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Fri 29th July 2005

GPs champion prostate testing

Filed under: Men's Health — JohnPotter @ 2:19 pm

Medical opinion is swinging towards prostate cancer screening for men, a leading Christchurch urologist says.

The debate was reignited at the national GPs conference in Christchurch yesterday, despite current Ministry of Health advice against a national screening programme.

In a show of hands, most GPs at the conference debate indicated they would offer prostate-specific antigen (PSA) blood-testing to men over 50 during a general health check-up.

Urologist Peter Davidson said prostate cancer was the third-biggest cancer killer in men after lung and colon cancer. About 550 men a year die of it, more than the 450 killed on the roads.

Clinicians were persuaded by recent research that showed screening improved the length of time sufferers lived after diagnosis.

However, epidemiologist Dr Ann Richardson said there was no strong evidence that screening made any difference to how long a man would live.

She said doctors should wait for the results of major studies under way in Europe and the United States. Those studies were randomised controlled trials, considered the gold standard in medical research.

One of the main dangers of screening was over-treatment, Richardson said.

Prostate Cancer Foundation president Barry Young said that although PSA testing was not diagnostic, it was no less accurate than mammography and there was not a better screening option.

“The Ministry of Health says men without symptoms should not ask to be tested,” he said.

“But the horrible thing is if you go along with symptoms and find it’s caused by prostate cancer, it’s generally too late. Once it’s out of the prostate, it’s incurable.”

Christchurch Men and Fathers Network co-chairman Don Rowlands said prostate cancer was a huge issue, but men’s health was not prioritised.

“Health is a competition for funds,” he said.

13 Responses to “GPs champion prostate testing”

  1. Moose says:

    This is an excellent example of how the femminists have infiltrated the govenment, and thwarted basic help for men in NZ. The proof lies in that it takes a vote of a group of GP’s at a conference to point out the terrible fact that prostate cancer is the main killer of men in NZ more so than road deaths. Dr. Anne Richardson, if she were a Doctor (or even a scientist) would know the basic idea of a scientific method. It is obvious she is just trying to delay any type of help or funding for the poor souls who suffer from, or will, prostate cancer. Does the money denied for prostate cancer research get diverted to breast and cervical cancer research ? Probably. Our scientists in NZ are always making breakthroughs in medicine and are more than competent to conduct research in this area, and probably with the appropriate funding would find the cure before any other country. Why should we wait for the UK or US to come up with results ?

  2. JohnP says:

    Im sorry Moose, but I have to disagree with your ‘excellent example’. Anyone upholding the scientific method will know that data proving that mass prostate screening would be worthwhile has not yet been collected, although I (and presumably the GPs at the conference who raised their hands) believe this is likely to happen in the next couple of years. Unfortunately, the only way of getting accurate information of this type is to do longitudinal studies over many years.

    Remember, every man currently contemplating prostate screening must weigh up the risks – he may be wrongly diagnosed positive, experience lots of unnecessary stress and interventions, and end up incontinent and impotent. For some of us, these are not trivial issues.

    I don’t believe feminists influenced the past decision not to recommend mass screening – I think it was driven more by a perception of unwarranted use of public money, and unacceptable levels of risk vs possible benefits.

    You might be on firmer ground if you argued that mass screening programmes for women were more ideologically based than scientifically justified, but ‘redressing the balance’ arguments don’t wash with me.

    We should be definitely be applying pressure for more funding of research of prostate cancer detection and treatment, and you are quite correct that NZ scientists are capable of world-beating discoveries.

    Incidentally, one of the most important criteria for a man making the decision whether or not to get screened for prostate cancer is family history – if your grandfather or uncles died of prostate cancer you should definitely be discussing the issues with your doctor. Every time a Family Court Judge removes all possibility of contact with an extended family just because they happen to be on the father’s side; this information becomes harder to access, which is directly contrary to a person’s best interest.

  3. Stephen says:

    Hello John,
    I disagree with your conclusions about the validity of screening for prostate cancer.
    You may not be aware of research I recently came accross on the web about this issue.

    It stipulated that screening for prostate cancer IS VIABLE.
    It works like this apparently.
    Each year a man gets a blood test done.
    If the level of a certain chemical in his bloodstream has increased by more than a certain amount over that year THEN he is deemed to be highly likely to be developing prostrate cancer and is checked more closely.
    I’m sorry I didn’t note the site I got this from – possibly Angryharry in his Men’s health section. However I’m sure some googling could bring it to light. I’ll try to retrace and find it for you.

    Interesting and disturbing point you raise about Family Courts effectively barring men from informationabout thier own risk factors.

  4. JohnP says:

    Yes, sure screening is viable, in fact I would say essential for some men (those with symptoms, family history etc).

    However the criteria for mass population screening (which would include a large number of men with little risk of developing this cancer), demands that the risks be weighed against the benefits. The balance as applied to any one individual man may be quite different from what applies to mankind in general.

