Balanced account of PSA debate in NZ Herald

NZ HERALD: The Herald’s medical reporter, Martin Johnston, has written a balanced account on where we are with the great PSA debate. READ MORE>

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Prostate screening misses out in Obama’s new health insurance

ASSOCIATED PRESS: Screening for prostate cancer will not be included in President Obama’s new preventive health insurance next year. READ MORE>

New health insurance policies beginning on or after September 23 must cover — without charge — preventive care that’s backed up by the best scientific evidence. Most people will see this benefit, part of the Obama administration’s health care overhaul, starting January 1.

The list includes tests strongly recommended by the US Preventive Services Task Force, an independent advisory panel that evaluates research.

Of note for men: Screening for prostate cancer isn’t included on the list because its benefits haven’t been conclusively shown by the best research, at least to the high level required by the law.

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Men with low PSA at 60 unlikely to die from prostate cancer

BRITISH MEDICAL JOURNAL: Men with a low PSA score at the age of 60 probably face little risk of dying from prostate cancer – even if they have it already, a new study claims. 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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Are we really no further ahead with prostate cancer testing?

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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Proponents of prostate cancer mass screening nervous as breast cancer screening debated in UK

THE INDEPENDENT (UK): Proponents of mass screening for prostate cancer are nervously watching a major debate in the UK over the effectiveness of mass breast cancer screening. READ MORE>

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Nurses should be trained to assist men decide about prostate cancer screening

URO TODAY: Nurses trained in decision counselling can facilitate shared decision-making about prostate cancer screening, says a new study. READ MORE>

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Negative info about prostate cancer screening can put men off

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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New Swedish research shows PSA testing can cut prostate deaths by half

NEW PROSTATE CANCER INFOLINK: A detailed analysis of the findings of a Swedish study into the effectiveness of prostate cancer screening using PSA tests is provided here by Mike Scott: READ MORE>

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.

Earlier stories

Reuters and other news agencies gave widespread coverage to the Swedish study over recent days.

REUTERS: An extensive study of 20,000 men into the merits of screening men between the ages of 50 and 65 for prostate cancer has found it can cut death rates from the disease by as much as half, report Swedish scientists. READ MORE> and HERE> and HERE> and HERE> and HERE>

Over 14 years of follow-up, prostate cancer death rates were cut almost by half in the (PSA) screening group compared with the non-screening group, as men were diagnosed and treated in time to stop the cancer from killing them.

Jonas Hugosson, who led the study, said the results showed that PSA screening of all men this age group “can result in a relevant reduction in cancer mortality.”

But the findings don’t necessarily mean nationwide prostate screening programs should introduced, experts said, since they run the risk of significant overdiagnosis of tumors in men who would not have suffered any harm from their cancer.

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