I have just read an interesting article on the subject of 'overdiagnosis' which is of special relevance at this time when we find ourselves in the midst of the controversy regarding screening for prostate cancer.
The NHS Choices article reviews a 'Daily Mail' (U.K.) newspaper report about a British Medical Journal article, the authors of which say that there is increasing evidence that too many people are being overdosed, overtreated and overdiagnosed.
Ths NHS article gives an excellent explanation of the term 'overdiagnosis' and gives examples relating to such conditions as breast and thyroid cancers, chronic kidney disase, asthma, osteoporosis, high cholesterol and, of course, prostate cancer.
Click here for the full NHS Choices article
Friday, June 1, 2012
Wednesday, May 30, 2012
Prostate Cancer Screening - the Debate Continues
As we have already reported in this recent post, there has already been some professional criticism of the US Preventive Services Task Force Policy advising against routine prostate cancer screening.
It was with interest that I read two commentaries from prostate cancer expert Dr. Gerald Chodak which address some of these criticisms.
The first point Dr. Chodak makes is that the criticism is almost exclusively focussed on the men who MIGHT miss out on 'potentially curative therapy' and ignores all those men who are actually being harmed by screening and treatment.
On his website ProstateVideos.com, Dr. Chodak has created a checklist of facts about prostate cancer in the form of a prostate cancer screening consent form which can help to put the current 'debate' into perspective and is well worth reading.
In his second commentary, Dr. Chodak refers to and recommends the following CNN article written by psychologist Dr. Charles Raison who talks about the mental health side of PSA screening:
The Danger of Fearing Cancer
It was with interest that I read two commentaries from prostate cancer expert Dr. Gerald Chodak which address some of these criticisms.
The first point Dr. Chodak makes is that the criticism is almost exclusively focussed on the men who MIGHT miss out on 'potentially curative therapy' and ignores all those men who are actually being harmed by screening and treatment.
On his website ProstateVideos.com, Dr. Chodak has created a checklist of facts about prostate cancer in the form of a prostate cancer screening consent form which can help to put the current 'debate' into perspective and is well worth reading.
In his second commentary, Dr. Chodak refers to and recommends the following CNN article written by psychologist Dr. Charles Raison who talks about the mental health side of PSA screening:
The Danger of Fearing Cancer
Sunday, May 27, 2012
Review of the Effectiveness of Saw Palmetto for treating BPH
Saw Palmetto is a herbal remedy used by many men to treat the symptoms of benign prostatic hyperplasia (enlarged prostate).
Although early studies on the use of Saw Palmetto confirmed that symptoms of BPH such as difficulty urinating, dripping and frequent urination at night were all eased using the remedy, a review of 17 more recent studies (which used more reliable testing methods) show that Saw Palmetto was no better at alleviating these symptoms than placebo.
The leader of one of the most recent of the studies, Dr. Michael Barry, agreed that taking Saw Palmetto definitely did make a difference to the symptoms but the improvement was seen equally in those men in the trial who took only the placebo.
Dr. Barry said that some men may still want to try Saw Palmetto as just the expectation of feeling better will yield some improvement.
For details of the research and the treatment of BPH, read the full Reuters Health Report.
Although early studies on the use of Saw Palmetto confirmed that symptoms of BPH such as difficulty urinating, dripping and frequent urination at night were all eased using the remedy, a review of 17 more recent studies (which used more reliable testing methods) show that Saw Palmetto was no better at alleviating these symptoms than placebo.
The leader of one of the most recent of the studies, Dr. Michael Barry, agreed that taking Saw Palmetto definitely did make a difference to the symptoms but the improvement was seen equally in those men in the trial who took only the placebo.
Dr. Barry said that some men may still want to try Saw Palmetto as just the expectation of feeling better will yield some improvement.
For details of the research and the treatment of BPH, read the full Reuters Health Report.
Saturday, May 26, 2012
Analysing the Cost of Avoiding Prostate Cancer Screening
Following finalization of the US Preventive Services Task Force Policy for prostate cancer screening which recommended against such screening, Dr. E. David Crawford & colleagues suggest that this approach may ultimately cost more due to having to treat greater number of patients with advanced disease.
Whilst adopting the USPSTF recommendation would initially save in the vicinity of $2.4 billion, the cost of treating men who will subsequently be diagnosed with 'clinically significant' prostate cancer would far exceed $2.4 billion.
Dr. Crawford also expressed concern that lack of screening would result in missing 0.57% to 1.22% of significant prostate cancer cases.
Dr. Crawford recommended that urologists should read the USPSTF report and give consideration to suggestions such as extending the amount of time in between screening individuals, using a better marker of disease progression and separating diagnosis from treatment.
Chicago urologist Anthony J. Schaeffer pointed out that it must be remembered that diagnosis does not necessarily have to lead to treatment and also that the ultimate decision as to whether or not to have a PSA test must be left to the patient, with his doctor providing him with sufficient knowledge to make such a decision.
Read the full report at Medscape Medical News (free sign-up may be required).
Whilst adopting the USPSTF recommendation would initially save in the vicinity of $2.4 billion, the cost of treating men who will subsequently be diagnosed with 'clinically significant' prostate cancer would far exceed $2.4 billion.
Dr. Crawford also expressed concern that lack of screening would result in missing 0.57% to 1.22% of significant prostate cancer cases.