    The PSA test you refer to (which should always be accompanied by the ‘finger test’) has been known in the past to have a high rate of false positives, although I understand accuracy is increasing. In addition, new treatments are less likely to produce unwanted side effects.

    There is still however, a valid concern that mass screening and treatment could result in creating significant numbers of impotent and/or incontinent men who had nothing wrong with them in the first place.

  5. Stephen says:

    Hi John,
    The research I’m seeing indicates that mass screening wouldn’t necessarily lead to treatment, but act as a sieve to find those men who would then warrant closer scrutiny.
    There’s an interesting corrolary to this too. Apparently mass screening which is researched and evaluated well can itself lead to refinements in screening and treatment procedures.
    Link re recent breakthroughs in prostate screening – htttp://foxnews.webmd.com

  6. JohnP says:

    I understand that:

    “mass screening wouldn’t necessarily lead to treatment”

    [edit] at least, not right away. That’s where the stress comes in. Doctor: “I’m sorry Stephen, but you have an elevated PSA level of 5, we better keep an eye on things.” [/edit]

    Study: Prostate Screening Saves Lives seems like a pretty balanced article, thank you.

    Note this:

    Goel tells WebMD. “In young men with no risk factors, PSA testing may not be indicated, even at this level of benefit. “

    The real point I wanted to make to Moose is that there is genuine scientifically-based debate going on behind this issue, rather than it being another feminist plot to disadvantage men.

  7. Stephen says:

    Hi John,
    I agree there are real medical concerns.

    But I still know from depressing experience that despite my years of independantly lobbying MPs including Jenny Shipley and Helen Clarke for prostate and testicular cancer research dollars neither could give a shit.
    Despite my appeals for compassion, equity and justice for men pointing out to them both that they were pumping millions of taxpayers dollars annually into breast and cervical screening, they offered not one jot of concern or sympathy in thier responses.
    All I got in both instances was a measly ‘your concerns are noted’ type reply. Cold, flat rejection.
    I was choked at thier callous disregard for men’s health, and naive to think they’d really care and listen to reason.

    As an aside, I notice John Tamihere’s gone deafeningly quiet on advocating for men’s health (for the time being anyway). Looks like he got the message not to mess with Clarke’s agenda by stirring up the male vote or he’ll get dealt to severely.
    The sooner Helen and her gaygirl entourage are gone the sooner I’ll repatriate.
    And have a bloody good party up to celebrate doing so!

  8. Mark S says:

    This is the sort of excellent discussion I enjoy seeing on MENZ!

    Now to the big “P” in many men’s psyche at the moment and: To screen or not to screen?

    I’ve recent personal involvement with a family member who has been treated for Prostate Cancer. Some of this information may be valuable for those of you interested.

    First, the NZ Cancer Foundation have a free-call line you can ring and ask any questions you wish to about any form of cancer. The calls are fielded by experienced oncology nurses. If required, expert opinion is sought.

    Second, if a family member has Prostate Cancer, male children and siblings are twice as likely to contract the cancer. “Testing” is recommended for men over 45 years of age in this category.

    Third, the “entrenched” medical community will tell you there is no benefit in screening when the cancer is asymptomatic – that many more men die “with” rather than “because of” Prostate Cancer.

    Fourth, there is a blood test that measures PSA – Prostate Specific Antigen (?I think this is right). This is a chemical produced by the prostate gland that causes the ejaculate to “glob” (urologist’s term), but, within 20 minutes, allows the semen to become fluid again.

    The blood test measures the level of PSA in the blood. This level varies in most healthy males from day-to-day by (according to the urologist) up to 30%. It can be affected by how often (or not) a man has sex, whether or not he has exercised, his diet and the list goes on. However, if early screening is undertaken, a “normal” range can be established.

    The medical profession know that, when Prostate Cancer is present, more PSA passes through the wall of the prostate into the blood. This means the PSA reading increases over time as the cancer grows.

    A reading of 6 is high, but acceptable. At this level, needle biopsy of the prostate is likely to be recommended. While not a “nice” thing to have, the biggest downside is that it is not guaranteed to discover any cancerous cells.

    Our family experience was over a period of some 7 years since the PSA reading hit 6. Needle biopsy failed to determine a positive cancer result.

    The PSA reading gradually rose to over 25, which the urologist just could not understand when the biopsy came back negative.

    The outcome of this is that earlier in 2004, a twice-a-year biopsy came back positive. After considering the options: surgery versus radio-therapy, the latter was chosen after a family meeting.

    Elsewhere on MENZ there has been an article about research into the limiting of testosterone in the treatment of Prostate Cancer by radio-therapy. This involves a “pill” that is lodged “subcutaneously” (under the skin) of the stomach area. The “pill” causes testosterone production to drop almost to nothing and the treatment is for at least 4 months.

