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Posts Tagged ‘NZ Prostate Cancer Foundation’

WatsonPROSTABLOG NZ: A leading NZ scientist has discovered a novel compound he believes will suppress the prostate cancer that is killing him.

Dr James Watson (right) – a former professor at the University of California, now back in NZ – discovered too late he has advanced cancer, so has embarked (with a fellow Kiwi scientist, who also has advanced prostate cancer) on a research project to stop his deadly disease.

He believes he has identified a treatment that will stimulate his immune system to fight the cancer, which has spread beyond his prostate.

He has decided to test the compound on himself, with the assistance of another eminent Auckland medical specialist.

His quest is driven partly by the altruism of finding a viable treatment for all men whose prostate cancer moves to a stage that defies treatment, and partly by his anger at not being diagnosed early when the disease could have been treated easily.

He saw several GPs before one offered him a PSA test, by which time his level was a lethal 987.

He and colleague Dr Richard Forster, an expert on immunology and plant biology, have set up a company to develop their discoveries.

They revealed their progress at the annual conference of the NZ Prostate Cancer Foundation in Napier.

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JULY 29: PROSTABLOG NZ: Don’t waste your time eating raw tomato if your aim is to stave off prostate cancer, a leading NZ scientist says.

The tomato has to be cooked to do any good, immunologist Dr Richard Forster told the NZ prostate Cancer Foundation’s annual meeting in Napier last weekend.

Watch this website for a full report soon of what Dr Forster and his colleague Dr Jim Watson have to say about avoiding and treating prostate cancer.

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JULY 17: PROSTABLOG NZ: We’ve arrived!

Prostablog has been “adopted” by the Prostate Cancer Foundation of New Zealand as its blog and there is now a link to us from the foundation’s website.

PCF

It’s been a good week for Prostablog in other ways: on Wednesday we had 225 hits, our biggest ever readership since the site began on April 1.

Page loads now average about 150 a day, not counting those who have an RSS feed (not counted by StatCounter).

The site has had 8385 hits in its two and a half months.

This is the 599th post.

The biggest readership is from the US (about 45%), while NZ viewers make up between 25% and 30%. The chart below shows where some of the last 2000 hits came from (the chart on StatCounter is much longer than this):

Blog1

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BarryYoungJUNE 22: PROSTABLOG NZ: For many years New Zealand men have refused to accept the lack of a formal screening programme for prostate cancer and have opted for self-requested screening, says NZ Prostate Cancer Foundation president Barry Young (right).

“Without screening programmes, New Zealand men have taken the initiative and established their own,” he says in a statement released to Prostablog NZ. today.

“Nearly 3000 men are diagnosed with prostate cancer every year and about 600 die of it, so you can see the scale of what is happening.

“We are hopeful that the recently announced Health Select Committee inquiry will decide to change this and create a formal prostate cancer screening programme.

“It is every man’s right to know what is happening within his body and to decide for himself whether he should be treated for a disease or not.

“This is particularly the case with prostate cancer, which can be developing within a man’s body without him knowing about it.

“What men have to realise is that in its early stages prostate cancer doesn’t usually exhibit symptoms and when symptoms do occur it is usually too late for effective curative treatment.

“This is why men need to be screened for the disease.  The best chance to cure it is while it is still within the prostate.  Once it is out of the prostate it is usually too late.

“About 10 per cent of men will get prostate cancer and this is bad enough for the average bloke.  But there are some walking time bombs out there, men who have a father or grandfather or brother who has been diagnosed with prostate cancer.

“These men are many times more likely to get the disease.  Depending upon how many of their direct relatives have been diagnosed with prostate cancer, the likelihood that they will get it can climb up beyond 80 per cent.

“Because of this we recommend that men begin annual screening for prostate cancer when they reach 50.  If there is a history of the disease in the family then the screening should start at 40.

Paul Hutchison“We trust that this is the sort of thing that will be looked at during the Health Select Committee inquiry into screening for prostate cancer.  We have already offered the chair of the committee, Dr Paul Hutchison (left), our complete co-operation.”

