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Posts Tagged ‘prostate over-treatment’

URO TODAY: The common claim that PSA testing leads to high and unacceptable levels of prostate cancer over-detection – and therefore over-treatment – is an exaggeration, according to a presentation at the 107th annual meeting of the New York Section of the American Urology Association. READ MORE>

In this 69-page slide presentation, Dr William J Catalona – the US “father” of the PSA test – analyses a number of studies of PSA testing and seeks to discredit those which show testing leads to over-diagnosis and treatment:

Over-detection is a relatively small issue when considered in the context of the larger issue of preventing suffering and death from prostate cancer, especially when good clinical judgement is used and patients receive appropriate, effective and high quality treatment.

He is critical of what he calls the premature reporting of two big randomised studies of PSA testing earlier this year, saying much more followup time is needed before meaningful results can be obtained.

Notwithstanding that, Dr Catalona – a professor at Northwestern University in the US –  refers to the European study (ERSPC) in making this observation about whether men should choose to be tested:

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PROSTABLOG NZ: In what seems a perverse coincidence (for pro-testers), just as NZ’s Parliament begins an inquiry into prostate cancer screening and treatment,  an American report casting renewed doubt about PSA testing and rectal exams has re-ignited global debate.

The report says more than a million US men have had needless treatment for prostate cancer over two decades because the test/exam discover the presence of cancer but not its severity.

Discussion on the internet is widespread. See some of it HERE> and HERE> and HERE> and HERE> and HERE> and HERE> and HERE> and HERE> and HERE> and HERE> and HERE> and HERE>

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World debate on whether we should have prostate cancer screening – using the PSA blood test and digital exams – has flared in the past month following publication of two big studies, which now appear seriously flawed.

The studies – one in the US and another in Europe – are being reported as not providing a convincing case for screening.

We’ve seen no public debate about all this in New Zealand yet. However, across the Tasman, the Prostate Cancer Foundation of Australia website has published some analysis from the American Cancer Society.

It suggests the studies were limited by the following weaknesses:

  • They were not conducted over a long enough period (longer than 10 years) to show conclusive outcomes in terms of survival.
  • The US one studied two groups – those getting “regular” health care, and those getting annual prostate tests: but about half the members of the “regular” group were also getting tested. That negated a proper comparison.
  • Over the period of the studies (up to a decade), prostate treatment advanced, meaning some of the issues about “over-treatment” were no longer clear-cut.
  • The US required a PSA of 4 before a needle biopsy was triggered. Some deadly forms of prostate cancer were therefore missed (some don’t show up at all).

Much was made of a figure from the European study – that 1410 men would need to be screened to save one life. But if the statistics are viewed another way, screening reduced death rates by 20%.

Read the review by clicking HERE>

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