Screening for Prostate Cancer
Sam
Screening. Its a hot topic.
"www.ncbi.nlm.nih.gov/pubmed?term=Findings from the European Randomized Study of Screening for Prostate Cancer (ERSPC)"
[ Aside. I have to post here, but see Pat'scomments on NTP@Yahoo]
This is one of the observations found in the published paper (ref below):
“The main limitation is incomplete explanation of the lack of an effect of screening during follow-up.”
In my view this tells us something about treatment during screening follow-up.
We are looking at significant disease – not 'go-away watchful waiting' or the like. Significant disease, provides us with this model of surgery and/or radiotherapy, followed by castration therapy in what is called “standard treatment”.
My previous oncologist was eager to impress me with this fact about standard therapy, including castration drugs. But at the same time could offer me no more than two years life expectation in 2010. That was way past the meagre years of my prognosis in 1996 after waiting nearly a year for a diagnosis. No screening for me. Zilch. Nada. When it was agreed I had the disease, everyone involved in the early days believed I would not see past the Millennium.
Moral
message: Having lived so long past expectation gives me an obligation
to say what I believe is wrong with current thinking and treatment
regarding prostate cancer. When I get a chance I also like to praise what is good about
prostate cancer treatment, and medicine generally. When I make statements about my diagnosis and treatment, such as found in this email I am aware of my responsibility to portray an accurate picture.
Background
brief: Since 1995 I had exhausted the primary options, meaning
surgery, radiotherapy and more recently chemotherapy. This would
arguably be 'failure of the standard treatment plus a bit more'.
Surviving for so many years, and insisting on having some QoL has
been very difficult. My periods OFF treatment and ON testosterone have
lead me to be seen by the oncology dinosaurs in my home town
as a “difficult patient” who they are reluctant the help. The battle of surviving has not just been against the disease. It has been against institutional inertia and (un)professional laziness: and has led to me becoming in a very real sense an
“NHS refuge”. I have had to flee one PCT area to another, in order to obtain meaningful disgnosis of disease progression, and timely follow-on treatment. Yes, my local oncology doctors washed their hands
of me after I complained of their incompetence to the PCT. The PCT
backed the local oncologists because cancer patients are dead men, and dead
men do not tell tales, eh !
I hope the local PCT management are embarassed by this failure amongst their colleagues, and ashamed in the face of morality.
Anyway here I am, still standing, if not somewhat weakened and creaking. Had I accepted what the local oncology dinosaurs had to offer I would be dead long gone. Thank God the oncology doctors in an adjacent PCT had some humanity about them. Could see where I was coming from. Could understand why I periodically refused the standard treatment and used androgen.
Starting years ago and using the “androgen is good for you” lens I experimented with androgen gel. Even prescribed by my Urologist – once he knew what I was up to and could see for himself it was not killing me. [ Now here is a different animal (the Urologist) in my neck of the woods. He was not convinced with the 'theory' that androgen is OK – if anything he erred on the side of castration. But that is another matter and I had already demonstrated that androgen will not always kill you outright.] For me, slopping a couple of 5 mg satchets of testosterone on my belly stopped the pain and worsening symptoms for some time. I was able to put on weight and increase muscle mass as well as improve my cardiovascular health, and GO TO WORK.
Unfortunately
I had to go back to standard therapy after many years of playing this
game of catch me if you can with my cancer. This is merely a single
example - case study - but .. what I am trying to say by way of the hurried paragraphs above is that from my experience: ** screening is next
to useless, if you do not know how to treat the disease that you have
detected. **
Doctors screen for, and detect prostate cancer – but they still do not know how to treat it. Hence the OBSERVATION found in the concluding section from this very important paper:
“The main limitation is incomplete explanation of the lack of an effect of screening during follow-up.”
Most guys with prostate cancer will pass this whole thing by as an 'anomaly'. Their life in the prostate cancer community (and beyond) has no place for 'anomalies'. Moreover, since the standard treatment is serving many of them better than nothing why demand more ? Who cares ?