Mr Young says the decision about whether to be screened for prostate cancer, and then whether to be treated for it, is a matter for each man and his family.

Men should be informed about the various pros and cons associated with the diagnosis and treatment of prostate cancer.

“It is a complicated business and we find that men and their families often need guidance in making a decision, but in the end the decision must be theirs, once they have been fully and accurately informed.

“The Foundation’s mission statement says our role is: ‘to create or enhance an environment to empower men to make informed decisions about the diagnosis and treatment for prostate cancer’.

“I don’t see how anyone can argue with that, and if a screening programme helps with this then we will be all for it.”

For any further information, please call Barry Young, 0274-825-253

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JUNE 4: PROSTABLOG NZ: Any hopes the NZ Prostate Cancer Foundation and some top urologists may have that the government will change its mind  any time soon about promoting prostate cancer screening among men are not helped by a new NZ Medical Journal article. READ ARTICLE HERE>

There has been world-wide  renewal of the debate about population-based screening campaigns since publication in the New England Journal of Medicine in March of the results of a couple of long-term studies into whether PSA testing saves more lives.

The authors of the NZ article think the results support a long-held fear that PSA testing leads to “over diagnosis” and unnecessary treatment of slow-growing prostate tumours that were never going to do any harm.

The Otago University researcher and epidemiologist say:

“The results of the randomised controlled trials might optimistically be considered to indicate that: eventually there will be a reduction in prostate cancer mortality from PSA testing of asymptomatic men 55–69 years of age; the considerable harms from such testing are bearable by patients and the health care sector, and; PSA testing of asymptomatic men should be facilitated.

“Another view would be that we now have inconclusive evidence from randomised controlled trials of any decrease in prostate cancer mortality and unequivocal evidence of major harms, mainly from over-diagnosis and consequent overtreatment, so much so, that good health care should involve advising asymptomatic men against PSA testing at this time.”

The article is timely, since the Ministry of Health is due to release an updating statement on its prostate screening policy.

Its stance has been that a campaign like those for cervical and breast cancer screening is not appropriate for prostate cancer, given widely held views that it may do more harm than good.

This is a view shared by the Cancer Society, but not the prostate cancer foundation, whose president, Barry Young, has called the stance scandalous.

His opinion appears to be backed by statistics showing the death rate among Maori men from prostate cancer is twice that for non-Maori. The cervical and breast cancer campaigns feature TV advertisements clearly aimed at Maori and Pacific Island women.

Recent US studies show poorly educated men in lower socio-economic groups fare worst from prostate cancer, as do black Americans.

The NZ Medical Journal article seems at odds with the American Urological Association’s recently updated guidelines, which urge men of 40 to be PSA-tested so a baseline for later comparison can be established (level change and speed of change are significant).

However, the AUA is equivocal about what the two studies reveal and stops well short of recommending population-based screening. It advises “well-informed” men to seek individual assessment by their physicians, a view held by the NZ Ministry of Health.

The ministry has been reviewing the studies. One of its committees discussed them on May 18 and has made a recommendation on screening to the Director General of Health, who is expected to make a statement as early as Monday.

This will undoubtedly assist the new Minister of Health, Tony Ryall, who contradicted himself when he announced new health targets in May. He made no mention of prostate cancer, despite his January statement that it would be a top priority for the new Government.

NZ Medical Journal, June 5, 2009:

PSA testing in asymptomatic men to diagnose prostate cancer remains experimental

By Brian Cox, Mary Jane Sneyd

The recent reductions in prostate cancer mortality seen in some countries have been attributed to earlier detection of the cancer by PSA testing.

However, the randomised controlled trials show that if any benefit from PSA testing exists it would not be seen within 7 years of its introduction.(1,2)Therefore, the mortality reductions observed are likely to be due to more cases being offered curative therapy or the availability of better treatment.

In 1996, PSA testing of asymptomatic men was considered experimental and the major potential for over-diagnosis and subsequent overtreatment with major sideeffects was highlighted3 and now the results of two studies have become available.

These results provide conflicting evidence of the effectiveness of PSA testing in reducing mortality from prostate cancer.

