Prostate drug debate: What’s it worth to stay alive a few more months?

WASHINGTON EXAMINER.COM:  Here’s a well-written article on the current US debate about how much a life is worth – more specifically, how much the government Medicare scheme and health insurers pay out for cancer drugs that prolong life for a few months. READ MORE>

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Dear Dr Hutchison and colleagues – here’s some advice

PROSTABLOG NZ:  HERE are four key issues the NZ Parliamentary inquiry into the detection and treatment of prostate cancer ought now to be focusing on:

• Mass screening…or not: Not. The evidence in favour of mass screening of all middle-aged men for prostate cancer is not sufficiently strong in statistical terms to overcome the counter-arguments concerning needless and over-treatment and high likelihood of after effects that will blight quality of life.

But…it’s not strong enough yet. That may change as more studies are done and closer analysis of the large random trials is completed. PSA testing may also improve, or be replaced with something better, a test that defines the actual risk to the patient.

• Guidelines to GPs must be revised. Currently, GPs are forbidden by the Ministry of Health to routinely offer PSA tests and/or rectal examinations for prostate cancer unless a man asks, or mentions symptoms. Since this can be a symptomless disease (until it’s too late), that is unacceptable. It also presumes that people don’t move around, change doctors, lose track of medical records, or simply have little idea of the implications of dad dying of prostate cancer.

If the Ministry of Health wants to avoid high-risk treatment being offered unnecessarily, it needs to move the initial gatekeeping further up the food chain to the specialists.

• Specialists’ advice needs to be delivered via a more balanced and less costly method. At present, the system works well enough up to the point the pathologist finds signs of cancer in biopsy samples.

But after that, men are left to fend for themselves when it comes to seeking advice from a range of authorities. Some don’t bother, and just go with what the urologist offers. Some can’t afford the $1600 charged by a cancer specialist (oncologist), who may be the most neutral source of advice available.

In the US, the first specialists in the hierarchy, urologists, earned themselves the unenviable moniker of “prostate snatchers” because of the lucrative, medical insurance-backed business of prostate surgery.

How about panels of doctors representing the main treatment options in NZ (surgery, robotic surgery, external beam radiation, brachytherapy, watchful waiting) reviewing the case notes and offering clearly explained options to patients?

• The public needs to be kept up to date – in layman’s terms – with diagnostic and treatment developments. This is not happening at present. The Ministry and its satellite committees do not have readily available, up-to-date information on the web to help men with newly diagnosed prostate cancer become fully informed before making one of the biggest decisions of their lives.

As wealthy male baby boomers hit the danger zone, enormous amounts of US, European and Asian money are going into researching and developing new drugs, methods of surgery and radiation, diagnostic tools and a bewildering range of related methdologies.

That’s the point – it’s bewildering to the average Kiwi, who must hope his medics are keeping up to date and that the government is adequately funding new treatments.

For example, there is Provenge, a new $100,000+ drug regime that will extend life for a few months, and which is now selling big in the US. When will we see it here?

Communicating the relevance of the overseas prostate industry boom to Kiwis cannot be left solely to the news media here: that’s worse than leaving it to chance and the public relations industry.

Few, if any, journalists in NZ take an abiding interest in prostate cancer (why would they – it’s one of many diseases), and what they do write is sometimes ill-informed, incomplete, inaccurate and out of date.

Finally, the Health Select Committee would be wise to keep its files open on this inquiry. It would be a mistake to shut the doors on a tsunami of prostate cancer information that emerges daily on the web.

Developments are moving so quickly, the committee should require the Ministry of Health to report regularly about what’s happening. The inquiry report, when it finally emerges, should be an interim one that can be updated over time.

The committee is wrestling with questions that are far from settled.

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Provenge approval expected to rejuvenate cancer vaccine industry

MARKETWIRE:  The approval of Dendreon’s prostate cancer vaccine Provenge in April was a boon for a nascent cancer vaccine industry that had suffered several setbacks, and should lead to an influx of market opportunities and a surge in regulatory activity. READ MORE>

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Jury still out on how long immuno-therapeutic drugs like Provenge can prolong life

KANSASCITY.COM:  Researchers can cite anecdotes of cancer patients given months to live who have survived 15 years or longer after receiving vaccines, but so far conclusive evidence from large clinical trials is scant. READ MORE>

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Why has it taken so long for prostate cancer cell detector to arrive in Australasia?

PROSTABLOG NZ:  Australian news media are breathlessly reporting that a “new” prostate cancer diagnostic tool, the cell search machine, is being set up in their country for the first time (in Brisbane). READ MORE>

Should we be excited? Yes – that this technology – used in the US for more than five years – is finally appearing in our part of the world (although not yet in NZ).

My gripe is not about the news itself, but the way ill-informed journalists report such announcements, swallowing the official spin without question.

The real story lies in challenging governments over the delays that attach to such breakthroughs making their way Down Under.

Has anyone thought to ask NZ or Australian ministries of health how long it will be before Provenge (a new treatment for advanced prostate cancer) is available here?

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Prostate cancer drug Provenge finally starts earning money for its maker

WALL ST JOURNAL: New wonder drug for treating advanced prostate cancer, Provenge, is finally making money for its manufacturer, Dendreon Corp. READ MORE>

Since the $93,000 treatment was launched at the beginning of May, doctors have written 500 prescriptions for the treatment, the company disclosed.

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Provenge extends prostate patients’ lives about four months – at a cost of $130,000

ABC NEWS: The new US wonder drug for treating advanced prostate cancer – Provenge – extends life about four months – at a cost of $NZ130,000 ($US93,000).

The makers say it took 15 years to develop, at a cost of $US1.2 billion. READ MORE> and MORE>

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New Provenge treatment for advanced prostate cancer faces another hurdle

WALL ST JOURNAL: The US government says it will begin analysis on whether the Dendreon company’s expensive immunotherapy treatment for prostate cancer – Provenge – is “reasonable and necessary.” READ MORE> (you need to subscribe)

The answer to that debate – the latest hurdle in Dendreon’s push to get Provenge used – will affect sales of the costly treatment.

If the Centers for Medicare and Medicaid Services covers it, that would increase the number of patients eligible and likely prompt private insurers to do the same. A denial by CMS could severely stifle the product’s growth.

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Year-long wait for Provenge in US hospitals

BLOOMBERG: Prostate cancer patients seeking Dendreon Corp’s new tumour-fighting vaccine, Provenge, face delays of a year or more as hospital waiting lists dwarf the company’s capacity to produce medicine. READ MORE>

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Provenge treatment for advanced prostate cancer showing few side effects

US NEWS AND WORLD REPORT: The newly approved therapeutic prostate cancer vaccine, Provenge, is safe and has few side effects, a new study finds. READ MORE>

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