Screening for PCa
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From: Califchief on 5 Aug 2008 14:26 Full story with tables and figures at http://www.annals.org/cgi/content/full/149/3/185 SUMMARIES FOR PATIENTS Screening for Prostate Cancer with Prostate-Specific Antigen Testing: U.S. Preventive Services Task Force Recommendations 5 August 2008 | Volume 149 Issue 3 | Page I-37 Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine. Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians. The summary below is from the full reports titled "Screening for Prostate Cancer: U.S. Preventive Services Task Force Recommendation Statement" and "Benefits and Harms of Prostate-Specific Antigen Screening for Prostate Cancer: An Evidence Update for the U.S. Preventive Services Task Force." They are in the 5 August 2008 issue of Annals of Internal Medicine (volume 149, pages 185-191 and pages 192-199). The first report was written by the U.S. Preventive Services Task Force; the second report was written by K. Lin, R. Lipsitz, T. Miller, and S. Janakiraman. What is the U.S. Preventive Services Task Force? The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care. What is the problem and what is known about it so far? The prostate is an organ in men that surrounds the tube that empties urine from the bladder. It adds fluid and nutrients to semen, the fluid that carries sperm. Prostate cancer is the most common non-skin cancer and the second leading cause of cancer death in men. Measurement of prostate-specific antigen (PSA) in the blood can find prostate cancer before symptoms develop. Abnormal PSA levels require prostate biopsy to see whether cancer is actually present. To perform the biopsy, doctors insert a hollow needle into the prostate to obtain a piece of the prostate gland to examine under a microscope. It is not known whether treating prostate cancer before symptoms develop helps patients. Most prostate cancer grows very slowly, and many men with prostate cancer die of something else before the prostate cancer causes a problem. Early detection, however, puts men at risk for unnecessary worry and side effects of treatment. Surgery and radiation therapy, common treatments for prostate cancer, can cause problems with sexual function and bowel and bladder incontinence. How did the USPSTF develop these recommendations? The USPSTF reviewed published research to measure the benefits and harms of screening for prostate cancer. What did the authors find? Good evidence indicates that PSA testing can find prostate cancer. However, for men younger than 75 years, no good-quality evidence shows that finding prostate cancer by screening rather than waiting until symptoms develop leads to fewer men dying of the disease. For men age 75 years or older, the benefits of finding prostate cancer by screening are small to none. Good evidence indicates that treatment of prostate cancer found by screening can cause harms, such as sexual dysfunction, bowel and bladder incontinence, and even death. Other harms from screening include pain from prostate biopsy and worry about test results. What does the USPSTF suggest that patients do? For men younger than 75 years, the USPSTF does not recommend for or against routine screening for prostate cancer by using PSA testing. Men who are interested in screening for prostate cancer should discuss it with their doctors. Before screening, men should understand the potential benefits and harms of early treatment. For men age 75 years or older, the USPSTF recommends that doctors and patients do not routinely screen for prostate cancer because the harms are likely to outweigh the benefits. What are the cautions related to these recommendations? These recommendations apply to men at average risk for prostate cancer and not to men at high risk, such as those with a father or brother with prostate cancer. ___ Blue Wave/QWK v2.12
From: Steve Jordan on 5 Aug 2008 17:57 On August 5, Califchief wrote: > Full story with tables and figures at > http://www.annals.org/cgi/content/full/149/3/185 > > SUMMARIES FOR PATIENTS > > Screening for Prostate Cancer with Prostate-Specific Antigen Testing: > U.S. Preventive Services Task Force Recommendations And here is how I have responded elsewhere: "At risk of seeming cruel, I must say that I wonder whether Ned engages in PCa screening tests. "From the USPSTF website at http://www.ahrq.gov/clinic/uspstf/uspsprca.htm#summary here is what they say: "'The USPSTF concludes that for men younger than age 75 years, the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined.'" "In