The results of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial in the United States were published because, at this time, the study’s monitoring board raised concerns about the harms they identified from PSA testing in asymptomatic men,(2) whereas the European Randomized Study of Screening for Prostate Cancer (ERSPC) study protocol precipitated publication when a statistically significant result was obtained from analyses conducted at regular intervals.(1)

A summary of the design of these two studies is shown in Table 1.

The ERSPC study was conducted in 7 countries, used various PSA cut-off points for recommendation for biopsy, varying screening intervals, and different age eligibility, with screening ceasing when the upper age of eligibility was reached.

In the PLCO trial, men aged 55–74 years were offered annual PSA testing for 6 years, combined with digital rectal examination for 4 years, or in the control arm received usual care.

Active annual follow-up by questionnaire and linkage to the National Death Index was undertaken with a median duration of follow-up of 11.5 years (range
7.2–14.8). The PSA assays for each PLCO trial centre were performed by one laboratory. A cut-off of 4ng/ml was used to recommend referral to their usual doctor.

Table 2 summarises the main results of these studies.

The results of the ERSPC study suggested a 20% reduction in prostate cancer mortality from PSA testing, along with other screening tests such as digital rectal examination (DRE) and transrectal ultrasonography (TRUS), in asymptomatic men after a median of 9 years of follow-up (RR=0.80, 95%CI 0.65–0.98).

Table 1. Summary of the design of the PLCO trial and the ERSPC study

Screening 1

The PLCO trial observed a non-significant 13% increase in prostate cancer mortality in those offered annual PSA tests (RR=1.13, 95%CI 0.75–1.70) after 7 years of follow-up for all subjects.

This was not significantly altered by inclusion of available data to 10 years of follow-up (67% of subjects) or if confined to those with one PSA test, or 2 or more tests, in the previous 3 years at baseline.

The chance of a diagnosis of prostate cancer increases with the number of biopsies taken.

In the ERSPC study the number of biopsies after a positive screening test varied between countries, but standardisation was recommended in 1996, whereas in the PLCO trial the decisions about biopsy and treatment were left to the man’s usual health care provider.

This meant that, in the PLCO trial, any further assessment procedures and treatment were expected to be similar for both the intervention and control group.(4)

Table 2. Summary of the PLCO trial and ERSPC study results of PSA screening for prostate cancer

Screening 2

In Finland, Sweden, and Italy, randomisation of the offer of screening occurred after selection from population registers – a study of the effect of the introduction of prostate screening in the general population (the effectiveness of screening).

In the Netherlands, Belgium, Switzerland, and Spain, randomisation occurred after acceptance of the invitation to participate—a study of screening in those who accept it (the efficacy of screening).

Efficacy is greater than effectiveness and effectiveness measures the overall benefit of offering PSA testing to asymptomatic men in the population.

Therefore, the ERSPC study estimate of benefit is greater than would be achieved from population-based PSA testing in asymptomatic men.

In the PLCO trial 40% of the control subjects had at least one PSA test by the second year of follow-up (contamination of the controls) and this increased to 52% by the sixth year of follow-up.

The contamination of the control group in the ERSPC study was not reported in the recent publication but varied from 6.7% to 36.6% among centres during 1996–2001.(5)

This resulted in a smaller relative increase in prostate cancer diagnoses between intervention and control groups in the PLCO trial (22%) compared to the ERSPC study (71%).

Detailed analyses of both the similarities and differences among the different trials included in the ERSPC study are likely in the future.

The beneficial effects from randomised controlled trials of screening almost always exceed what is obtained when the technology is introduced into routine health care, as the tight controls for the decision making process and management protocols of trials tend to be lost.

A greater length of follow-up of the trials will be required before more conclusive results are available. However, the contamination of the control groups in both studies may not have occurred equally among different risk groups for prostate cancer death, resulting in unresolvable bias.

What is now unequivocal from these two trials is the magnitude of over-diagnosis and subsequent overtreatment resulting from the PSA testing of asymptomatic men.

Overdiagnosis is the detection of prostate cancer that would not become clinical disease in a man’s natural life.

