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>
Posts Tagged ‘Health Select Committee’
NZ Parliament releases prostate cancer report
Posted in SELECT COMMITTEE INQUIRY, tagged Health Select Committee, NZ, NZ Parliament, prostate, PROSTATE CANCER, prostate detection, Prostate inquiry, prostate report, PSA on July 27, 2011| 2 Comments »
How does ‘encouraging’ men to have PSA tests differ from mass screening?
Posted in Uncategorized, tagged blood test, blood tests, cancer screening, catheter, digital diagnosis, digital examination, Health Select Committee, Mark von Dadleszen, mass screening for prostate, medical checkups, Ministry of Health, NZ Health Select Committee, NZ Parliamentary inquiry into prostate cancer, Paul Hutchison, prostablog, prostate, PROSTATE CANCER, Prostate Cancer Foundation of NZ, prostate cancer inquiry, prostate cancer screening, prostate testing, prostate treatment debate, prostate-specific antigen, PSA, PSA test, Screening debate on April 2, 2011| 3 Comments »
PROSTABLOG NZ: Exact meaning of the word “encourage” will be pivotal in the continuing New Zealand saga on how best to prevent prostate cancer.
“We will be encouraging men to go to their GPs to discuss options…including whether or not they should have a PSA test,” says the chairman of Parliament’s inquiry into prostate cancer, Paul Hutchison, in today’s Dominion Post newspaper (see below).
In the same story, his statement is welcomed by Prostate Cancer Foundation of NZ president Mark von Dadelszen: “…we would certainly applaud that move.”
What they both mean by the term “encourage” is about to become the focus of a debate that has churned around in global prostate cancer politics since PSA testing became commonly available in the early 1990s.
First question: how does “encouraging” men to be tested differ from a national screening programme (which Hutchison signals will be rejected in the inquiry report due in a matter of weeks)?
A national screening programme presumably involves the Ministry of Health spending millions promoting tests to the general populace, as it does with breast and cervical cancers.
Such programmes “encourage” people to get along to their doctor and have the tests.
How will men be encouraged? Not with a lot of advertising, it seems.
So how, exactly?
By training barbers to spread the word to their clients, as has been tried in the US?
By sending doctors into communities to talk about risks and options, as the Foundation did last year when it flew a team to the Chathams?
By leaving it to the Foundation to publicise the disease and urge men to act, as happens now?
Whatever approach the Health Select Committee is about to recommend, it needs to deal with a mammoth in the waiting rooms – the Ministry of Health instruction to GPs that they must not raise the topic of PSA and rectal examination until the patient does or unless they spot symptoms obviously related to what is often a symptomless disease.
This is the real crux of the dilemma the Select Committee has presumably been wrangling with since its first public hearings in September, 2009.
What instruction will it recommend the Government give to the Ministry, whose staff and advisers adamantly oppose any widening of the availability of PSA testing?
Up to now, men have been the subject of a mild but just as deadly form of Russian roulette when it comes to being diagnosed.
Take my own case.
Over the past 30 years, I’ve been under the care of four GPs. The first never mentioned prostate cancer (to be fair, I was under 50); the second (mid 1990s) refused to consider PSA tests because to him they were unproven; the third insisted on it without my bidding; and my current one responded readily to my request for tests (saying Ministry instructions forbade him raising the matter unless I spoke up first!).
Anecdotal evidence suggests the Ministry’s obfuscation is becoming increasingly irrelevant – for some people, anyway.
The Foundation’s awareness campaigns have been effective, if I judge by the number of male acquaintances now being diagnosed early and successfully treated.
However, I suspect there are dangerous class factors at play here.
Me and my mates are okay because we have been blessed by education, higher socio-economic status, media awareness and access to health provision.
I fear for those who don’t. The Ministry’s stubbornness condemns them to an uncertain fate.
National prostate screening rejected
Dominion Post April 2, 2011
A PARLIAMENTARY inquiry into prostate cancer screening will not be recommending a national screening programme despite pressure from cancer survivors to do so.
The Prostate Cancer Foundation has backed the committee’s approach, but a former patient says the decision is disappointing.
Health select committee chairman Paul Hutchison said the inquiry, which has been running since May 2009, was not due to report back for another few weeks, but when it did, it would not advocate screening.
There was still controversy over whether blood tests for prostate-specific antigens led to fewer prostate cancer deaths, he said.
