Here we go again. More debate about prostate cancer screening. I wonder of cost of services, not just screening but also treatment is driving this debate? Rather than focus on screening I wish the debate was focused on how to evaluate patients for treatment. We know that some men are still diagnosed with advanced cancer. We also know that some men may be over treated. It bothers me that we may be sacrificing some men because some are over treated.
To read the memo quoted below click here.
Ruth Etzioni, Ph.D., of the Fred Hutchison Cancer Research Center in Seattle and colleagues reviewed several recent articles on PSA velocity. They point out in their commentary the important differences between studies of PSA velocity in the cancer screening setting and studies of PSA velocity and prostate cancer progression after diagnosis. These differences lead them to question whether PSA velocity is useful for early detection of prostate cancer.
No studies to date have addressed the costs and benefits of using PSA velocity for prostate cancer screening. “One of the main goals of this commentary has been to reconcile some of the inconsistencies across studies by highlighting features of study design and potential sources of bias that might explain why different types of studies have produced differing results,” the authors write.
I wish I had a solution. I would appreciate feedback from people who read this blog.
To read the abstract in the Journal of the National Cancer Institute click here.
MY FIRST THOUGHT WHEN I READ THIS IS THAT SOME RESEARCHERS ARE SPENDING TIME AND MONEY ON AREAS THAT HAVE NOTHING TO DO ABOUT SAVING LIVES. I WONDER WHO IS FUNDING THESE STUDIES?
There is no question that men are over treated. Part of the problem is the uncertainty that the current diagnostic tools create. There is no way to accurately predict how aggressive a cancer is with the current tools.
Yes, we have predictive nomograms and markers that point to the potential stage of the disease at diagnosis, but there is still a disparity between biopsy and pathology when a patient is treated surgically. This disparity is considerable and can be as high as 50% and potentially also affects all in situ treatment results.
Could this uncertainty in diagnosis be part of the high percentage of treatment failure reported in the treatment of PCa? I believe it is a great part of the problem. Going back to over treatment, the question is what is the real percentage of over treated men? Huge numbers (in the 80% range)are proposed by those opposed to screening, but the real number is probably much lower when one considers the rate of treatment failure and the unexplained reduction in the mortality rate since the introduction of PSA testing. Etzioni herself previously reported a more respectable figure of 14%. The rate of change of PSA and PSADT should be trigger points for investigation. What is done with the information obtained is another question that require analysis and better imaging tools should provide men with a higher probability of doing well by active surveillance and avoiding treatment.
Opponents to screening should try to explain the rate of treatment failure and the reduction in mortality rate before promoting their continued effort to lure men to sleep about PCa risk…
Hi Kathy-I think screening should be done. I started getting a PSA done with my yearly physical about 6 years ago at age 46, after a friend was diagnosed (at age 48). At age 52 my PSA jumped from 1.9 to 5.5 in one year (age 51). Where would a guy like me be without screening. Granted, I asked for the test to be done myself. But what of the guys who don’t know, don’t ask, don’t get diagnosed, and end up with non-organ confined disease, and metastasis. Isn’t it worth saving men’s lives by screening and watching the rate of increase in the PSA?
Thanks again for all you do for us.
I hear too many stories like yours. Guess that is one reason I am doing this blog. We all need to keep talking, the way your friend did for you. I hope that things are going better for you now. You sound like an empowered patient. That will go a long way to help you along your journey.
Ralph, you refer to “the high percentage of treatment failure reported in the treatment of PCa” and yet ACS even presents of statistics of 100% survival for 5 year for local/regional cases PCa (90% of all PCa cases), and 33% for distant. Seldom does one find reported clinical results from the most active practitioners in the literature that exceed 70% even for the high-risk cases. Where do you get this high percentage of failures, and what is that percentage?
BTW, Etzioni is a statistician, highly regarded (and often used by) Dr. Ian Thompson who himself has published several cautionary articles on PSA screening. She’s a bean counter and seems to approach her analysis with a preconceived position and then gets numbers to support the position, IMO.
Kathy, your Etzioni quote does NOT appear in the memo for which you provided the link:(Prostate Cancer Therapy Linked to Increased Risk of Heart Disease Death – http://jnci.oxfordjournals.org/cgi/content/full/99/20/1497-a?etoc ).
The link to the abstract does lead to Etzioni’s article:
Is Prostate-Specific Antigen Velocity Useful in Early Detection of Prostate Cancer? A Critical Appraisal of the Evidence
However, all that is there is one generalized opinion after another:
“We review recent studies of PSAV and determine a set of statistical considerations that we believe to be critical in study evaluation and interpretation. We explain why the association between PSAV and disease-specific survival does not necessarily imply that PSAV will be a useful screening tool. In addition, we argue that the standard concept of PSAV—the absolute change in PSA per year—confuses disease aggressiveness with the interval from disease onset to detection.”
Hardly anything here to sink one’s teeth in, or even understand the basis of her position.
You ask for feedback, Kathy, and here is mine:
Perhaps if you gave the actual titles of the articles you quote from, as well as providing accurate links, a productive dialogue might be possible.