This is sometimes referred to as indolent prostate cancer and has been known for a long time to be very common.

This over-diagnosis has been estimated to be 48% (95%CI 44%–55%) for annual screening and 50% (46%–57%) for 4-yearly screening in men aged 55–67 years.(6)

The treatment of prostate cancer by either radical prostatectomy or radiotherapy carries significant risks such as chronic incontinence (urinary or faecal), impotence, or, in some instances, death.

In addition to significant side-effects, the treatment of many men who will not benefit produces increased waiting times and reduced accessibility to radiotherapy and surgery for other patients who may benefit from them.

For example, if we accept the ERSPC study results, 1480 men would need to be screened and 48 additional cases of prostate cancer treated for each death from prostate cancer prevented over a 10-year period.

Moreover, about 24 of the additional cases treated would receive treatment for a condition that would not have become clinical prostate cancer in their lifetime, and of these about 4 would have chronic incontinence or impotence.

The decision about the value of PSA testing in asymptomatic men is not solely determined by the magnitude of any reduction in prostate cancer mortality but by the balance of harms versus benefits.

Despite previous claims of effectiveness,(7,8) it now appears that if there is a reduction in prostate cancer mortality from PSA testing in asymptomatic men, it is likely to be small.

The current results of the trials assist in resolving the controversy regarding the value of PSA testing of asymptomatic men.

The results of the randomised controlled trials might optimistically be considered to indicate that: eventually there will be a reduction in prostate cancer mortality from PSA testing of asymptomatic men 55–69 years of age; the considerable harms from such testing are bearable by patients and the health care sector, and; PSA testing of asymptomatic men should be facilitated.

Another view would be that we now have inconclusive evidence from randomised controlled trials of any decrease in prostate cancer mortality and unequivocal evidence of major harms, mainly from over-diagnosis and consequent overtreatment, so much so, that good health care should involve advising asymptomatic men against PSA testing at this time.

It is easy to understand the belief that the early detection of cancer must result in a reduction in the mortality from the disease.

Historically, many clinicians and patients have been seduced by this idea many times for a variety of cancers.(9)

However, the current randomised controlled trial evidence suggests that claims of benefit from PSA testing in asymptomatic men have probably been overstated and that, as indicated by the authors of one of the trials,2 the recognised harms must be more rigorously considered to protect many men from iatrogenic illness.

Author information: Brian Cox, Associate Professor; Mary Jane Sneyd, Research Fellow; Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin.

Acknowledgement: Associate Professor Cox and Dr Sneyd were funded by the Director’s Cancer Research Trust.

Correspondence: Brian Cox, Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand. Fax: +64 (0)3 4797164; email: brian.cox@otago.ac.nz

References:
1. Schroder FH, Hugosson J, Roobol MJ, Tammela TLJ, Ciatto S, Nelen V, et al. Screening and prostate-cancer mortality in a randomized European study. New England Journal of Medicine. 2009;360(13):1320–8.
2. Andriole GL, Crawford ED, Grubb RL, Buys SS, Chia D, Church TR, et al. Mortality results from a randomized prostate-cancer screening trial. New England Journal of Medicine. 2009;360(13):1310–9.
3. Cox B. Prostate cancer screening is experimental. The New Zealand Medical Journal. 1996;109(1017):63–4.
4. Barry MJ. Screening for prostate cancer – the controversy that refuses to die. New England Journal of Medicine. 2009;360(13):1351–4.
5. Ciatto S, Zappa M, Villers A, Paez A, Otto SJ, Auvinen A. Contamination by opportunistic screening in the European Randomized Study of Prostate Cancer Screening. BJU International. 2003;92 (Suppl. 2):97–100.
6. Schroder FH. Detection of prostate cancer: the impact of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The Canadian Journal of Urology. 2005;12 (Suppl. 1):2-6.
7. Lamb DS, Slaney D, Smart R, Nacey JN, Russell G, Scott B, et al. Prostate cancer: the new evidence base for diagnosis and treatment. Pathology. 2007;39(6):537–44.
8. Smart R. PSA testing and DRE, TRUS scanning with sector biopsy, improved histology, curative treatments, and active surveillance for prostate cancer: asuccess story for men’s health. New Zealand Medical Journal. 2008;121(1287):57–68.
9. Richardson AK. Prostate cancer screening: is it possible to explain diametrically opposed views? New Zealand Medical Journal. 2005;118(1209).

