GET ONE.... ERROR ON THE SIDE OF CAUTION!!!!
October 6, 2011
U.S. Panel Says No to Prostate Screening for Healthy Men
By GARDINER HARRIS
Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.
The draft recommendation, by the United States Preventive Services Task Force and due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a P.S.A. test — sometimes without their knowledge — during routine physicals.
The task force’s recommendations are followed by most medical groups. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the P.S.A. test is even more forceful and applies to healthy men of all ages.
“Unfortunately, the evidence now shows that this test does not save men’s lives,” said Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. “This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does.”
But advocates for those with prostate cancer promised to fight the recommendation. Baseball’s Joe Torre, the financier Michael Milken and Rudolph W. Giuliani, the former New York City mayor, are among tens of thousands of men who believe a P.S.A. test saved their lives.
The task force can also expect resistance from some drug makers and doctors. Treating men with high P.S.A. levels has become a lucrative business. Some in Congress have criticized previous decisions by the task force as akin to rationing, although the task force does not consider cost in its recommendations.
“We’re disappointed,” said Thomas Kirk, of Us TOO, the nation’s largest advocacy group for prostate cancer survivors. “The bottom line is that this is the best test we have, and the answer can’t be, ‘Don’t get tested.’ ”
But that is exactly what the task force is recommending. There is no evidence that a digital rectal exam or ultrasound are effective, either. “There are no reliable signs or symptoms of prostate cancer,” said Dr. Timothy J. Wilt, a member of the task force and a professor of medicine at the University of Minnesota. Frequency and urgency of urinating are poor indicators of disease, since the cause is often benign.
The P.S.A. test, routinely given to men 50 and older, measures a protein — prostate-specific antigen — that is released by prostate cells, and there is little doubt that it helps identify the presence of cancerous cells in the prostate. But a vast majority of men with such cells never suffer ill effects because their cancer is usually slow-growing. Even for men who do have fast-growing cancer, the P.S.A. test may not save them since there is no proven benefit to earlier treatment of such invasive disease.
As the P.S.A. test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a P.S.A. test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both. As a result of these complications, the man who developed the test, Dr. Richard J. Ablin, has called its widespread use a “public health disaster.”
One in six men in the United States will eventually be found to have prostate cancer, making it the second most common form of cancer in men after skin cancer. An estimated 32,050 men died of prostate cancer last year and 217,730 men received the diagnosis. The disease is rare before age 50, and most deaths occur after age 75.
Not knowing what is going on with one’s prostate may be the best course, since few men live happily with the knowledge that one of their organs is cancerous. Autopsy studies show that a third of men ages 40 to 60 have prostate cancer, a share that grows to three-fourths after age 85.
P.S.A. testing is most common in men over 70, and it is in that group that it is the most dangerous since such men usually have cancerous prostate cells but benefit the least from surgery and radiation. Some doctors treat patients who have high P.S.A. levels with drugs that block male hormones, although there is no convincing evidence that these drugs are helpful in localized prostate cancer and they often result in impotence, breast enlargement and hot flashes.
Of the trials conducted to assess the value of P.S.A. testing, the two largest were conducted in Europe and the United States. Both “demonstrate that if any benefit does exist, it is very small after 10 years,” according to the task force’s draft recommendation statement.
The European trial had 182,000 men from seven countries who either got P.S.A. testing or did not. When measured across all of the men in the study, P.S.A. testing did not cut death rates in nine years of follow-up. But in men ages 55 to 69, there was a very slight improvement in mortality. The American trial, with 76,693 men, found that P.S.A. testing did not cut death rates after 10 years.
Dr. Eric Klein of the Cleveland Clinic, an expert in prostate cancer, said he disagreed with the task force’s recommendations. Citing the European trial, he said “I think there’s a substantial amount of evidence from randomized clinical trials that show that among younger men, under 65, screening saves lives.”
The task force’s recommendations apply only to healthy men without symptoms. The group did not consider whether the test is appropriate in men who already have suspicious symptoms or those who have already been treated for the disease. The recommendations will be open to public comment next week before they are finalized.
Recommendations of the task force often determine whether federal health programs like Medicare and private health plans envisioned under the health reform law pay fully for a test. But legislation already requires Medicare to pay for P.S.A. testing no matter what the task force recommends.
Still, the recommendations will most likely be greeted with trepidation by the Obama administration, which has faced charges from Republicans that it supports rationing of health care services, which have been politically effective, regardless of the facts.
After the task force’s recommendation against routine mammograms for women under 50, Health and Human Services Secretary Kathleen Sibelius announced that the government would continue to pay for the test for women in their 40s. On Thursday, the administration announced with great fanfare that as a result of the health reform law, more people with Medicare were getting free preventive services like mammograms.
