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Overtreating? ~ Round 3...Britain is changinging it's mind?

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Posted 3/18/2009 9:18 PM (GMT 0)

From my friend Kathy Meade...

Routine prostate cancer screening could cut death rates from the disease by 20%, a major study suggests.  The results, which suggest 2,000 lives a year could be saved in the UK, have prompted a review of the current policy not to offer routine NHS screening. The study, based on results from 162,000 men, assessed the impact of testing levels of a protein called prostate specific antigen (PSA).

It is published in the New England Journal of Medicine.

There has been concern that the PSA test could produce inaccurate results, leading to some men receiving unnecessary treatment which carries a risk of side effects such as impotence and incontinence.  But the latest study suggests that although the test can result in some men receiving treatment that they do not need, the benefits of screening may outweigh the risks. In the UK men over 45 can ask their GP for a PSA test, but it is not offered as standard. Currently, only about 6% of men ask for the test.

Worldwide, prostate cancer is the second leading cause of cancer death.

To read the entire article: http://news.bbc.co.uk/2/hi/health/7949028.stm

Interesting that in Great Britain that they are considering changing their recommendations.
Posted 3/18/2009 9:24 PM (GMT 0)
In case you haven't noticed...

I have thrown a series of discussions up on the subject of overtreating prostate cancer. My position is still neutural. But when you read these things it may place some of back into "Get it out mode".

The fact is that in the US prostate cancer death rate has dropped since the introduction of the PSA screening assay's. But it remains true that some cases are good cases ofr Active Surveillence nstead of treatment. I think we need to consider Active Surveillence a treatment not a lack of it. As a prostate cancer patient is is still a decision, it means to monitor not ignore the cancer, and it will be used between each stepping stone to guage where we are in our cancer. Interventions will become a well timed action as opposed to a knee jerk reaction.

This is a great post on the PPML from Kathy. What a wonderful advocate for us all!

Tony
Posted 3/18/2009 10:09 PM (GMT 0)
Amen lifeguyd,
Brawley is with the American Cancer Society (ACS) BTW. But I concur. Testing does not due any harm. Treating with inadequate data does more damage than published I believe. But that is precisely how he said it that screening does more harm than good. Nope! That's wrong.

I mentioned it before that three of ther very highest PCa oncologists ~ Schellhammer, Myers, Lee, have all chosen interventions.

Oy.... More to follow. I can't wait to sit on that panel in Miami and watch the doctors talk about this one...

Selmer I caught that post on the other thread and commented. Great job!

Tony
Posted 3/19/2009 1:29 AM (GMT 0)
Last year I visited my family physician because I was having trouble relieving myself. He administered a DRE and told me my prostrate was very large but soft and smooth. He felt that it probably was benign but thought maybe a PSA test was in order. The way he put it to me I didn't think I had a problem but since a blood test is so easy I said I would like to have it. As you can see by my stats it's a good thing I did. At least in my case the PSA test was very important.
Posted 3/19/2009 3:23 PM (GMT 0)
Selmer you can see how emotional people can get about this. When you have people claiming responsible doctors have "secret agendas" only because they don't agree with them what can you say?

Now we have a couple of studies one where it's said there's a 5% risk and many here still opt of radical treatments not to be that one out of twenty.

Now we have another study that claims a 2% risk and I'm sure the same amount will claim to opt for radical treatments not to be that one out of fifty.

When would they take the risk? When it's like .0005% or would they still opt for radical treatments then?

Oh well all I have left to say I've been feeling very vindicated with my opinions the last few days after all these results. Contrary to popular opinion here if they result in some robotic machines gathering a little dust, urologists and radiologists with a little less to do in the future I believe will be a good thing. Of course that's just IMHO most others here will differ I'm sure.
Posted 3/19/2009 3:31 PM (GMT 0)
1 out of 20 is still something to think about considering the seriousness of cancer in general, and the way that prostate cancer can flare up unexpectedly. Even 1 out of 50 isn't that much of a long shot, not if you are the "1", and it destroys your life as you know it and for you family too. Some of us are low risk takers and some are high risk takers. When so many have lost a fortune in their 401 plans by going for the "big money" in the stock market, I was one that stuck to treasury notes, etc, the safe route. Didn't make much, nope. But didn't lose a dime either. Depends how one looks at things. Me, I would always be concerned about being the one out of 20 or the one out of fifty, some one has to be the statistic, don't want it to be me.
Posted 3/19/2009 3:53 PM (GMT 0)
1 out of 50 is yes a long shot.. I'm surprised you drive in a car the odds of dying or tragic injury are a long shot too. Actually I just googled that and one site said 1 in 84 of dying in an auto accident. So sell the Chevy.

Comparing this to 401k is just silly. Btw I stayed more with CDs myself and lost $10,000 on my Federal TSP account I couldn't draw out until last month anyway(You need to be at least 59 1/2 to do so). Good thing that was only an optional deposit for me I retired under the original federal civil service system and thus my pension is not affected.
Posted 3/19/2009 7:01 PM (GMT 0)
realziggy,

the point of the 401k was not a comparisom to pc issues, cant believe you thought i meant that. the point was the way that people are risk takers or low risk takers, that was my point. geez, everyone wants to be a technocrat on every word or phrase.
Posted 3/19/2009 7:31 PM (GMT 0)

Purgatory said...
realziggy,

the point of the 401k was not a comparisom to pc issues, cant believe you thought i meant that. the point was the way that people are risk takers or low risk takers, that was my point. geez, everyone wants to be a technocrat on every word or phrase.