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PART 21 of My PC Adventure – see full story HERE>

The headline for this – the penultimate chapter of my prostate story – isn’t what it seems.

SunsetIt’s not a goodbye, nor a resignation to impending death, nor a signal I’m giving in to the vicissitudes of age.

It’s a metaphor, of course, drawn from a famous NZ play by that name ( The End of the Golden Weather  by Bruce Mason ) which spoke to my boyhood of  “…the eternal optimism of the child and the harsh certainty of age…”

To quote one tribute to Mason’s 1959 work:

“Golden Weather tells the story of the loss of innocence and of human fallibility…”

The end of my golden weather refers, in part, to the “official”  finish of my recovery from the surgery that took out the prostate cancer, a two-month idyll during which I’ve researched and written about prostate cancer in this forum, which began as a personal blog and has grown to a website with a following around the world.

(That’s one reason, incidentally, why I have explained “end of the golden weather” – now two of five visitors to this site are from the US. The proportion of Kiwi readers is about one in three).

In this case, “end of the golden weather” also has a literal meaning, since my time at home has been blessed with a remarkable (for Wellington) patch of fine, still weather, an “Indian summer“.

In the last few days, winter has roared in from the Antarctic, bringing snow to the South Island and to hills around Wellington.

Rain hits the windows on the southerly side of the house as I write this, and I know the days of teeshirts and sunhats are over for a while.

Tomorrow, I return to work. Truly, the end of the golden weather, but in fact something well overdue if I am to feel fully restored.

Which is what I want to write about: how do I feel about what’s happened (that classically banal and inappropriate journalistic question)?

Perhaps I should begin with what I don’t feel.

I don’t feel old. At 62, the body and mind are in the kind of shape my parents’ generation, the Depression and war-shaped cohort, associated with their 40s. My mindset accords with that silly epithet, “60 is the new 40”.

I am getting old, of course, but cancer has had no obvious role in that gradual process.

It didn’t turn my beard white, steal the hair from the top of my head, slow up my legs in social soccer games, nor account for loss of memory for people’s names after we’ve just been introduced, nor the keeping to speed limits, and restricting of booze intake to a Heinie a day, and the working day hours to no more than a dozen.

All those things have been creeping up since I was 30.

I don’t feel debilitated. I’m back to the fitness I enjoyed prior to the operation in March, easily able to walk briskly over my personal training challenge, Wellington’s Mt Victoria.

These pictures show the 151 steps I climb on the route to the top, and a view from that top after my first post-surgery ascent, about six weeks after the operation:

MtVic 1

MtVic 2

As I rather over-excitedly reported in an earlier chapter, my urinal turn-around time is reduced to that of a youngster.

I have no major problems with incontinence – just a little drip of a leak sometimes when I’m tired and forget to brace the pelvic muscle when I laugh or cough.

And the big one – suffice to say, that’s not a problem either, without the use of Cialis or the dreaded injections. Bang goes my excuse to browse in the adult shops for a cheap pump.

I don’t feel apprehensive. I’ve got cancer, but we got it early, it would seem, and it was slow-growing – Gleason grade 6 (I’m now thinking it was there for years before my GP, bless him, encountered it with his digit).

It hadn’t migrated out of the prostate, and prior to the operation my PSA was a mere .77.

I’m a little less sanguine about the “let’s cut the bastard out and be done with it” mindset I had early on, because research tells me there’s never any guarantee that something microscopic didn’t escape into my system during the op, or even during the biopsy. Highly unlikely…but possible.

I expect when my PSA is tested in August I’ll show the required nil level, but I’ve also read data which shows it might rise again after a couple of years. I need to show nil PSA for a decade before I can possible say I’m cured.

But something has changed. Ever so subtly.