Heightened levels of prostate specific antigen – PSA – can indicate the presence of prostate cancer. However, early detection can result in aggressive and unpleasant treatment of tumours that would never have grown or created ill-health.
The inquiry has heard from a huge number of prostate cancer survivors, many of whom asked for a screening programme for all men aged 50 and older.
Dr Hutchison could not go into detail about the committee’s findings but said there were two main conclusions.
‘‘We will not be recommending a PSA screening programme. However, we will be encouraging men to go to their GPs to discuss options … including whether or not they should have a PSA test.
‘‘Those are the two points that are loud and clear.’’
Prostate Cancer Foundation president Mark von Dadelszen said the organisation did not support a national screening programme because of ‘‘issues’’ with the PSA test.
‘What it does advocate is that men should be encouraged to have screening tests . . . we would certainly applaud that move.’’
Napier farmer Duncan McLean, who has just got the all-clear five years after being diagnosed with prostate cancer, said encouragement was good but the committee should recommend a full screening programme.
Mr McLean, 57, had his prostate gland removed in 2006 after several years of increasingly high PSA readings, followed by a biopsy that confirmed the cancer.
‘‘PSA testing is essential. I’m alive today because of it. It’s really disappointing they’re not [recommending screening].’’
Fears about over-treatment were ‘‘bollocks’’, he said. ‘‘You don’t leap in and go under the surgeon’s knife – I was monitored for three years before I had surgery.’’
International research on the matter is split, with several largescale studies under way.
The results of a 20-year Swedish study, published yesterday in the British Medical Journal, found screening did not significantly reduce prostate cancer deaths but the risk of overdetection and unnecessary treatment was considerable.
However, another Swedish study found death from prostate cancer more than halved among men who were screened.
Year has passed and no news from NZ’s parliamentary inquiry into prostate cancer
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).
A brief mention in Sunday paper’s story about people who reveal all on the web
Posted in NZ Media coverage, tagged Brachytherapy, catheter, Health Select Committee, LDR brachytherapy treatment, Mark Ebrey, prostablog, prostate, prostate blog, PROSTATE CANCER, Sunday magazine, Sunday Star-Times on September 5, 2010| 1 Comment »
PROSTABLOG NZ: Kiwi prostate cancer campaigner Mark Ebrey sent this supportive note today about my small appearance in the Sunday Star-Times‘ magazine feature about people who reveal all on the web:
“I see you got an honorable mention in the Sunday magazine today. Well done.
I’ve got a petition currently before the Health Select Committee considering whether to review the LDR brachytherapy treatment option.
You will be interested to know I had the implant a month ago yesterday and to date – absolutely no side effects whatsoever, other than the pain over heart where the $24,000 bill is.
Am beginning to wonder about a disease I had no symptoms for, and treatment with no side effects – have I actually been conned?”
NZ Government: More than 40 men would suffer incontinence, impotence or bowel dysfunction for every life saved by prostate screening
Posted in Digital exams, PROSTATE CANCER, PSA tests, Screening debate, SELECT COMMITTEE INQUIRY, tagged American Urological Association annual conference, Australian Medical Journal, Biopsy, blood test, bowel dysfunction, cancer research, catheter, Health Select Committee, inquiry into prostate cancer screening, Mike Scott, Ministry of Health, national prostate cancer screening programmes, New Prostate Cancer Info-link, NZ Guidelines Group, population-based screening, prostablog, prostate, prostate blog, PROSTATE CANCER, prostate cancer screening, prostate-specific antigen, PSA, PSA test, PSA tests/digital rectal examinations, PSA/DRE, Robin Smart, Screening debate, sexual dysfunction, two large international screening trials, urinary dysfunction on June 13, 2010| 3 Comments »
PROSTABLOG: When can we expect a report from the NZ parliamentary inquiry into the early detection and treatment of prostate cancer, which was launched a little over a year ago?
No word on that from the committee, but perhaps two of the most powerful “words” in the debate on screening were submitted to the committee just before last Christmas (unreported in the news media, so far as I can tell).
They came from eminent pro-screening urologist Robin Smart and from the Ministry of Health’s expert panel, the NZ Guidelines Group, which has been strongly anti-screening (population-based).
Here’s a couple of quotes from Smart’s submission, which discussed the inconclusive results of the two large international screening trials published in March last year:
The conclusion is that it is now very difficult if not impossible to conduct trials of controls having no testing versus screened having PSA/DRE (PSA tests/digital rectal examinations) testing with endpoints of death or metastases in advanced countries especially the United States.
