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Posts Tagged ‘Testing for Prostate Cancer’

JULY 3: PROSTABLOG NZ: In what seems to be exquisite timing, NZ’s parliamentary select committee on health is starting an inquiry into prostate cancer screening – just as some of the best recent analysis of screening emerges in the US.

The latest informative discussion comes from Mike Scott at the New Prostate Cancer Infolink website, one of the leading American aggregators of up-to-date information.

As global debate hots up following recent publication in a medical journal called CA: A Cancer Journal for Clinicians of an article about screening and an accompanying editorial, Scott today makes some interesting points:

  • Media reporting of this latest look at the two large randomised studies is well wide of the mark.
  • What the article actually makes clear is we just do not know how best to use the tools currently available to test an individual man so as to ascertain with accuracy his real risk for clinically significant prostate cancer.
  • So — surprise, surprise — we need better tests, as America’s Prostate Cancer Organizations have already clearly stated.
  • A critical element, covered in the article, is the importance of taking account of the patient’s age, life expectancy, family history, race/ethnicity, and other personal health factors in making the decision whether testing for prostate cancer is appropriate or not.
  • The article does not discuss, at all, the potential merits of  “baseline” PSA testing (at any specific age).
  • The journal’s accompanying editorial uses some “loaded” language in making the correct recommendation that regular, mass, population-based screening is not currently justified based on the available evidence. That “loaded” language is centered around the use of the terms “over-diagnosis” and “over-treatment.”
  • There is excellent evidence today that “mass, population-based screening” using mammograms to look for breast cancer is no more justified that prostate cancer screening, on any good statistical basis. Some 2,970 women must be screened once to find 27 cancers and save one life (in women aged between 40 and 65 years of age). The editorial repeats the finding of the European trial that it would be necessary to screen 1,410 men and find an additional 48 cancers to prevent one prostate cancer-specific death.
  • There are simple answers to the issue of “over-reaction” (to screening findings from doctors and patients), and they start with greater honesty — among the clinical community and among the survivor community — about what we really do and don’t know.
  • Over the past 30 years, prostate cancer deaths have dropped 20% in the US, but…”We still can’t tell [which patients are at real risk] beforehand, and so fear and  ‘standard practice’  tell us that we should proceed with treatment ‘to be on the safe side’. We need to do better. And it doesn’t help to demonize the problem with terms like ‘over-diagnosis’ and ‘over-treatment’.”
  • In all truth, we do not have good enough information to allow us to know the best thing to do for the vast majority of men who are at only a statistical (as opposed to a clinically evident) risk for prostate cancer.

It’s to be hoped someone draws the Health Select Committee‘s attention to this latest development in the debate, which has rumbled along since late March, when the results of the long-awaited studies were published in the New England Journal of Medicine – and failed to resolve anything.

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tony ryall_29JUNE 5: PROSTABLOG NZ:  Prostate cancer is a priority for the new National Government, says Minister of Health Tony Ryall (right).

The fact prostate cancer is not specifically listed as one of the six new Health Targets does not mean the issue is no longer a priority, he says in reply to a query from Prostablog.

He was asked to explain why prostate cancer did not rate a mention when he announced six new Health Targets in May, after he told media in January that prostate cancer was a priority for the Government.

“The health targets I announced focus on six measurable targets, one of which is shorter waiting times for patients needing radiation therapy,” he says in a letter received by Prostablog author Jim Tucker today. “Therefore some men with prostate cancer will benefit from this new target.”

The Cancer Control Strategy was still in place with its focus on improving services for all types of cancer.

The work on prostate cancer included the provision of good information for men considering having a PSA test.

“There are differing opinions about the value of population screening of men without symptoms using PSA testing,” says Mr Ryall.

“NZ’s present policy on screening our population for prostate cancer is the same as those of Australia, the UK, the US, Canada and European countries, and aligns with the recommendations of the World Health Organisation.”

Analysis of data on PSA testing volumes and practice in NZ showed that about 50% of men in the older age group were already being tested “on an opportunistic basis”.

This was comparable to participation rates in screening programmes in other countries.

“The Ministry of Health continues to review the international evidence about PSA screening, including the latest evaluations of tests and screening programmes,” he says.

The NZ Guidelines Group, with the Royal NZ College of GPs, had developed a resource called Testing for Prostate Cancer: a consultation resource, which aided the discussion between a man and his general practitioner as part of a consultation.

The advice provided in the resource was consistent with international approaches and advice (see MOH website: www.moh.govt.nz )

Mr Ryall says the MOH and the Health Research Council were planning research into prostate cancer treatment outcomes in NZ: “When completed, this research will provide quantifiable data around successful treatment and any detrimental side effects.”

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