Posts Tagged ‘Over-treatment’

URO TODAY: Guidelines on “watchful waiting” or “active surveillance” as options for those diagnosed with prostate cancer reflect a changed attitude towards treatment in the light of the early detection of these tumours and the data now available regarding active surveillance. READ MORE>

A corresponding change in actual medical practice would be desirable. The treatment of prostate cancer should always be adapted to the individual needs of the patient, and risky treatments should only be used when absolutely necessary.

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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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JULY 31: URO TODAY: If population-based screening and testing were adopted in the UK, five times as many men would be diagnosed with prostate cancer, a new study has concluded. READ MORE>

Researchers at the Department of Social Medicine, University of Bristol, report:

If population-based PSA testing were introduced in the UK, approximately 2660 men per 100,000 aged 50-69 years would be found to have prostate cancer, compared to current rates of approximately 130 per 100,000.

If half of men accepted PSA testing, approximately 160,000 cancers would be found, compared to 30,000 diagnosed each year at present.

Population-based PSA testing resulted in a significant downward stage and grade migration, and most such cancers were of low stage and grade, which could lead to risks of over-treatment for some men.

Mike Scott (New prostate Cancer Infolink) has this to say about the study:

What this study does do…is identify the real clinical value of a test that could actually discriminate with accuracy, early on between those patients at real risk for clinically significant disease (apparently about 30,000 per annum in the UK) and the 130,000 who might be identified with histologically identifiable but clinically non-significant disease.

That’s an awful lot of men who could benefit from knowing early on what their real risk might be for clinically significant disease — one way or the other!  READ MORE>

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JULY 11: NEW PROSTATE CANCER INFOLINK: It may not seem “rational” to large numbers of people not to treat some cancers aggressively.

And that alone is one of the reasons why we will never overcome the problem of over-treatment without really good tests to help us separate the wheat (the truly clinically significant forms of cancer) from the chaff (the cancers that will never cause symptoms or death).

The immediate and the long-term implications for cancer screening (at least in the cases of breast and prostate cancer) are vast. READ MORE>

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JULY 11: ASSOCIATED PRESS: One in three breast cancer patients identified in public screening programs may be treated unnecessarily, a new study says. Doctors and patients have long debated the merits of prostate cancer screening out of similar concerns that it over-diagnoses patients. READ MORE>

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JULY 3: NEW PROSTATE CANCER INFOLINK: Results from a UK study show the potential of transrectal, whole-gland, high-intensity focused ultrasound (HIFU) in patients with low risk, organ-confined prostate cancer. However, many of those treated likely fall into the category of men who don’t actually need treatment for their prostate cancer at all, and the risk for post-treatment erectile dysfunction after HIFU in this trial appears to be significant — at about 30 percent after 1 year of follow-up. READ MORE>

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JUNE 30:  SCIENCE CODEX.COM: The two recently reported large randomised studies in Europe and the US illustrate that the price to pay for 20% reduction in prostate cancer deaths is high – over-diagnosis and over-treatment are great problems. The answers lie in improving the PSA test or finding biomarkers that effectively separate aggressive cancers from slow-growing ones. READ MORE>

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