Dr. Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence in Britain, said he was given a P.S.A. test several years ago without his knowledge. He then had a biopsy, which turned out to be negative. But if cancer had been detected, he would have faced an awful choice, he said: “Would I want to have it removed, or would I have gone for watchful waiting with all the anxieties of that?” He said he no longer gets the test.
But Dan Zenka, a spokesman for the Prostate Cancer Foundation, said a high P.S.A. test result eventually led him to have his prostate removed, a procedure that led to the discovery that cancer had spread to his lymph nodes. His organization supports widespread P.S.A. testing. “I can tell you it saved my life,” he said.
Re: GET ONE.... ERROR ON THE SIDE OF CAUTION!!!!
I'm sure that if you read or listen to the national news, every few years there's such articles as this one...it being about the prostate...listen for the next couple days about the pros and cons fo this addressing...In the past there have been those about the mammograms or PAP smears for females...then the need for the colonoscopy tests for all genders...I don't think there is a soul on the planet who gets one of the colon things just for the hell of it...your doctor encourages them...How about so much of the 'swill' that you have to drink to prep for the latter testing...."water boarding torture" hell, just threaten to make the offensive one drink a prep drink, orange flavor at that!!! and then another and another!!!! If OBAMACARE goes into effect fully, we're going to see a lot more of these procedures cut back or degraded that they aren't necessary. Chief
Re: GET ONE.... ERROR ON THE SIDE OF CAUTION!!!!
October 7, 2011
Panel’s Advice on Prostate Test Sets Up Battle
By GARDINER HARRIS
A day after a government panel said that healthy men should no longer get screened for prostate cancer, some doctors’ groups and cancer patients’ advocates began a campaign to convince the nation that the advice was misguided.
Their hope is to copy the success of women’s groups that successfully persuaded much of the country two years ago that it was a mistake for the same panel, the United States Preventive Services Task Force, to recommend against routine mammograms for women in their 40s. This time, the task force found that a P.S.A. blood test to screen for prostate cancer does not save lives, but results in needless medical procedures that have left tens of thousands of men impotent, incontinent or both.
Both sides in the battle have marshaled distinct arguments, and both said their only goal was to protect patients. Caught in the middle are 44 million men in the United States over the age of 50 who must now decide whom to believe. Some have already had a P.S.A. — prostate-specific antigen — test and must choose what to do with the result. Others have undergone biopsies, surgeries, radiation therapy and even drug treatment that results in a form of chemical castration. Many have suddenly confronted the thought, perhaps for the first time, that their pain and suffering may have been for nothing.
Members of the government panel said they knew that they would have to defend their recommendation and delayed issuing their report for two years to prepare for the battle that was certain to ensue. Dr. Michael L. LeFevre, co-vice chairman of the task force, said the panel originally voted against routine screening for prostate cancer in 2009. But after the firestorm over its advice on mammography, Dr. LeFevre said he deliberately slowed down the process.
“I looked at this and said, ‘I know this is going to happen with prostate cancer for all the same reasons, and we absolutely have to have the science right,’ ” he said. As for the resulting delay, Dr. LeFevre said, “I will take full blame and full credit.”
If the panel’s analysis of the science is correct, thousands of men were probably harmed by unnecessary tests and treatments during the delay.
At the heart of its advice is the startling finding that thousands of doctors in the United States have been doing many of their patients more harm than good. While the panel did not explicitly level such a charge, Dr. LeFevre said that the dangers of common treatments were what drove the members to recommend against screening. “If you’re the guy doing the treatment, that’s pretty hard to swallow,” he said.
Sure enough, urologists — the doctors who most often treat prostate cancer — promised to fight. The American Urological Association issued a statement saying that the recommendation “will ultimately do more harm than good.” Many urologists reacted angrily.
“All of us take extraordinary issue with both the methodology and conclusion of that report,” said Dr. Deepak Kapoor, chairman and chief executive of Integrated Medical Professionals, a group that includes the nation’s largest urology practice. “We will not allow patients to die, which is what will happen if this recommendation is accepted.” He and other urologists said that the P.S.A. test is just one part of an overall strategy that, in the hands of well-trained doctors, can help prevent death and other consequences of cancer.
Treating patients with prostate cancer is a highly profitable business in the United States, and much of the practice of urology is dedicated to this fight. If men no longer get screened routinely, urologists will see a steep decline in patient visits and income. But Dr. Kapoor rejected the notion that profit plays any role in his defense of screening.
“That I’m going to treat patients that don’t need therapy is morally repugnant,” he said.
But Dr. Otis Brawley, chief medical officer of the American Cancer Society, suggested that is what doctors like Dr. Kapoor are doing. “We in medicine need to look into our soul and we need to learn the truth,” he said. “If your income is dependent on you not understanding something, it is very easy not to understand something.”