other words, it's up to patients and their medics to conduct a biopsy. Nothing new. "And "'For men 75 years or older, there is moderate certainty that the harms of screening for prostate cancer outweigh the benefits.'" "Sure, don't test; let 'em die, they're useless old men anyway, right? "So: What was he purveying, his personal views or what the USPSTF report actually says? You be the judge. "And: Again and again and again it must be made clear to the beancounters that the PSA test IS NOT diagnostic of PCa." Lastly, please note that not one of the panel is a practicing physician. Certainly not involved in cancer treatment. See, http://www.ahrq.gov/clinic/uspstfab.htm Regards, Steve J, waxing bitter again �Prostate cancer is often described as a curable disease made incurable by late diagnosis." --David Wright, Advanced PCa patient East Comiston, Scotland
From: MikeHi on 5 Aug 2008 17:58 On Tue, 05 Aug 2008 13:26:00 -0500, califchief(a)fidotel.com (Califchief) wrote: (giving more detail on an earlier thread) Big Snips... > For men age 75 years or older, the >benefits of finding prostate cancer by screening are small to none. > Big Snips.... >What are the cautions related to these recommendations? >These recommendations apply to men at average risk for prostate cancer and >not to men at high risk, such as those with a father or brother with >prostate cancer. Am I being terribly thick when I ask: "how can they be sure a man is not 'at high risk' without Gleason scores and PSA velocity/doubling time?" Our pathfinding fighter kh faithfully records in his throwaway style some pretty awful daily battles he is experiencing during his chemo labrat trials. But in his most recent post, Aug.2, he also notes: >I don't enjoy this treatment but it's a whole lot better than the back >pain from bone mets in the spine. It beats having the beast choking >me to death like 18 months ago. I've no doubt that the undiagnosed man over 75 would feel the same terrible pain and choking in the same way. My best wishes for none of that to everybody, and to no more of it for kh, as the new stuff comes flying in. MikeHi "Exponential lightspeed". Def: The discovery of the cure for Pca at a speed which defies Einstein.
From: len on 5 Aug 2008 20:24 On Aug 5, 1:26 pm, califch...(a)fidotel.com (Califchief) wrote: > Full story with tables and figures athttp://www.annals.org/cgi/content/full/149/3/185 > > SUMMARIES FOR PATIENTS > > Screening for Prostate Cancer with Prostate-Specific Antigen Testing: > U.S. Preventive Services Task Force Recommendations > 5 August 2008 | Volume 149 Issue 3 | Page I-37 > > Summaries for Patients are a service provided by Annals to help patients > better understand the complicated and often mystifying language of modern > medicine. > > Summaries for Patients are presented for informational purposes only. These > summaries are not a substitute for advice from your own medical provider. If > you have questions about this material, or need medical advice about your > own health or situation, please contact your physician. The summaries may be > reproduced for not-for-profit educational purposes only. Any other uses must > be approved by the American College of Physicians. > > The summary below is from the full reports titled "Screening for Prostate > Cancer: U.S. Preventive Services Task Force Recommendation Statement" and > "Benefits and Harms of Prostate-Specific Antigen Screening for Prostate > Cancer: An Evidence Update for the U.S. Preventive Services Task Force." > They are in the 5 August 2008 issue of Annals of Internal Medicine (volume > 149, pages 185-191 and pages 192-199). The first report was written by the > U.S. Preventive Services Task Force; the second report was written by K. > Lin, R. Lipsitz, T. Miller, and S. Janakiraman. > > What is the U.S. Preventive Services Task Force? > The U.S. Preventive Services Task Force (USPSTF) is a group of health > experts that reviews published research and makes recommendations about > preventive health care. > > What is the problem and what is known about it so far? > The prostate is an organ in men that surrounds the tube that empties urine > from the bladder. It adds fluid and nutrients to semen, the fluid that > carries sperm. Prostate cancer is the most common non-skin cancer and the > second leading cause of cancer death in men. > > Measurement of prostate-specific antigen (PSA) in the blood can find > prostate cancer before symptoms develop. Abnormal PSA levels require > prostate biopsy to see whether cancer is actually present. To perform the > biopsy, doctors