Dr. Crawford recommended that urologists should read the USPSTF report and give consideration to suggestions such as extending the amount of time in between screening individuals, using a better marker of disease progression and separating diagnosis from treatment.
Chicago urologist Anthony J. Schaeffer pointed out that it must be remembered that diagnosis does not necessarily have to lead to treatment and also that the ultimate decision as to whether or not to have a PSA test must be left to the patient, with his doctor providing him with sufficient knowledge to make such a decision.
Read the full report at Medscape Medical News (free sign-up may be required).
Thursday, May 24, 2012
Dr. Chodak on routine prostate cancer screening
In this video Dr. Chodak explains that the reason for the recommendation is fundamentally that, according the best information currently available, the benefit of routine screening is very small (or non-existent) and is outweighed by the harms of such screening.
Dr. Chodak points out that a PSA blood test itself does not cause undue pain, discomfort or suffering but that an abnormal test result means that one or more prostate biopsies will be called for and such biopsies are not without side-effects.
If prostate cancer is actually diagnosed, the treatments also all have side-effects which can include sexual dysfunction, loss of bladder control and other complications.
The bottom line is that, if diagnosed, the chances of suffering treatment side-effects are much greater than the chances of being able to avoid suffering and/or death from prostate cancer.
Dr. Chodak refers to a recent study which showed that there was no difference in survival after 10 years in men whose prostate cancer was treated or left untreated.
Wednesday, May 23, 2012
Promising New Therapy for Localized High-risk Prostate Cancer
A recent clinical trial has shown that the drug abiraterone (which is already being used to treat men with advanced prostate cancer), may also be of very great benefit to patients with localized high-risk prostate cancer.
After 6 months of treatment, the study showed that abiraterone (Zytiga) completely eliminated or nearly eliminated the tumour in the prostate in an unprecendentedly high 34% of men in the trial.
Localized high-risk prostate cancer comprises approx. 15% of all prostate cancer and is often not able to be cured by prostatectomy (removal of the prostate) with most patients eventually dying from the disease.
The disappearance of the tumour in the prostate itself (as shown in the current trial) translates into a much better outcome for patients.
All participants in the trial had hormone therapy (in addition to abiraterone) and all underwent prostatectomy after completing the drug treatment.
A further clinical trial will be required to validate the results but, as yet, has not been planned.
After 6 months of treatment, the study showed that abiraterone (Zytiga) completely eliminated or nearly eliminated the tumour in the prostate in an unprecendentedly high 34% of men in the trial.
Localized high-risk prostate cancer comprises approx. 15% of all prostate cancer and is often not able to be cured by prostatectomy (removal of the prostate) with most patients eventually dying from the disease.
The disappearance of the tumour in the prostate itself (as shown in the current trial) translates into a much better outcome for patients.
All participants in the trial had hormone therapy (in addition to abiraterone) and all underwent prostatectomy after completing the drug treatment.
A further clinical trial will be required to validate the results but, as yet, has not been planned.
Tuesday, May 22, 2012
U.S. task force: End routine prostate cancer screening
NEW YORK (Reuters) -
A task force advising the U.S. government on Monday recommended against routine use of the prostate-cancer screening test called PSA, or prostate specific antigen, for lack of a discernible health benefit.
Like a draft proposal last October, the U.S. Preventive Services Task Force gave PSA screening a D, for "don't recommend" in healthy men.
PSA, a blood test, is a poor screening tool because PSA levels can rise for reasons unrelated to cancer, including age and prostate enlargement. Yet an elevated PSA level can trigger a biopsy to check for cancer.
Most biopsies show no cancer, which means the PSA was a false positive.
Against the tiny benefit of PSA testing, the task force weighed its harms. At least 15 percent of PSA tests will trigger a biopsy, after which up to one-third of men experience pain, fever, bleeding, infection, difficulty urinating, or other problems requiring medical attention, studies show.
"When you stack up those harms, the tiny or zero benefits do not outweigh the risk," said task force co-chair Dr. Michael LeFevre of the University of Missouri Medical School. Because PSA tests cannot distinguish between aggressive and indolent cancer, said ACS's Brawley, "men are rendered impotent and put in diapers, and for what?" he asked. "They never really had cancer in the first place."
Read the full Reuters report:
U.S. task force: End routine prostate cancer screening:
A task force advising the U.S. government on Monday recommended against routine use of the prostate-cancer screening test called PSA, or prostate specific antigen, for lack of a discernible health benefit.
Like a draft proposal last October, the U.S. Preventive Services Task Force gave PSA screening a D, for "don't recommend" in healthy men.
PSA, a blood test, is a poor screening tool because PSA levels can rise for reasons unrelated to cancer, including age and prostate enlargement. Yet an elevated PSA level can trigger a biopsy to check for cancer.
Most biopsies show no cancer, which means the PSA was a false positive.
Against the tiny benefit of PSA testing, the task force weighed its harms. At least 15 percent of PSA tests will trigger a biopsy, after which up to one-third of men experience pain, fever, bleeding, infection, difficulty urinating, or other problems requiring medical attention, studies show.
"When you stack up those harms, the tiny or zero benefits do not outweigh the risk," said task force co-chair Dr. Michael LeFevre of the University of Missouri Medical School. Because PSA tests cannot distinguish between aggressive and indolent cancer, said ACS's Brawley, "men are rendered impotent and put in diapers, and for what?" he asked. "They never really had cancer in the first place."
Read the full Reuters report:
U.S. task force: End routine prostate cancer screening:
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