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>
Archive for the ‘SELECT COMMITTEE INQUIRY’ Category
Posted in SELECT COMMITTEE INQUIRY, tagged Biopsy, biopsy samples, blood test, blood tests, Brachytherapy, cancer research, catheter, comparison of treatments, diagnostic tests, diagnostic tools, digital diagnosis, digital examination, Erectile function, External beam radiation, inquiry in prostate cancer detection, Invasion of the Prostate Snatchers., journalists in NZ, male baby boomers, mass screening, medical checkups, Ministry of Health, new drugs, news media, NZ parliamentary prostate inquiry, oncologist, Over-treatment, overseas prostate industry boom, pathologist, prostablog, prostate, prostate blog, PROSTATE CANCER, prostate cancer screening, prostate cancer treatments, prostate snatchers, prostate treatment, prostate treatment debate, prostate-specific antigen, prostatectomy, Provenge treatment, PSA, PSA test, quality of life, Radical prostatectomy, Radiotherapy, robotic surgery, Screening debate, SELECT COMMITTEE INQUIRY, Specialist advice, surgery, urologists, urology, Watchful waiting on September 26, 2010 | 1 Comment »
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.
Posted in SELECT COMMITTEE INQUIRY, tagged American Cancer Society, Australian Cancer Council, Cancer Society, digital diagnosis, digital examination, Health Select Committee, Health Select Committee inquiry, large randomised trials, Ministry of Health, National Health Committee, NZ Guidelines Group, NZ prostate cancer inquiry, Parliamentary Health Select Committee inquiry, prostablog, prostate, prostate blog, PROSTATE CANCER, prostate cancer inquiry, prostate cancer screening, prostate-specific antigen, PSA, PSA test, Royal NZ College of General Practitioners, Screening debate, UK Cancer Research Council, Urological Society of Australia and New Zealand on September 12, 2010 | Leave a Comment »
PROSTABLOG NZ: It’s almost a year since the first hearings were held by the NZ Parliament’s Health Select Committee inquiry into the early detection and treatment of prostate cancer.
The obvious question now is when will it report back.
Since it published its terms of reference in August last year, the committee has received 33 submissions, four of them from the influential health lobby group, the NZ Guidelines Group, whose last submission was made in December.
This document made it clear that the group – an independent incorporated society originally set up by the government in 1996 – is opposed to population-based PSA screening.
To save one life, up to 41 men could incur significant harm.
It bases this view on its assessment of numerous NZ and international studies, including two large randomised trials (one European, the other American) that were reported last year.
Here are some of the last pages of the group’s December, 2009, submission (RCT = random controlled trial):
This also appears to be the main thrust of submissions on PSA testing from other health authorities (although the Guidelines Group is at pains to stress it is independent from the Ministry of Health).
Another “official” organisation, the National Health Committee, said in its submission (August 26, 2009) that it has seen nothing to change its 2005 advice to the MOH that population-based PSA screening is not an acceptable option.
However, it did favour targeted screening of high-risk groups, such as men with a family history of prostate cancer.
The NHC is aware that since providing its advice in 2005, clinical practice has found
that targeted screening for men at high risk of prostate cancer appears to be useful
and potentially cost effective. These are men who have a family history of prostate
or related cancers.
The Royal NZ College of General Practitioners – presumably speaking on behalf of doctors on the frontline – said in its submission it would go along with the NZ Guidelines Group’s views.
It did make a couple of pleas, however, calling for up-to-date information to hand out to patients, and for treatment to be available to all:
It is important that inequities in access relating to follow up after positive
screening results, and for symptomatic men, are identified and eliminated.
The Cancer Society agreed with the Guidelines Group, and backed this up by quoting from selected organisations in other Western countries.
Most agencies around the world have some form of recommendation that decisions for screening for prostate cancer should be made on an individual basis and in consultation with a medical professional:
The Australian Cancer Council states that:
“In the absence of direct evidence showing a clear benefit of population based screening for prostate cancer, a patient centred approach for individual decisions about testing is recommended. Screening discussions and decisions should always include and take into account, age and other individual risk
factors such as a family history of the disease” (Cancer Council Au 2005).
The American Cancer Society states that:
“The American Cancer Society (ACS) does not recommend routine testing for prostate cancer at this time. ACS believes that doctors should discuss the pros and cons of testing with men so each man can decide if testing is right for him. If a man chooses to be tested, the tests should include a PSA blood test and
DRE (digital rectal exam) yearly, beginning at age 50, for men at average risk who can be expected to live at least 10 more years.” (American Cancer Society 2009).
