Doubt raised over pomegranate juice anti-prostate cancer claims

NEW PROSTATE CANCER INFOLINK: All that favourable publicity for pomegranate juice and its anti-prostate cancer properties may be in trouble – a US company has been accused of over-selling its benefits. READ MORE>

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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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Do low-risk prostate cancer patients fully understand potential side effects of surgery?

NEW PROSTATE CANCER INFOLINK:  Men with low-risk prostate cancer who choose surgery need to realise the possible after-effects – reduced urinary and erectile function, shorter penis, penis distortion – they might have to live with for up to 35 years afterwards. 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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More not necessarily better when it comes to number of samples taken in a biopsy

NEW PROSTATE CANCER INFOLINK:  Is more better when it comes to the number of samples taken in a prostate biopsy? Not according to new research. READ MORE>

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Colour ultrasound images give better results in prostate cancer diagnosis

NEW PROSTATE CANCER INFOLINK: Enhanced ultrasound imaging – read colour – may give better diagnostic results for prostate cancer, a new study shows. READ MORE>

A new review by Trabulsi et al., just published on line in Urology, seems to endorse this viewpoint in one of the major urology journals. (We think for the first time).

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New review looks at best options for managing prostate cancer

NEW PROSTATE CANCER INFOLINK: Is there an optimal management for localised prostate cancer?, a new review by Singh et al., has just been published online in a new journal called Clinical Interventions in Aging.

The article appears to provide a thorough, sound, and neutral introductory review to all of the major management options. READ MORE>

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Diet care, nutrition, supplements have no real effect on prostate cancer prevention

NEW PROSTATE CANCER INFOLINK: There is minimal evidence of any well-defined effect of diet, nutrition or supplement use on the prevention of prostate cancer, says a new study. READ MORE>

The authors conclude exclusively that a high dietary intake of polyunsaturated n-6 fatty acids may increase prostate cancer risk because of their effects on inflammation and oxidative stress.

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