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Posts Tagged ‘Prostate inquiry’

PROSTABLOG NZ: The final report from a two-year NZ Parliamentary investigation into prostate cancer detection and treatment has been released by the Health Select Committee. READ MORE>

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JULY 3: PROSTABLOG NZ: In what seems to be exquisite timing, NZ’s parliamentary select committee on health is starting an inquiry into prostate cancer screening – just as some of the best recent analysis of screening emerges in the US.

The latest informative discussion comes from Mike Scott at the New Prostate Cancer Infolink website, one of the leading American aggregators of up-to-date information.

As global debate hots up following recent publication in a medical journal called CA: A Cancer Journal for Clinicians of an article about screening and an accompanying editorial, Scott today makes some interesting points:

  • Media reporting of this latest look at the two large randomised studies is well wide of the mark.
  • What the article actually makes clear is we just do not know how best to use the tools currently available to test an individual man so as to ascertain with accuracy his real risk for clinically significant prostate cancer.
  • So — surprise, surprise — we need better tests, as America’s Prostate Cancer Organizations have already clearly stated.
  • A critical element, covered in the article, is the importance of taking account of the patient’s age, life expectancy, family history, race/ethnicity, and other personal health factors in making the decision whether testing for prostate cancer is appropriate or not.
  • The article does not discuss, at all, the potential merits of  “baseline” PSA testing (at any specific age).
  • The journal’s accompanying editorial uses some “loaded” language in making the correct recommendation that regular, mass, population-based screening is not currently justified based on the available evidence. That “loaded” language is centered around the use of the terms “over-diagnosis” and “over-treatment.”
  • There is excellent evidence today that “mass, population-based screening” using mammograms to look for breast cancer is no more justified that prostate cancer screening, on any good statistical basis. Some 2,970 women must be screened once to find 27 cancers and save one life (in women aged between 40 and 65 years of age). The editorial repeats the finding of the European trial that it would be necessary to screen 1,410 men and find an additional 48 cancers to prevent one prostate cancer-specific death.
  • There are simple answers to the issue of “over-reaction” (to screening findings from doctors and patients), and they start with greater honesty — among the clinical community and among the survivor community — about what we really do and don’t know.
  • Over the past 30 years, prostate cancer deaths have dropped 20% in the US, but…”We still can’t tell [which patients are at real risk] beforehand, and so fear and  ‘standard practice’  tell us that we should proceed with treatment ‘to be on the safe side’. We need to do better. And it doesn’t help to demonize the problem with terms like ‘over-diagnosis’ and ‘over-treatment’.”
  • In all truth, we do not have good enough information to allow us to know the best thing to do for the vast majority of men who are at only a statistical (as opposed to a clinically evident) risk for prostate cancer.

It’s to be hoped someone draws the Health Select Committee‘s attention to this latest development in the debate, which has rumbled along since late March, when the results of the long-awaited studies were published in the New England Journal of Medicine - and failed to resolve anything.

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JULY 2: GUIDE2.CO.NZ: Parliament’s health select committee has issued terms of reference for its inquiry into early detection and treatment of prostate cancer.

The inquiry was announced on May 27 and the committee said today it would:

  • Seek a summary of the contemporary literature on the subject including incidence, mortality, groups at risk and testing options;
  • Seek opinions from asymptomatic men and patient advocacy groups;
  • seek opinions from specialist clinicians, radiation oncologists, urologists and general practitioners, epidemiologists and ministry officials;
  • Seek the best methods to promote awareness for early detection and treatment; and
  • Seek a cost benefit analysis, if appropriate.

The committee said it would call for submissions in the next few days.

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JUNE 27: OTAGO DAILY TIMES: Many men in New Zealand are suffering side effects after radiotherapy and surgery for prostate cancer which would never have killed them, and a screening programme would increase this, says University of Otago public health researcher Dr Brian Cox. READ MORE>

He was commenting on the recent announcement by chairman of the Health Committee Dr Paul Hutchison that the committee will conduct an inquiry into optimal screening (or early detection) and treatment of prostate cancer.

Dr Cox is concerned there is already considerable over treatment of men for this disease with very little evidence of any reduction in deaths from it.

Dr Cox, an epidemiologist, recently published an article in the New Zealand Medical Journal. READ IT HERE>

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