The UK Cancer Research Council states:
“in the UK, there is no national screening programme for prostate cancer because trials have not yet shown clear evidence that screening will reduce deaths from this disease. Also, many men diagnosed with
prostate cancer have very slowly growing cancers that will never cause any symptoms or problems in their lifetime. So at the moment there is no clear benefit in diagnosing prostate cancer early and it may actually cause harm for some men.”(Cancer Research UK 2009).
Urological Society of Australia and New Zealand states:
“Individual men aged 50 to 70 years with at least a 10 year life expectancy should be able to be screened by annual DRE and PSA testing, after appropriate counselling regarding the potential risks and benefits of investigations and the controversies of treatment.”(Urological Society ANZ 1999).
The majority of submissions – from prominent medical practitioners, prostate cancer lobby groups and patients – urged the committee to recommend PSA testing, if not on a population (all men) screening basis, then at least as a service offered routinely by GPs, without men having to ask (the current MOH policy).
Posted in Govt prostate policy, SELECT COMMITTEE INQUIRY, tagged catheter, Health Select Committee inquiry, Listener, NZ Ministry of Health, NZ Parliament; Health select committee, Paul Hutchison, prostablog, prostate, prostate blog, PROSTATE CANCER, prostate cancer treatments, PSA, PSA test, Screening debate on February 26, 2010 | 3 Comments »
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.
Are there more hearings?
When will we see the results?
Posted in AWARENESS and MEDIA, NZ Media coverage, SELECT COMMITTEE INQUIRY, tagged catheter, magazine inquiry, NZ Listener, NZ Parliamentary inquiry into prostate cancer, prostablog, prostate, prostate blog, PROSTATE CANCER, prostate treatment debate, screening, Screening debate on January 18, 2010 | Leave a Comment »
PROSTABLOG NZ: The NZ Listener magazine has commissioned an article on cancer and the theme will be screening.
I was interviewed for it today and I think the writer has a good grasp of the issues.
Look forward to seeing what she comes up with.
Does anyone know what happened to the NZ Parliamentary inquiry into prostate cancer?
It was supposed to get more evidence from the Ministry of Health in November, when the ministry expected to have completed its analysis of the two big randomised studies into PSA screening.
Posted in PROSTATE CANCER, SELECT COMMITTEE INQUIRY, Treatment debate, tagged advanced prostate cancer, battling medical system, Health Select Committee inquiry, NZ MPs, NZ Parliament, prostablog, Prostablog's 1000, prostate, prostate blog, PROSTATE CANCER, prostate cancer screening, prostate cancer treatments, prostate saga, prostate treatment, prostate treatment debate on September 25, 2009 | Leave a Comment »
PROSTABLOG NZ: This is a very special post – the one thousandth for Prostablog since we launched on April 1, 2009.
It’s special because I’ve reserved it for a brave and resilient couple, Kim and Brian, whose saga with prostate cancer brought tears to the eyes of every person in the Select Committee room at the NZ Parliamentary inquiry into prostate cancer this week.
I’ve never met Kim Cook. We’ve spoken on the phone just a couple of times.
But I know a lot about her from the way she has written for Prostablog over the past winter months.
Her story (entitled John and Mary’s story) is about the struggle she and partner Brian have faced getting treatment for his cancer, which is now advanced.
Kim said she wanted something to come out of their battle: how could she get her message across about the frustrations some prostate patients face with the medical system in NZ?
What better way than to tell the story to the Health Select Committee on the first day of its hearings.
They had already had about 10,000 words from her in a written submission.
What came on Wednesday, via phone teleconference (because Brian was not up to the trip from Auckland to Wellington), was a gritty, emotional but devastatingly precise introduction to their story.
Kim’s voice broke only once, near the end, when she talked of crying herself to sleep most nights.
MPs, reporters, audience, dabbed their eyes at this point.
It was important for the MPs on the committee to hear from this brave woman.
It was a reality check for them, a respite from the mostly dispassionate testimony of medics and bureaucrats.
Kim, Prostablog salutes you.
CLICK HERE to see what Kim said.
FOOTNOTE: prostablog has come a long way from the first days of April, when views were lucky to hit double figures.
Yesterday we had nearly 400 page uploads, the most for a single day. So far.
As I write this, I see that 21,278 people have taken a look since we launched. Probably, it’s a lot more than that, since direct RSS feeds are not recorded.
The most recent indication we have “arrived” was a request from a New York robotic prostatecomy clinic to please put a link to their website on our home page. Happy to oblige.