Re: Quality-of-Life Effects of Prostate-Specific Antigen Screening

[Henry Campbell]

Just say "NO" !         to any procedure until you know what you are getting into. I say the same thing about bungie jumping.

I don't have a problem with PSA screening used as a tool to inform a man about the possibilities or probability of having prostate cancer. I do have a problem with the medical industry not supplying enough information so that a rational decision can be made. I suspect very few if any of us prostate cancer survivors really had the pros and cons of what a high PSA could mean or what any treatment results could be expected. He who has had any type of prostate cancer treatment and has been ecstatic about his quality of life afterwards -- hold up your hand !! I have never met anyone that has had a better quality of life after any type of procedure be it radiation, surgery, cryo, etc.

The industry has a cash cow and it are us. Sounds like something Pogo would say.

Henry

Quality-of-Life Effects of Prostate-Specific Antigen Screening

N Engl J Med. 2012 Jul 15;367(7):595-605, EAM Heijnsdijk, EM Wever, A Auvinen, J Hugosson, S Ciatto, V Nelen, M Kwiatkowski, A Villers, A Paez, SM Moss, M Zappa, TLJ Tammela, T Makinen, S Carlsson, IJ Korfage, M-L Essink-Bot, SJ Otto, G Draisma, CH Bangma, MJ Roobol, FH Schröder, HJ de Koning

TAKE-HOME MESSAGE

Results from a follow-up study examining the benefits and risks associated with PSA screening for prostate cancer indicate that the risks in terms of loss of quality-of-life years may outweigh its benefits.

SUMMARY

OncologySTAT Editorial Team

In recent years, much controversy has surrounded the benefits of prostate-specific antigen (PSA) screening in detecting and ultimately managing prostate cancer. Reports on the harms and benefits of PSA screening have been highly inconsistent due to limited results from randomized screening trials. In some cases, up to 56% of PSA screen-detected tumors would have never resulted in clinical symptoms, but these overdiagnosed cancers are frequently treated, with associated risks of adverse effects. Thus, Heijnsdijk and colleagues, utilizing data from the European Randomized Study of Screening for Prostate Cancer (ERSPC), examined the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening.

In regard to QALYs, the investigators considered treatment-related complications, such as urinary incontinence, bowel dysfunction, and erectile dysfunction. QALYs were analyzed in both patients who were screened and those who were not screened. Based on a model developed by the investigators, it was predicted that annual screening would yield a total gain of 73 life-years. In addition, a relative increase of 40% in the number of prostate cancer diagnoses was predicted.). Ultimately, a total of 8.4 years were gained per prostate cancer death avoided.

Although the investigators recognized the benefits associated with PSA screening, they also noted that these benefits may have been mitigated by the impact of screening on QALYs. They noted that the extension of screening to age 74 would result in an overall gain of 82 life-years and an increase in the number of prostate cancer deaths prevented from 9 to 11. However, after adjusting the number of life-years gained from screening relative to quality-of-life effects, the investigators predicted a 32% reduction in unadjusted life-years since only 56 QALYs would be gained, primarily due to the large number of overdiagnosed cases (48% of cancers detected via screening) and an additional 372 negative biopsies.

That number projects to a 23% reduction from the predicted number of life-years gained. It is interesting to note that the 23% predicted reduction is higher than the 8% predicted reduction estimated for breast cancer screening.

In closing, strategies to reduce overdiagnosis would be necessary before universal PSA screening can be advocated. The investigators found that the benefits associated with PSA screening were diminished by the loss of QALYs due to postdiagnostic long-term effects. They noted that their study results indicate how clinicians need to evaluate the benefit of PSA screening in regard to the overall reduction in prostate cancer mortality with the associated harms.

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Summary written by the OncologySTAT editorial team

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[Georgia Sam]

There are several "instruments" (i.e. questionnaires) used for gauging
QoL after a particular episode in the life of a PC patient. [ For
example, comparing post diagnosis surgery to RP ] I do not know if any
of these go beyong 18 months or so.

The first year or so on treatment is not too bad. So one would not
expect too much disatisfaction, but it wears thin after a decade or
so. The question is are there any instruments for tracking QoL up to
the first decade survival and beyond ?

If this is true from the article Henry quoted below >

> > In closing, strategies to reduce overdiagnosis would be necessary before universal PSA screening can be advocated. The investigators found that the benefits associated with PSA screening were diminished by the loss of QALYs due to postdiagnostic long-term effects. They noted that their study results indicate how clinicians need to evaluate the benefit of PSA screening in regard to the overall reduction in prostate cancer mortality with the associated harms.
>

Then these questionnaires need to be asking a whole load of different
questions up front. Questions for example to determine the reliability
of the diagnosis and the need to perform the subsequent procedure(s)
being investigted. A can of worms. If you have had any experience of
such questionnaires drop us a line.

Sam

On Aug 28, 10:26 pm, Henry Campbell <Henryjcampb...@bellsouth.net>
wrote:

[Patrick OShea]

Sammy,

I'm registered to receive the TOC of countless journals by email.  The most obscure (although it has been going 20 years) might be Psycho-Oncology:

http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-1611

There might be papers of interest in the back issues.

e.g. http://onlinelibrary.wiley.com/doi/10.1002/pon.572/abstract

-Patrick

 

Dx04 @ 56 (DRE nodule 2002) |bPSA 3.3 (0.8 when nodule found)| GS=4+3, RP - no LN, no SV, but PSA nadir-0.3. DT=3 months Salvage RT 2005. Again, nadir=0.3. No HB. Arimidex. AndroDerm.

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From: Georgia Sam <georgias...@gmail.com>
To: prostatic-diseases-treatments <prostatic-dise...@googlegroups.com>
Sent: Friday, October 12, 2012 8:00 PM
Subject: [PDT:1223] Are we "cash cows" as Henry puts it. A right old can of worms. Re: Quality-of-Life Effects of Prostate-Specific Antigen Screening

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Prostate cancer is an exceptionally heterogenous disease. What is good for one man may not be so kind on the next. Be sure to research and test any new supplement or treatment before adopting it - and in any case run it past a medically qualified person for a second opinion.