Tuesday, May 22, 2012

Prostrate Cancer tests and fate

MSNBC.  May 23, 2012

POP1

One in a thousand helped.

A top panel of U.S. medical experts (the U.S. Preventive Services Task Force) has concluded that no man of any age should routinely be screened for prostate cancer using the popular PSA test.  They gave the prostate-specific antigen test a grade of D, saying that the risks of population-wide screening outweigh the benefits.

The panel said that there was convincing evidence that the number of men who avoid dying of prostate cancer because of screening after 10 to 14 years was very small.  Citing large epidemiological studies from both Europe and the United States, they said that the benefits of PSA screening and early treatment amounted to less than one prostate cancer death avoided for every 1,000 men screened.

POP2

Harms of unnecessary preemptive treatment.

The test, which measures a protein in the blood, does not diagnose cancer.  It looks for a particular sign that cancer may be present.  The surgery that follows a positive test includes radiation, chemotherapy and hormone deprivation.

The test often results in false positives.  It can’t tell how aggressive or benign a cancer may be so that doctors are often in the dark about whether the tumor requires treatment.  Erring on the side of caution, most men with positive PSA tests are biopsied and, if cancer is found, treated.  The result is that many men are being subjected to the harms of treatment and overtreatment for something that would never have become a problem.

Typical side effects of treatment include impotence, incontinence, even death.

POP3

The other side of the argument:

Retired University of Washington professor Jim Kiefert of Olympia, Wash. said of the task force,
“They do not give a damn about you.  They use population statistics to justify not giving PSA tests. They forget about people at the other end of the Bell curve."  His first PSA test at 50 led to a diagnosis of metastatic prostate cancer.  He has waged a battle against the cancer ever since, including surgery, radiation, and hormone deprivation therapies and he says “I wish I could have gotten a PSA test at 40 or 45 and gotten that cancer before it escaped the gland”.


POP4

Dr. Otis Brawley, chief medical officer of the American Cancer Society, defends the panel’s decision:

He says: 

"Just about every man who undergoes treatment after a PSA test will say that the test saved his life, though often he would have been just fine had the cancer never been detected and treated.”.......

POP5

......... Like the traveller in classical times who built a monument to the gods to honor them for saving him from drowning after a shipwreck, and who was asked where were the monuments to all those through history who had not been saved.

POP6

Agitation to continue testing is driven, at least in part, by financial incentives - makers of drugs, PSA tests, and doctors who prefer that the whole nation be composed of people who think they are sick.

Medicare and private insurers could use the conclusion to justify ending reimbursements for the tests.



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