It can only be described as an odd sense of betrayal. My body – until now more or less organically sound – has finally let me down in a most shocking way.

Okay, I’ve had marginally elevated cholesterol since 1991, but there is still medical disagreement about what that actually means. And I take a light dosage of blood pressure medication for something that runs in the family.

Neither of these has felt anything other than a mild indication of getting through the years towards maturity.

But cancer! That’s systems failure. That’s involved the first major invasion of my body, leaving a scar (physical and mental), and thoughts – which will no doubt recede – of organic deterioration, of a hurrying of the first steps towards the grave.

Sound morbid?

It does, doesn’t it, but actually it’s not something I’m dwelling on in a neurotic way. It emerges merely as one of the more philosophical after-effects of a mortal event, a reminder that, yes, there is death at the end of the journey, and there’s no way to dodge it.

It doesn’t affect my optimistic view of life in the slightest.

I come from a line of long-livers. My great grand-father died in his baker’s shop in London at the age of 99. My grandfather lived to 84, and my father convinced himself he would go at the same age, so did. On my mother’s side (she lived to 80), there was grandma lasting till 94 and grandfather going to 86. We don’t pop off early in my family.

Age expectation is a tricky calculation, incidentally. One of the interesting things in Michael Dattoli’s new prostate cancer book (reviewed recently on this blogsite) is a reminder that average longevity calculated at birth (about 78 for male Kiwis) is way shorter than that enjoyed by someone at 60 and beyond.

This chart from the Dattoli book shows what I mean:

AgeData

This is important in the debate about population-based prostate screening. One of the arguments against it (and against surgical treatment after about 75) is the thesis that because many tumours are slow-growing, something else will getya before the prostate.

As age expectation rises significantly once you’ve reached 60 (compared with what you started out with, when accidents and other factors are probably much more influential), so presumably does the point at which “watchful waiting” should apply.

My life expectation in terms of surviving prostate cancer is also being extended as we speak by the massive effort by scientists and doctors – in the US especially – to achieve breakthroughs in testing, diagnosis and treatment.

Any time soon they’re going to find a quick, non-invasive method of helping the medics know how bad the cancer is and how (or if) it should be treated.

This is undoubtedly an effect of the great surge into old age of my generation, the baby boomers, with our more positive attitude to aging and our demands (and wherewithal to pay) for better medical options.

So. How am I feeling?

Bloody good, bloody lucky, bloody optimistic.

Even so, I will be taking a few precautions.

The number of red meat meals will be dropped from four or five a week to one or two, the already fat-free diet will be applied even more rigorously, the brisk walks will be taken even more regularly, stress at work will be avoided (hah!), sunsets and scenery will be noted more diligently, the regular evening hit of red wine will be replaced with pomegranate juice (which looks exactly the same in a wine glass and, amazingly, tastes like a slightly sweet version of a Central Otago pinot noir)…but the single daily can of that nectar of life, the Heineken (no, they’re not paying me a cent), will continue.

This weekend we had a pleasant visit from my journalist colleague, Barry Young, who also happens to be president of the NZ Prostate Cancer Foundation.

Barry is 10 years free of prostate cancer after his prostatectomy, his PSA is nil, he can enjoy a good glass or three of red wine, and he tucked into seconds of lamb shanks (grown on the open fields of the Canterbury Plains, no doubt).

I’d be tempted to say us journos have an extra gene that bodes well when we get prostate cancer, but I know that’s not true (witness the death of the legendary Frank Haden a couple of years ago).

But our sense of outrage might help. It comes from our journalism-driven suspicion that there are people in positions of medical power who – with their dogmatic opposition to the promotion of prostate testing – are deciding the fate of a lot of men in this country.

This comment in no way applies to the medics who have treated me – surgeon Rodney Studd and the team at Wellington Hospital, Bob Hale at the urology department, the nurse-manager of the rehab clinic, and to GP Rob McIlroy.

Thanks to them, I feel confident of a long life. I don’t care about speaking too soon – I’m just not suspicious about tempting fate.

NEXT (some time away): PSA – wherefore art thou?

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