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Posts Tagged ‘Mike Scott’

NEW PROSTATE CANCER INFOLINK: The debate about mass screening for prostate cancer has been moved on significantly by by some recent Swedish studies, writes Mike Scott:

Is there a simple take-away from these three Swedish studies that correlates to the data from the meta-analysis of the six major screening trials? We believe that there is, and it is based on a testable premise:

  • All men should get a PSA test every 5 years starting at age 40, each of which is likely to be able to project a 25-year risk for diagnosis of prostate cancer and/or clinically significant prostate cancer.
  • Men who are shown to be at no significant 25-year risk based on these 5-yearly PSA tests may not need to get interim PSA tests unless there are other reasons for them to do so (based on clinical signs and symptoms, ethnicity, genetics, and other known factors).
  • Men who are shown to be at significant 25-year risk based on any one of the 5-yearly PSA tests should be encouraged to monitor their PSA with care over time in consultation with a prostate cancer specialist and make appropriate clinical decisions based on their individual data.

READ MORE>

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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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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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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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NEW PROSTATE CANCER INFOLINK: Prostate cancer is linked to gene variations we inherit, but there are other factors involved as well, writes Mike Scott. READ MORE>

It is all too easy to want to believe that prostate cancer (and other forms of cancer) might be like one of the truly heritable diseases that are utterly dependent on one’s genetics, such as sickle cell anemia or Huntington’s disease.

Unfortunately, it just isn’t going to be that simple.

The development of prostate cancer in any specific individual is most probably a multi-stage process.

It may well be linked to the genes you are born with, but it is also quite certainly linked to other things that happen as you age.

As yet, we have minimal understanding of what those “other things” really are.

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NEW PROSTATE CANCER INFOLINK:  How often after prostate surgery should a “low risk” patient have his PSA tested to check if the cancer is coming back? READ MORE>

Tollefson et al. conclude that,  in low-risk patients, the risk of biochemical failure is inversely proportional to time for which the PSA is undetectable after radical prostatectomy.

They go on to suggest that taking PSA levels every two years should be sufficient to identify the majority of low-risk patients who experience biochemical progression.

The “New” Prostate Cancer InfoLink would certainly agree that annual PSA testing is probably unnecessary in the majority of patients who are treated surgically for low-risk disease if their PSA is undetectable after surgery.

However, the key question is how long should annual PSA testing be carried out before the patient can be switched to testing every two (or perhaps even every three) years.

Based on this paper, it would seem likely that even low-risk patients should all receive at least annual testing for three years after surgery.

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NEW PROSTATE CANCER INFOLINK: The US Food and Drug Administration is warning companies offering genetic tests for diseases – including prostate cancer – that their claims can’t be backed up by research data.

Mike Scott says the prostate cancer ones are, as yet, not particularly useful, and he sets out criteria for companies to meet as more tests are developed and marketed over the next five years. READ MORE>

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