insert a hollow needle into the prostate to obtain a piece > of the prostate gland to examine under a microscope. > > It is not known whether treating prostate cancer before symptoms develop > helps patients. Most prostate cancer grows very slowly, and many men with > prostate cancer die of something else before the prostate cancer causes a > problem. Early detection, however, puts men at risk for unnecessary worry > and side effects of treatment. Surgery and radiation therapy, common > treatments for prostate cancer, can cause problems with sexual function and > bowel and bladder incontinence. > > How did the USPSTF develop these recommendations? > The USPSTF reviewed published research to measure the benefits and harms of > screening for prostate cancer. > > What did the authors find? > Good evidence indicates that PSA testing can find prostate cancer. However, > for men younger than 75 years, no good-quality evidence shows that finding > prostate cancer by screening rather than waiting until symptoms develop > leads to fewer men dying of the disease. For men age 75 years or older, the > benefits of finding prostate cancer by screening are small to none. > > Good evidence indicates that treatment of prostate cancer found by screening > can cause harms, such as sexual dysfunction, bowel and bladder incontinence, > and even death. Other harms from screening include pain from prostate biopsy > and worry about test results. > > What does the USPSTF suggest that patients do? > For men younger than 75 years, the USPSTF does not recommend for or against > routine screening for prostate cancer by using PSA testing. Men who are > interested in screening for prostate cancer should discuss it with their > doctors. Before screening, men should understand the potential benefits and > harms of early treatment. > > For men age 75 years or older, the USPSTF recommends that doctors and > patients do not routinely screen for prostate cancer because the harms are > likely to outweigh the benefits. > > What are the cautions related to these recommendations? > These recommendations apply to men at average risk for prostate cancer and > not to men at high risk, such as those with a father or brother with > prostate cancer. > > ___ Blue Wave/QWK v2.12 As usual, one can't read "there is no evidence that testing benefits" as meaning "there is evidence that testing does not benefit". They could equally well have said there is no evidence that testing does not benefit men. Also, what the mean by 'no evidence" is no prospective randomized test. However, there is a randomized prospective test of Swedish men showing that RP is usperior to WW in a variety of ways. Of course, that is not the same thing, and what happens in the Swedish context may not tell us anything about what is true in the US. Finally, we don't usually make decisions just on the basis of the existence of randomized prospective studies. If that were the universal standard, there would be little in medicine we could do. It doesn't make sense cavalierly, to ignore all other forms of evidence.
From: Alan Meyer on 5 Aug 2008 20:43
"Califchief" <califchief(a)fidotel.com> wrote in message news:1217968350.17.0(a)fidotel.com... > Full story with tables and figures at > http://www.annals.org/cgi/content/full/149/3/185 .... Public health policy is very different from medical practice because, among other things, it aims at: 1. Producing better health in the community "on average", 2. Setting policy priorities based on the average circumstances of patients, and 3. Lowering total costs to society. It may be that most men who are given a diagnosis of low grade cancer will panic. Perhaps "on average" they'll demand treatment even though they don't need it. Cancer is scary. It may also be that most urologists, who make their living from prostate surgery, will want to perform it - both because they genuinely believe in it (though it's funny how we tend to believe strongly in what turns out to be in our economic interest), and because they make money from it. It may be that "on average" doctors can't be trusted to give the right counseling to people. It may further be the case that the financial cost to society of treating cancers that don't really need treatment is greater than the cost of dealing with untreated cancers that did need it. Those may all be reasons for setting public health policy against PSa testing. But I don't think they apply to a man who is capable of educating himself and thinking for himself and who has access to at least reasonably good and honest medical advice. Alan |