you for your email.

We are very happy to share our involvement with Movember and the funding we have received from them. We have very detailed project plans and accounting processes, which we use to report back to Movember on a regular basis, so I can do this straight away for you.

How much did the Cancer Society receive from the Movember organisers last year?

The Cancer Society received 50% of funds raised from the 2008 Movember Campaign. The Mental Health Foundation was the recipient of the other 50%.

What was that money spent on?

The money was divided into a three-way split – one third research, one third for regional projects and one third for national projects.

The research share was awarded in our last grants round to two projects:

To improve the health and quality of life of prostate cancer patients on androgen deprivation therapy by programmed physical activity

Dr Justin Keogh and Dr Daniel Shepherd, School of Sport and Recreation, AUT University, Auckland. Money from this grant round will be used by the investigator to explore how to best get men with prostate cancer into exercise programmes and how they may stay in it. Men on hormone treatment for prostate cancer lose some strength and exercise may reverse this.

RADAR prostate cancer trial

The biggest prostate cancer trial in Australasia has been running since 2007. Associate Professor David Lamb, based in Wellington, is investigating how long to use hormone therapy in prostate cancer, and whether the side effectives of treatment (osteoporosis) could be reduced by the use of bone-hardening drugs (bisphosphonates).

So far the regional budget has been awarded to eight regional projects:

  • Field Days – men’s health with a focus on prostate cancer – Waikato.
  • Developing a resource being a hardware education tool for prostate cancer – Central Districts.
  • Men’s Health Challenge brochure delivered to the RFU – Taranaki Centre.
  • Workplace-based men’s health initiative with a focus on prostate cancer (with an intention it will be developed into a national model) – Wellington
  • A prostate cancer support project to visit rural areas using kaumatua who have had prostate cancer to talk to the men/women and also a project with all the Rotary Clubs focusing on prostate cancer – Gisborne/East Coast.
  • What do men want? A series of focus groups asking men about how they want information about prostate cancer delivered to them – booklets, advertising, and also reviewing the Cancer Society’s current prostate cancer literature for suitability – Auckland.
  • Hawkes Bay A&P Show – Men’s Warrant of fitness

National Office has spent some of its allocation on the Men’s Health Challenge – targeting organisations such as the Defence Forces, Fire and Police Service where the employees are largely men.

What proportion was spent on prostate cancer?

All the money has been spent on prostate cancer in the sense that all the projects have a focus on prostate cancer and there is a component in every activity addressing prostate cancer.

In addition the projects promote reducing risks behaviours – such as not smoking, eating well and exercising -as we see these as an important aspect of public education.

What amount do you expect to receive this year?

We don’t really have any idea – we have not made any projections.

What will this year’s proceeds be spent on?

We plan to repeat the exercise of one third to research, one third to regional projects (which there will be a grant round again for) and one third to developing national programmes and resources focusing on prostate Cancer

What proportion of the overall sum raised by Movember is given to your society?

Once expenses are taken out, the Cancer Society receives half the money in conjunction with the Mental Health Foundation.

How much did the society receive from the Rowing For Prostate team in the Indian Ocean Rowing Race? I understand you agreed to be a beneficiary of that. The team apparently raised 24,000 pounds for the UK Prostate Cancer Charity.

The Rowing for Prostate Team approached the Cancer Society of New Zealand to ask us to be a beneficiary for this fundraiser in New Zealand.

Initially, as was Movember, the Rowing for Prostate team had aligned itself to the Prostate Cancer Foundation. Both organisations found it very difficult to work with the Prostate Cancer Foundation and approached us instead.

We felt the project had a great deal of merit in that the boys were very high profile, committed to spreading the word about prostate cancer and were good role models in terms of living healthy lives.

At this stage we do not know the amount we will receive from this fundraising event.

On this last question – how much came from the four English expats living in NZ who made up the Rowing For Prostate (RFP) team – Prostablog can assist to a small degree.

We found an English fundraising organisation called Just Giving that handled the RFP fundraising, which involved some radio stations in Auckland and a Rowing For Prostate website (now gone).

It says the rowers’ target was £24,000.00 ($NZ51,827.43), its main beneficiary is the UK Prostate Cancer Charity, and the target was slightly exceeded (£24,145.03 raised so far).

Prostablog has emailed the website to ask how much of the money is coming back to the NZ Cancer Society, but so far there is no reply.

A similar request made to the organisers of the Indian Ocean Rowing Race referred us to the Rowing For Prostate team, but our inquiry some weeks ago has drawn no response.

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URO TODAY: Is leaving apparently low-grade prostate cancer alone and waiting to see what happens really a viable option? We can’t be sure until more research is done, says the “father” of PSA testing, Professor William Catalona. READ MORE>

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