Geez you post something about your 401 showing you as not a risk taker in a post about how much risk one should take in opting or not for PCa treatments, and you wonder why I read it as a comparison??...Oh Yeah my bad????

BTW are you going to sell your car? That was my comparison on a survival issue just like opting for PCa treatments. I noticed you ignored that part of my post...
Posted 3/20/2009 2:58 AM (GMT 0)
I don't think a 1 in 50 chance (2%) is small at all...
Posted 3/20/2009 3:02 AM (GMT 0)
Further, they keep saying "treated unnecessarily for a cancer that was never a threat to his life or health." This is simply not a correct statement. "Did not result in his death within the 10 year timeframe of the study" is the only correct thing that can be said. Says nothing about threat that could perhaps have materialized at 12, 15, or 20 years.

All of the argumentation is predicated on the supposition that you will die of something else earlier than the PCa gets you. Seems to me to be a questionable bet.
Posted 3/20/2009 4:55 AM (GMT 0)
The amount of risk that I was willing to take with cancer was lowered considerably after watching my dad die from stage IV prostate cancer. It took 18 painful months after diagnosis. The meds he was on pretty much fried his brain near the end and he was not the man I had known all my life. I was determined not to go that way. When I was diagnosed 20 years later, I immediately went for the most radical and fastest way to get rid of the cancer. I have never regretted it nor have I ever looked back.

The only way to treat any cancer is with early diagnosis and aggressive treatment...

Jim
Posted 3/20/2009 1:11 PM (GMT 0)
realziggy - yes, I chose to ignore your "chevy" remark, as I only drive Ford products, so I assumed that part of your question didn't require an answer. seriously, i don't think about the odds on everything going on in my life, i am not some kind of insurance agent. but when faced with the reality of a genuine PCa dx, I had to deal with what was before me. Speaking only for myself, once I knew I had a Gleason 7 with a rapidly rising PSA above 12, which had almost tripled in a year, and no other symptons of prostate problems, and clear DRE's for over 5 years, it didn't take rocket science to realize that I was in a serious situation, with an agressive cancer in my body. as a business man for all my career, i don't always have the luxury of time to make a decision. i researched for months before my final dx, talked to a lot of people, and then sat with my doctor and we worked through every combination of treatment options available to me. i stand by my choice, but i do not push it on anyone else. you are doing as you please, as you should, and as I hope for myself, and for all men here, I hope our choices end up being right.
Posted 3/20/2009 3:00 PM (GMT 0)

Friends,

The data analysis of the study suggested that the U.S. study was skewed - the patient population had been tested previously and some of the patients that had already chosen treatment were not included while those that tested clear up to that point were included.  The differing European "20%" result was attributed to the fact that few if any of the population studied had tests before the study.

I visited my Urology/Surgeon yesterday (to be told I only need my micro-PSA done annually now!) and I asked him about this study and how deadly such talk could be to some men.  He offered that the real need is to differentiate between an "old-age-non-aggressive-prostate-cancer" and more aggressive cancer in men expecting to live more than ten years.

This type-of-cancer aspect of the study's data was not published.  The Sloan-Kettering Physician - that Selmer mentioned - said in a TV interview that
  ... interpretation of this fairly complex data is such a gray area and that he felt the meaningful results from the data thus far collected will "shake out" something a bit different in the next couple of years - as the reason for the difference in the two continents is addressed.

Of course they will continue to collect more data and filter out the population bias. 
And hopefully it won't be an accountant whose job is on the line to save money that interprets data and decides
      ... that "only" 2% stage-four-disease death is acceptable.... 

I still vote that every male gets a PSA test annually beginning at age 40. 
This inexpensive test can track both change from a baseline & momentum
     -   while other tests and decision trees can determine treatment. 
Only an accountant-ostrich would use such data to suggest ignorence is money-saving-bli$$...

I can't check in to this site very often due to access restrictions at work. 
Still, I think about you here often. 

This fight becomes so personal and intense.  One of my sisters had a procedure done at M.D. Anderson, yesterday (Raphael Pollock, M.D. - Chair of Oncology Surgery leading the surgical team.)  (So far, so good.)

My primary thought/prayer for everyone:  A cheap, easy, no-side-effect, cure for all cancer - now.

CCedar

ICTHUS!


Posted 3/20/2009 4:31 PM (GMT 0)
Cedar,
At a speaking engagement last night Nick Vogelzang said the same thing and questions the motive to include pretested cases in the study. This definately skews a study when it has a handpicked control arm. Reported in the NEJM was an article not a study. Vogelzang sided with the European study...

You are doing great...Great news my dear friend! Keep the EM letters coming. One of these days, I will be smarter than a 5th grader!

Tony
Posted 3/20/2009 6:29 PM (GMT 0)

Prostate cancer is again in a swirl of controversy.  Much of the public hears the urban legend that prostate cancer is a slow-growing and you'll die of something else (Read: A 'good' cancer) 

Studies like the recent ones publicized by the press tend to  add to the notion that testing is a waste of money and gives you information that is marginally helpful at best and harmful at worst.  

I disagree.  PSA screening tests (DRE and PSA) give valuable information.  The decision on what to do with it requires understanding, judgment, research and a weighing of expert, often controversial opinion. 

Ultimately, it is a personal decision.  Too many people throw themselves into the physician's hands without taking what must be personal responsibility for their own decision. 

A book that was published 25 years ago and republished several years ago looks at the personal medical decision-making process and medical expertise.  It is a thought-provoking book that helped me in deciding about prostate cancer treatment.  (I read it a couple of years before my own diagnosis with prostate cancer). The Silent World of Doctor and Patient  by Jay Katz, MD.   

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