Dr. Derek Raghavan, president of the Levine Cancer Institute in Charlotte, N.C., said that at the very least, men must stop being so anxious about the results of their P.S.A. tests. “Men come into my office crazy and absolutely fearful,” he said. But even P.S.A. test results that are considered high by many doctors — in the hundreds, for instance — are not dangerous unless the levels are rising rapidly, Dr. Raghavan said.
“We need to educate men to slow down,” he said.
But Dr. J. Brantley Thrasher, chairman of urology at the University of Kansas Medical Center, said he feared that the task force’s recommendation will eventually lead insurers to stop paying for many prostate cancer treatments and lead many men not to get tested.
“There is no question that some people are being overtreated in this country,” Dr. Thrasher said. “But we can’t go back to the day when men waited so long to be treated that all I could do for them was give them narcotics and wait for them to die.”
The choices are fateful for men, many of whom believe the P.S.A. test saved their lives. Robert Ginyard, 49, of Baltimore, said he had gradually rising P.S.A. tests for years when his doctor finally suggested he see a urologist. A biopsy showed that he had cancer, but not an aggressive kind.
Studies show that many men have cancer in their prostate that never results in illness or death. But Mr. Ginyard, like many men, could not live with the idea that he was harboring cancerous cells. His father had prostate cancer, and he is black — factors that put him at higher risk. But he is in his 40s, and dangerous prostate cancer is very rare in men younger than 50.
“I’ve got two young daughters, and that man instinct kicked in,” he said. “And I said, ‘It’s not about my life right now. It’s about making sure that I take care of my family.’ If you have cancer, you get it out and you bother with the statistics later.”
So Mr. Ginyard had his prostate removed last year and underwent radiation therapy. The side effects, including impotence and incontinence, were significant, but he said they have since passed.
The task force’s recommendation, he said, “gives men another reason to place their personal health and well-being on the back burner.”
Re: GET ONE.... ERROR ON THE SIDE OF CAUTION!!!!
The place where I worked for 35 yrs. had a "wellness" day every year where they did blood tests for colesteral , PSA, blood sugar, liver function and a ton of others. My PSA numbers, over a period of years, rose slowly by 1/4 to 1/2 point each year or so, but still in the normal range. My doctor told me that it was a normal function of aging. After I retired, I continued getting tested every year or 2 and the number seemed to stabilize at 3 to 3.7. After I had a hip replacement I had another test that came back 7. My doctor told me not to worry that it was most likely the result of being catheterized during the hip replacement. I waited 2 weeks and repeated the test. It dropped down to 6. The doctor said it probably would continue to fall but to be safe he recommended seeing a Urologist. The Urologist suggested a biopsy rather than waiting and repeating the test. The biopsy results showed low grade cancer in 12 out of the 18 specimens. The Urologist said I needed radical surgery immediately. I went to 2 other doctors at the University of Florida at Gainsville, one a Urological surgeon, the other a radiation Oncologist. They both agreed that the radical surgery was an option but they showed me statistical proof that, with my grade of cancer, the outcomes of any of the treatments over a period of 18 yrs. were the same. That included seed implants, robotic surgery, radiation therapy, radical surgery etc., even watchful waiting, although they did not recommend watchful waiting. I went with radiation therapy because it had the least side effects and was the least invasive. I had treatments 5 days a week for 9 weeks. I had no side effects. My PSA numbers after the treatments were less than 1, even after having a second hip replacement this year. Although I had no symptoms before or after I still feel relieved to have gone through it. I find it hard to believe all of the different doctors I went to would have all advised me to get treatment I didn't need. What do you think?
Re: GET ONE.... ERROR ON THE SIDE OF CAUTION!!!!
Gunner, that was one hell'va good write....thank you or sharing those views and experiences with us...I've had much the same level of readings as yours however mine being a bit higher and consistant...Early in the addressing of the prostrate issues, the doctor had me given a biopsy...that's been the most alarming with the pissing of blood afterwards...He keeps me on 2 'scripts and those are FLOMAX and AVODART....As for checkups, I go see the Doctor once a year...he takes time with me as I usually take him some little wooden gimmick that entertains the hell out of him...last time I gave him my own simple invention that he become very interested in...I call it the EARTHQUAKE WARNING DEVICE....a little wooden 8 inch long fish I shape like a shark...I make a matching hardwood base and suspend the fish to the base with this 5 inch long wire pin...the fish hangs suspended over the base and you place it on a solid surface where there are no movements, vibrations, air flow or otherwise...any movement of the fish beginning to bounce about may be a suspect earthquake. Yeah, he was caught up in the drama of the fool thing and I was ready to leave....I turned to say 'so-long' as saw he was lubricating his gloved finger.........Chief
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