This is largely due to the international improvements in these aspects because of PSA/DRE testing and consequent reluctance of men to remain in control groups.
This in turn means that it is going to continue to be difficult for authorities and governments responsible for making decisions concerning setting up national prostate cancer screening programmes who are waiting for more information before doing so.
These decisions will have to be made largely on current information from existing trials, studies and experience…
The weight of evidence in favour of PSA/DRE testing is now irrefutable after almost two decades of international experience.
To go back to the time before PSA testing would now be unthinkable.
Of course we hope for the perfect tests, perfect treatment and continue to look for improvements. But men today need the benefit of current technology which the evidence shows is saving between a third to a half of those who would otherwise die of prostate cancer where it is applied.
In its final submission (dated the same day as Smart’s, December 16), the guidelines group gave a contrary view.
It looked at nearly 10,000 research abstracts and chose 166 it says were relevant to the brief given to it by the Ministry of Health.
Its analysis concluded that the potential harm from population-based screening outweighs benefits.
The best case scenario it could find estimated that a screening programme conducted on all men aged 50 to 74 for nine years would save about 40 lives a year (from the 600 who die from the disease in NZ each year).
Those 360 lives saved over nearly a decade had to be weighed against the following “harm” that could be done:
- An estimated 41 men would suffer significant treatment complications for every one life saved.
- Of the additional 1953 men per year requiring prostate cancer treatment (presumably on top of the 2500 now), 43% to 88% would have sexual dysfunction, 10% to 35% urinary dysfunction and 8% to 43% bowel dysfunction (the range depending on whose research is consulted)
- Each year, there would be the following additional complications – 838 to 1677 cases of sexual dysfunction; 156 to 838 cases of bowel dysfunction; and 195 to 682 cases of urinary dysfunction.
Meantime, international debate on screening continues.
HERE> is a report on a pro v con panel discussion at the recent American Urological Association annual conference.
And, Mike Scott, sitemaster of the New Prostate Cancer Info-Link in the US, says he agrees with an April article in the Australian Medical Journal that said population-based screening (that is, screening of all men) cannot be sanctioned until something more accurate than the PSA test is developed. READ MORE>
Prostate cancer inquiry delayed as House takes urgency
Posted in PROSTATE CANCER, SELECT COMMITTEE INQUIRY, tagged Health Select Committee, inquiry postponed, NZ Parlioament, prostablog, prostate, prostate blog, PROSTATE CANCER, prostate cancer inquiry on September 15, 2009| Leave a Comment »
PROSTABLOG NZ: Those turning up for the first day of hearings at the inquiry into prostate cancer need to check first, because the NZ Parliament has gone into urgent session, meaning all meetings will be delayed or postponed.
The hearings before the Health Select Committee were scheduled to begin in Bowen House, Wellington, at 10am and go through to 12.30pm.
Tomorrow’s sitting was to be the first of two, the second set down for Wednesday next week, when Prostate Cancer Foundation board members will make their submissions.
There were no details available tonight of how a postponement tomorrow may be accommodated.
Widespread confusion over prostate cancer advice in NZ ‘untenable’ says chair of Parliamentary inquiry
Posted in PROSTATE CANCER, Screening debate, SELECT COMMITTEE INQUIRY, Treatment debate, tagged Dominion Post, Dr Paul Hutchison, early detection and treatment, Health Select Committee, leading New Zealand urologist, NZ Parliament, prostablog, prostate, Prostate advice, prostate blog, PROSTATE CANCER, prostate cancer screening, prostate confusion untenable, prostate treatment, prostate treatment debate, PSA, PSA test, Robin Smart, Screening debate, select committee prostate inquiry, urology, widespread confusion on September 1, 2009| Leave a Comment »
PROSTABLOG NZ: The widespread confusion many men feel over the advice they receive on early detection and treatment of prostate cancer is untenable, says Dr Paul Hutchison, chairman of the NZ Parliamentary Health Select Committee. READ MORE>
He says this in an article he wrote for today’s Dominion Post newspaper in Wellington, just two weeks from when his committee will be hearing submissions to its inquiry into prostate cancer screening and treatment.
That a leading New Zealand urologist, Robin Smart, recently concluded ‘‘the evidence suggests that between 200 and 300 of the 600 men who die annually of prostate cancer could be saved by current technology’’ indicates greater efforts need to be made, he writes.