    The positive effect of this is that the cancer shrinks and is weakened. This means the radio-therapy is much more effective and can be more localised (less radiation trauma to adjoining tissue).

    The downside is that testosterone is what makes us Men; it is what provides a large part of our energy and drive; it provides us with a level of emotional strength.

    Radio-therapy was an 18 week course finishing late in 2004. Towards the end of this time, all of us helped out with transport because the drain on our patient was terrible to watch. Speak with the NZ Cancer Foundation if you wish to get some idea of the side-effects of radio-therapy.

    I will also express my heartfelt gratitude to all the ladies who nurse at the Auckland Hospital Radio-Therapy unit. Their demeanour was always wonderful as they grew to know our patient by name (as you can imagine) and take a genuine interest in how he was managing the day-to-day living while under radio-therapy. Medals are long overdue for these nurses.

    The final outcome has, in general, been very positive for our patient. The effects of the therapy have passed. His PSA reading is now down well under 1 – all the medicals are pleased. The Family are also pleased that life will continue with a reasonable quality for him.

    Given that the screening we are speaking about is a blood test just like the ones done for anaemia, diabetes, kidney function etc, why are we not screening “at risk” individuals over the age of 45 once a year in order to establish a “normal” PSA reading. Then, when a change occurs (a steady increase over time), further investigation may be done.

    This form of screening would not be as costly as screening for breast cancer and might be able to provide “early warning” where a man is set to die “because of” Prostate Cancer.

    In my situation, I am twice as likely to develop the cancer. I would like to think that I can have an annual blood test after my 45th birthday to provide the early warning. With the current femi-nazi brigade in charge, I will not be holding my breath….that shade of blue doesn’t suit me.

    Remember, the steady increase in a PSA reading is a “reasonable indication” there is Prostate Cancer present to some level. A needle biopsy is currently the only current test that can discover cancerous cells, but its reliability is impaired because the cell sample is, generally, very small relative to the size of the gland.

    The impotence and incontinence are risks of both surgery and radio-therapy – not of the blood test nor the biopsy.

    Go in peace! Stay healthy and happy!

  9. Stephen says:

    Thanks Mark S for a well laid out explanation. Well done. It was as I’d figured but struggled to explain myself.
    Just another of the many reasons I’m not keen to repatriate to socfem new zeal and………..

  10. banjo says:

    Just bumped into this page,very good by the way!
    Without going into too much detail,my Father was diagnosed with prostate cancer about 5 years ago.
    He had it removed after all the options were explained.
    I have obvious interest now in this field and have invested some money in a UK company called Mediwatch.
    They are soon to market a ‘one stop’PSA test called PSAwatch.
    Basicaly you would be able to go to your local GP and have the test done there with immediate results.Blood results usually are sent to a lab. which is both costly more time consuming.
    From what I can gather it’s not the level of PSA that is important it is the rate of change that gives a better indication for further in-depth testing.
    Just interested in your views?

  11. JohnP says:

    Banjo, I believe you are correct about a sudden increase in the rate of change being a reasonably reliable indicator that something is wrong.

    I can certainly understand why you are personally concerned about testing, given your dad’s experience. How old are you?

    Does the ‘one stop’ test include a DRE (Digital Rectal Examination)?

  12. banjo says:

    John,The ‘one stop test’ is a PSA test that can be carried out by your GP/nurse while you wait (10-15 mins) at a cost of about £3.00.This is then fed into a unit called a bioscan (about £1000) to give the result.The results can then be stored/sent to other units via bluetooth tech.for further analysis/records.

    To answer your question about DRE,I don’t think it includes this but with the tech.they may be able to tabulate the results together…if that makes sense?

    The PSA test if i’m right,is to back up the DRE as well as give an ‘indication’of PSA before and after prostate cancer.

    I’m nearly 39 now so will be having a test soon..just to get a baseline.Have done quite a bit of research into PSA testing for/against.

    As I said before I have a financial interest in Mediwatch but obviously a concern nearer to home.

    The website for mediwatch is:

    http://www.mediwatch.com/

    Look under products

    One Stop Prostate Assessment System &
    Near Patient Tests
    Use the male/female signs for more info.

    Must add i’m not trying to get you to buy shares in the company,just interested in any comments!
    Cheers

  13. banjo says:

    morning all,
    Iv’e posted loads of articles from the internet about PSA testing on a shares BB.It makes good reading.Probably best if you go to ‘recent’ and then work backwards.Not sure if you will be able to see them if you don’t join…i’ll leave it up to you!
    Below is the main webpage
    http://www.advfn.com
    below is the MDW thread
    http://www.advfn.com/cmn/fbb/thread.php3?id=6556613

    Be warned though,this is a shares BB but saying that it is mostly me contributing…forget about the Mediwatch (MDW)aspect and just read the articles I have posted.

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