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Posts Tagged ‘advice to GPs’

OPINION

PROSTABLOG NZ: For now, the debate about whether all men should be screened for prostate cancer is dead.

For now.

For sure, it will re-ignite at some future time, as prognostic tests are improved to the point where doctors can tell when  a prostate tumour discovered in a man needs treatment and when it can be left alone.

Why is the debate dead in the meantime?

Two studies published by the British Medical Journal today back up what most analysts have been saying since the March publication of early results of the two big randomised trials that have been looking at PSA/digital testing.

That mass screening will uncover a lot of cancers that are harmless. Over-treatment will result. It has already.

Even the NZ Prostate Cancer Foundation appears to have conceded this is the case.

At last week’s initial hearings by the Parliamentary inquiry into prostate cancer, Foundation president Barry Young said the organisation was “not dogmatic” about screening.

So where does this leave things?

Should we abandon PSA and rectal exams?

Hardly. They are reliable tools for diagnosis and must still be available to men who ask for them, men whose families have a history of prostate or breast cancer, men with symptoms like reduced urination, unexplained pains, blood in the urine, etc.

Where the debate still needs to continue is in the arena of primary health: how can the confusion that appears to reign among GPs and their patients be clarified.

And does all this rule out a marketing campaign urging men to be checked?

No way. It just needs to be done with a clear message.

Not a lot to ask.

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AUGUST 5: AMERICAN CANCER SOCIETY: In an effort to resolve confusion about what men need to be told about prostate cancer screening, the American College of Physicians has published advice to GPs about what they should advise patients. READ MORE>

For patients potentially interested in prostate cancer screening, physicians should engage them in shared decision-making; this is of even greater importance given the outcomes of the recent reports from the US
and European screening studies.

It is difficult for physicians to provide comprehensive and balanced information concerning prostate cancer screening decisions during a brief clinic visit.

The American College of Physicians has published a useful summary of discussion points to consider when counseling patients about prostate cancer screening:

● Prostate cancer is an important health problem.
● The benefits of one–time or repeated screening and aggressive treatment of prostate cancer have not yet been proven.
● DRE and PSA measurements can have both false–positive and false–negative results.
● The probability that further invasive evaluation will be required as a result of testing is relatively high.
● Aggressive therapy is necessary to realize any benefit from the discovery of a tumour.
● A small but finite risk for early death and a significant risk for chronic illness, particularly with regard to sexual and urinary function, are associated with these treatments.
● Early detection may save lives.
● Early detection and treatment may avert future cancer–related illness.

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