It would be great to be able to dismiss the problem of ineffectual support for this disease as a 'grumpy old gripe'. But the reality remains that 5-10% of men with prostate cancer will die from the disease before they get to enjoy their retirement. That says something queer about “.. an old man's disease” and one you are much more likely to “.. die with not from”. These are epithets that reflect the majority perception but NOT the evidence based reality.
It is a somewhat depressing prospect that we must continue with this majority perception because of the nature of prostate cancer and the inertia of old men. Notwithstanding, I continue to do my duty by informing – and inviting comment from - those who will listen.
Sam.
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Eur Urol. 2012 Jun 7. [Epub ahead of print]
Screening for Prostate Cancer Decreases the Risk of Developing Metastatic Disease: Findings from the European Randomized Study of Screening for Prostate Cancer (ERSPC).
Schröder FH, Hugosson J, Carlsson S, Tammela T, Määttänen L, Auvinen A, Kwiatkowski M, Recker F, Roobol MJ.
Source
Department of Urology, Erasmus MC, Rotterdam, The Netherlands.
Abstract
BACKGROUND:
Metastatic disease is a major morbidity of prostate cancer (PCa). Its prevention is an important goal.
OBJECTIVE:
To assess the effect of screening for PCa on the incidence of metastatic disease in a randomized trial.
DESIGN, SETTING, AND PARTICIPANTS:
Data were available for 76 813 men aged 55-69 yr coming from four centers of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The presence of metastatic disease was evaluated by imaging or by prostate-specific antigen (PSA) values >100 ng/ml at diagnosis and during follow-up.
INTERVENTION:
Regular screening based on serum PSA measurements was offered to 36270 men randomized to the screening arm, while no screening was provided to the 40543 men in the control arm. OUTCOME MEASUREMENTS AND
STATISTICAL ANALYSIS:
The Nelson-Aalen technique and Poisson regression were used to calculate cumulative incidence and rate ratios of M+ disease.
RESULTS AND LIMITATIONS:
After a median follow-up of 12 yr, 666 men with M+ PCa were detected, 256 in the screening arm and 410 in the control arm, resulting in cumulative incidence of 0.67% and 0.86% per 1000 men, respectively (p<0.001). This finding translated into a relative reduction of 30% (hazard ratio [HR]: 0.70; 95% confidence interval [CI], 0.60-0.82; p=0.001) in the intention-to-screen analysis and a 42% (p=0.0001) reduction for men who were actually screened. An absolute risk reduction of metastatic disease of 3.1 per 1000 men randomized (0.31%) was found. A large discrepancy was seen when comparing the rates of M+ detected at diagnosis and all M+ cases that emerged during the total follow-up period, a 50% reduction (HR: 0.50; 95% CI, 0.41-0.62) versus the 30% reduction. The main limitation is incomplete explanation of the lack of an effect of screening during follow-up.
CONCLUSIONS:
PSA screening significantly reduces the risk of developing metastatic PCa. However, despite earlier diagnosis with screening, certain men still progress and develop metastases. The ERSPC trial is registered under number ISRCTN49127736.
Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.
- PMID:
- 22704366
- [PubMed - as supplied by publisher]
LinkOut - more resources
Sam
Well worth a look at this article from the BBC Health website.
http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-19121402
The article raises some interesting points.
* It admits we know next to nothing about the cause of the disease. However ..
* Acknowledges the developmental stage of prostate growth is crucial to understanding.
* Identifies a 'gene' (Decorin) that is relatively absent in malignant prostatic growth at the fetal stage.***
* Suggests Decorin may be used as a screening tool as well as a treatment tool.
***
"We pinpointed which genes were active in embryonic prostate development and compared their behaviour in the development of prostate cancer.
"Through this process we were excited to discover that the presence of one gene - Decorin - was reduced in tumours compared to normal prostate cells.
"This observation suggests that Decorin's normal role may be to slow cancer growth, which is a really exciting possibility.
***
But read it for yourself why not and get back with your impression. Let's see what PubMed has ro say about Decorin.
Sam.
dtc
> http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-19121402
Sam
On 8/6/2012 8:25 PM, Sam wrote:
http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-19121402
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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.