Re [PDT:1224] Are we "cash cows" as Henry puts it. A right old can of worms. Re: Quality-of-Life Effects of Prostate-Specific Antigen Screening

[Sam]

Thanks Pat. Something to get my teeth into :-)



On Sat, Oct 13, 2012 at 3:40 PM, Patrick OShea <pjos...@yahoo.com> wrote:
> 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.
> ________________________________
> 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
>
> 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:
>> 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.
>>
>> > Access this article »
>>
>> > Summary written by the OncologySTAT editorial team
>>
>> > ____________________________________________________________
>> > 53 Year Old Mom Looks 33
>> > The Stunning Results of Her Wrinkle Trick Has Botox Doctors Worried
>> > consumerproducts.com
>
> --
> --
> 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.
>
>
>
>
>
> --
> --
> 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.
>
>
>