Archive for February, 2010

PROSTABLOG NZ: The ideological debate about prostate cancer screening hasn’t moved along much in New Zealand over the past few years.

I’m judging this from an anecdote a guest speaker at my journalism course told students this week.

An experienced journalist, she said a few years ago she was writing a piece for NZ Listener magazine about PSA screening, and the Ministry of Health would speak to her only on the condition they got to see the resulting article prior to publication.

That usually causes journalists to feel apprehensive, and in this case her fears were realised.

The Ministry people hit the roof over what she wrote (basically, that all men over 50 should be urged to get PSA tests), and made this plain to her editor.

Judging by what I heard from the Ministry team at the Health Select Committee hearing into prostate cancer screening late last year, the official view is still the same: PSA bad.

Speaking of which – I wonder when we’re going to hear anything further from the committee?

Chairman Paul Hutchison made the MOH people promise to deliver their final views last November.

Did they?

Are there more hearings?

When will we see the results?

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PROSTABLOG NZ:  It’s nearly a year since I shed that damned tricky wee organ, the prostate…and perhaps, inevitably, I’m back at this blog.

Not filing daily, as I did for six months, but adding something now and again as prostate information comes up.

But there’s something else that’s brought me back – you guys.

You’ve written some wonderfully encouraging feedback, evidence perhaps that my original motivation for blogging after my surgery in late March, 2009, was appropriate.

Prior to the operation, I could make no sense of the web’s technically complex, at times hysterical, sometimes misleading morass of prostate “information”.

Take a look at the latest message to come in today (SEE BELOW).

It’s from an Auckland man who will have a robotically guided prostatectomy next week, and he writes that my account has given him some comfort.

Can’t ask for better than that.

Good luck, John.

Have two more bits of good news (from my point of view).

  1. My second PSA test result came in this week and the antigens are still undetectable.
  2. Son Kirk and wife Megan have just brought our first grandchild into the world – “Sparky” Oliver Thomas Tucker (right).

Meantime, catch up with a bit of our “new” post-prostate lifestyle, Lin’s account of our campervan travels around the South Island of NZ earlier this year.

Titled  Thecatcametoo (because he did), it recounts what you can do about seeing your own country if you set your mind to it.  CLICK HERE>

Hello Jim & Lin,
A HUGE thank you for posting all this personal information. My wife Vickie read an article in the Listener with a link to your wonderful site.
I enjoyed your style of writing in an informative and humorous manner, and with your vivid description, I was actually able to visualise events as if I was there, sort of a 3D movie.
You are a lucky man, Jim, to have such a supporting and loving wife, as am I.
I am having surgery next Wednesday, so I found your story in the nick of time. It has calmed my nerves somewhat,and answered a lot of questions for me.
Looking forward to the catheter…NOT.
I will be having a “robotic-assisted radical prostatectomy” in Ascot Hospital in Auckland. Costs big money. Luckily, I have insurance, and have been paying premiums for 20 or so years. Almost quit several times.
I will post again after surgery.

John Montgomerie

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PROSTABLOG NZ: Wellington freelance writer Ruth Nichol has published her investigation into cancer screening in the latest NZ Listener magazine.

It’s an excellent read.

Buy the mag to read it all. Here are a couple of pages:

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PROSTABLOG NZ: Rates of prostate cancer detected in NZ are expected to rise about 23% in the decade leading up to 2016, moving from 91 cases per 100,000 to 112.

That’s the finding of a Ministry of Health cancer projection report released late last month, but only just picked up by news media (none of whom looked in detail at prostate cancer).

Something the report calls the “burden of new cases” is expected to increase by 71% over the 2006-2016 period. This term is not explained (for the uninitiated).

Interpreting the report is something of a challenge.

The Ministry’s researchers have chosen to single out prostate cancer projections as the only ones that “could not be updated  (although they have been extended), as these are based only on data up to 1984-88”.

The reason given is something they dub the “PSA effect”.

It’s hard to be sure, but this apparently means that because of a sudden upsurge of PSA testing in the late 1980s and early 1990s – leading to perhaps half of the Kiwi aged male population getting tested – there has been a massive blip in the detection statistics.

A half generation of men who would otherwise have not been detected until symptoms showed at an older age have been diagnosed “early”.

This has distorted trends to such an extent, it seems, the projection models can’t cope.

Graphs from the report, reproduced here, show the “bulge” effect. In the bottom one, the solid lines showing rates up to 2006 are extrapolated out (dotted lines) from 1986, ignoring what really happened because of PSA testing:

The Ministry says until rates return to what would have been expected “pre-PSA”, it cannot provide reliable predictions.

Despite that constraint, it has a go anyway: it concludes the rate of prostate cancer will continue to rise (presumably because of the baby boomer bulge moving through).

Confused? Join the club.

Why is prostate cancer being dealt with differently from other cancers that have been the subject of widespread screening and marketing campaigns, such as breast and cervical?

Is it because those screening campaigns were Ministry-approved, while PSA is frowned on by the Ministry because it leads to a problem – once prostate cancer is found there is no reliable way to know if it needs treatment, leading to possible over-treatment, and with it, unnecessary cost on the health system.

It would be useful to hear from epidemiologists on this, despite their inherent bias against PSA testing casting doubt on their views.

Still, they might help unravel the technicalities of the Ministry’s convoluted explanation.

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PROSTABLOG NZ: You Tube’s silent treatment of my plea to restore my piddling video because it has a social value transcending their “community guidelines” raises some issues.

These have nothing to do with prostate cancer, but bear with me.

As a journalist with nearly half a century’s experience, I’m finally waking up to the fact that media accountability has slipped even further away from the ideal.

It was never strong. Large media organisations have tended to deal arbitrarily with complaints, often calling on the utility of press freedom to justify their frequent breaches of public trust.

But at least there were actual mechanisms for holding them to account.

You could write to the editor, and if that didn’t do it, complain to the regulatory body – although, because it was usually self-regulatory, you didn’t hold your breath waiting for satisfaction.

You got a better deal with broadcasting in countries like NZ, which (under the guise of governments “needing to allot frequencies in orderly fashion”) have laws regulating media behaviour, laws with teeth.

Now, we have You Tube, which – like still images website Flickr, and aggregators like Google – is a global behemoth run by computers, and a law entirely unto itself.

If they choose to ignore your complaint, they will. And in my case, have. And there are no regulatory agencies to whom I can take my case, except perhaps the courts, if I had enough money.

There is an irony here. I could perhaps go to the “old media” and have them air it, if they could be persuaded.

They might be interested. After all, it’s a fairly bizarre case, isn’t it: prominent Kiwi journalism educator gets pissed off after his socially important video on, um, pissing, is taken off line.

It’s the sort of weird story that appears daily in newspaper “odd spots” round the world.

Then, and only then, might the new model of media conglomerate sit up and take notice.

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