The Prostate Cancer Awareness Week
(pcaw.org) has compiled the following information on the prostate
testing controversy.
Kaiser Permanente Recommends Against Prostate
Screenings
The Prevalent View of ASCO, the American
Cancer Society and many HMO's
The Danger in this
View
Best
Reason to Fight for More
Research
We'll Send You a Free
Annual Checkup Reminder
Newsbytes
Kaiser Permanente Recommends Against Prostate
Screenings
* The Reasons Kaiser gives for not having a PSA test:
Many other expert organizations like the U.S. Preventive Services
Task Force, the National Cancer Institute and the Canadian Task Force
on Periodic Health Exams do not recommend PSA testing. Althought
the American Cancer Society recomends prostate cancer screening and
wants to increase public awaerness, the more frequent testing that
they recommend has not been shown to prevent prostate cancer deaths.
(Actually, the American Cancer Society no longer recommends testing,
either.)
The Prevalant View of ASCO, the American
Cancer Society and many HMO's
Unlike other cancers, prostate cancer grows very slowly in many (not all) men, so slowly that they would not threaten the life of the patient if not treated. So detecting cancer may subject some men to surgery and other treatments that might not ever be needed. Since prostate cancer treatments have significant side effects, treating it unnecessarily can seriously affect a man’s quality of life.
Until there is more complete research to evaluate, ASCO does not yet have an official statement about prostate cancer screening, or recommendations for men on when they should start getting tested for prostate cancer. Patients should discuss their situation with their doctor and work together to make a decision.
Prostate cancer is the most commonly diagnosed malignancy in American men. It is curable if diagnosed early. Early detection is the key.
About 30,000 men will die from it this year alone. Men over 40 don't need another excuse to avoid taking care of their health.
But the argument against the use of the prostate specific antigen blood test for detecting prostate cancer has provided that excuse -- pitting public health officials and primary care physicians, who claim there is no evidence of PSA success beyond a reasonable doubt, against many urologists who ask why a 27 percent decline in prostate cancer mortalities in the past five years isn't evidence enough.
Despite American Cancer Society and American Urological Association guidelines that encourage doctors to offer a PSA test and a digital rectal exam while discussing the risks of the disease, too many doctors lean toward discouraging the test, focusing on misplaced convictions that the test discovers insignificant tumors and that it doesn't save lives.
Physicians who have deferred or waffled on PSA testing are losing their licenses and seeing their malpractice insurance carriers pay out millions of dollars to bereaved families.
In a November 2001 wrongful death suit, a widow was awarded $3 million in a case in which the doctor in question "did not tell the patient about [the high PSA level] or recommend further testing or follow up visits."
A study at Long Beach Community Cancer Center of 48 such prostate cancer malpractice cases determined that, of the 22 awards totaling over $8.4 million, roughly $7.5 million "could have been avoided if PSA screening and diagnostic guidelines . . . had been followed."
These cases have become legal benchmarks as the PSA debate has moved from the doctor's office into the courthouse. They should come as a warning to science and public health policy officials across the country: If you continue to delay a decision on PSA, lawyers and lawmakers will make it for you.
Urologists will tell you that, despite imperfections, the PSA test has changed the prostate cancer diagnostic landscape. Before it, nearly three out of four men diagnosed with the disease were in the late stages -- when prostate cancer is neither readily treatable nor curable. The advent of screening has inverted that statistic, giving men a fighting chance. Regional studies support that early detection reduces mortality. One study in Austria shows that prostate cancer mortalities were markedly reduced with widespread PSA screening.
Even though newer blood tests help clarify the likelihood of cancer when PSA is abnormal, we still need more research to determine better models for early detection. But should we doom the thousands of men who could die waiting up to 14 years for the results of a randomized trial to determine "perfect intelligence" on the PSA? With so many lives in the balance, how much evidence do we need to convince us that prostate cancer is our enemy, not the test that so often detects it in time to permit a cure?
Men over the age of 40 -- and even younger if they are at higher
risk of prostate cancer (African Americans and men with family
histories of the disease) should "get on with it." Set aside the
excuses and resolve to be tested every year.
Source: Carl Frankel, an advocate for the National
Prostate Cancer Coalition, is retired general counsel for the United
Steel Workers of America and a prostate cancer survivor.
www.post-gazette.com/healthscience/20020611hprostate4.asp
Best Reason to Fight for More Research
The major reason all of these major organizations that deal with cancer are not recommending testing is because, unlike breast cancer, they say they haven't found anything that improves or extends a man's life if he gets prostate cancer so, basically, just let it grow.
With almost five-times more research spending per death, plus untold millions on awareness, breast cancer cures are seeing great results. At the rate men bought Viagra, you've got to believe they would spend a lot if there was something that could stop prostate cancer without becoming impotent or incontinent.
The difference is that women have raised the banners. Have spend their personal time and money to make things happen, have purchased millions of Breast Cancer Awareness Stamps, have made a difference.
Unlike women, few men have done any of those things, and while the U.S. Postal Service did create a Prostate Cancer Awareness stamp, over 50 million of the 78 million stamps went un-purchased.
Will you wake up before you get prostate cancer to find a way that helps men live out those final years happier and healthier? Will you?
Note: Spending in 1997 on research looked something like this:
Breast Cancer $12,800/death, prostate cancer $2,700/death.)
Men "Unwilling" to Discuss Cancer
"You cannot sit back and do nothing because you'll never have perfect intelligence on the enemy...Get on with it." General Norman Schwarzkopf said after he was diagnosed with prostate cancer
