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Posts Tagged ‘blood tests’

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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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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PROSTABLOG NZ: My last PSA test recently showed it continues to be undetectable, some 20 months after my surgery in March, 2009.

But I’m not getting cocky just yet (forgive the pun).

From what I’ve read about prostate cancer treatment, if the cancer bug has got out of the organ during/after a prostatectomy, there’s a good chance the first signs will come two years after the operation.

My two-year anniversary comes up in a couple of months – so wish me luck.

It’s interesting how long it takes to fully recover from the surgery’s effects.

My scar is virtually gone and I’ve felt fit for ages.

There’s no incontinence. I haven’t done the pelvic floor exercises for more than a year, but there’s never any problem with not being able to hold it in, even when I’m busting.

Not that I put myself in the busting mode if I can avoid it.

So, hey, no regrets and no real worries. I’m bloody lucky.

Well, there is one worry – the number of friends and people I know who have been diagnosed. Talk about an epidemic.

And I wonder if the NZ Parliamentary Health Select Committee will ever get round to reporting back on its prostate cancer inquiry…

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PROSTABLOG NZ:  HERE are four key issues the NZ Parliamentary inquiry into the detection and treatment of prostate cancer ought now to be focusing on:

  • Mass screening…or not: Not. The evidence in favour of mass screening of all middle-aged men for prostate cancer is not sufficiently strong in statistical terms to overcome the counter-arguments concerning needless and over-treatment and high likelihood of after effects that will blight quality of life.

But…it’s not strong enough yet. That may change as more studies are done and closer analysis of the large random trials is completed. PSA testing may also improve, or be replaced with something better, a test that defines the actual risk to the patient.

  • Guidelines to GPs must be revised. Currently, GPs are forbidden by the Ministry of Health to routinely offer PSA tests and/or rectal examinations for prostate cancer unless a man asks, or mentions symptoms. Since this can be a symptomless disease (until it’s too late), that is unacceptable. It also presumes that people don’t move around, change doctors, lose track of medical records, or simply have little idea of the implications of dad dying of prostate cancer.

If the Ministry of Health wants to avoid high-risk treatment being offered unnecessarily, it needs to move the initial gatekeeping further up the food chain to the specialists.

  • Specialists’ advice needs to be delivered via a more balanced and less costly method. At present, the system works well enough up to the point the pathologist finds signs of cancer in biopsy samples.

But after that, men are left to fend for themselves when it comes to seeking advice from a range of authorities. Some don’t bother, and just go with what the urologist offers. Some can’t afford the $1600 charged by a cancer specialist (oncologist), who may be the most neutral source of advice available.

In the US, the first specialists in the hierarchy, urologists, earned themselves the unenviable moniker of “prostate snatchers” because of the lucrative, medical insurance-backed business of prostate surgery.

How about panels of doctors representing the main treatment options in NZ (surgery, robotic surgery, external beam radiation, brachytherapy, watchful waiting) reviewing the case notes and offering clearly explained options to patients?

  • The public needs to be kept up to date – in layman’s terms – with diagnostic and treatment developments. This is not happening at present. The Ministry and its satellite committees do not have readily available, up-to-date information on the web to help men with newly diagnosed prostate cancer become fully informed before making one of the biggest decisions of their lives.

As wealthy male baby boomers hit the danger zone, enormous amounts of US, European and Asian money are going into researching and developing new drugs, methods of surgery and radiation, diagnostic tools and a bewildering range of related methdologies.

That’s the point – it’s bewildering to the average Kiwi, who must hope his medics are keeping up to date and that the government is adequately funding new treatments.

For example, there is Provenge, a new $100,000+ drug regime that will extend life for a few months, and which is now selling big in the US. When will we see it here?

Communicating the relevance of the overseas prostate industry boom to Kiwis cannot be left solely to the news media here: that’s worse than leaving it to chance and the public relations industry.

Few, if any, journalists in NZ take an abiding interest in prostate cancer (why would they – it’s one of many diseases), and what they do write is sometimes ill-informed, incomplete, inaccurate and out of date.

Finally, the Health Select Committee would be wise to keep its files open on this inquiry. It would be a mistake to shut the doors on a tsunami of prostate cancer information that emerges daily on the web.

Developments are moving so quickly, the committee should require the Ministry of Health to report regularly about what’s happening. The inquiry report, when it finally emerges, should be an interim one that can be updated over time.

The committee is wrestling with questions that are far from settled.

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PROSTABLOG NZ:  This hardly helps those of us who support the need for widespread prostate cancer screening, but deeper analysis of the European randomised study of PSA testing says such screening is dangerously counter-productive.

Dangerous in the sense that – as the epidemiologists (trends counters) have long claimed – too many men with harmless prostate cancer are being treated aggressively, and needlessly.

The new analysis comes form a bunch of Dutch scientists, who conclude that population-based (that is everyone) screening using the PSA test, while undoubtedly saving some lives, cannot be justified because of the potential over-treatment harm that may be done to 60%-plus of men diagnosed with the cancer.

Mike Scott at the New Prostate Cancer Infolink reaches the same conclusion, and says we need to rethink the whole approach to prostate cancer diagnosis. READ MORE>

More than ever, we must find a way to separate those with life-threatening versions of prostate cancer from those whose disease will not kill them.

It seems, in a way, that we are no further ahead than prior to the days of the PSA test’s introduction in the 90s.

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NEW PROSTATE CANCER INFOLINK:  How often after prostate surgery should a “low risk” patient have his PSA tested to check if the cancer is coming back? READ MORE>

Tollefson et al. conclude that,  in low-risk patients, the risk of biochemical failure is inversely proportional to time for which the PSA is undetectable after radical prostatectomy.

They go on to suggest that taking PSA levels every two years should be sufficient to identify the majority of low-risk patients who experience biochemical progression.

The “New” Prostate Cancer InfoLink would certainly agree that annual PSA testing is probably unnecessary in the majority of patients who are treated surgically for low-risk disease if their PSA is undetectable after surgery.

However, the key question is how long should annual PSA testing be carried out before the patient can be switched to testing every two (or perhaps even every three) years.

Based on this paper, it would seem likely that even low-risk patients should all receive at least annual testing for three years after surgery.

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BLOOMBERG: Campaigns urging men to get tested for prostate cancer need to be carefully worded – or they can have the opposite effect, a German study shows. READ MORE>

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