Never happier than when holding a baby.
The March 20, 2012 NCI Bulletin contains a short article that, in my mind, further muddies the waters insofar as prostate cancer is concerned. The question muddied is as follows: should clinicians (your primary care physician and/or urologist) routinely use PSA to screen for prostate cancer in low-risk men?
PSA stands for prostate-specific antigen. For you biochemistry freaks this is a glycoprotein, called kallikrein-3, and is coded for by the KLK3 gene. It plays several roles in reproduction. It tends to be markedly elevated in the blood of men with some (most?) kinds of prostate cancer. Heretofore many “clinicians” have ordered PSA analyses as part of routine physical exams. Now, however, that practice has been called into question.
Apparently there have been two huge studies of the efficacy of PSA as a weapon against prostate cancer. The earlier was conducted under the auspices of the NCI and involved 77,000 men who (so far) have been followed for at least seven years. In this study (the PLCO study) there was no statistically verifiable difference between the death rate of screened and unscreened participants. However, there were enough “false positives” to generate needless medical activity, some of it uncomfortable and all of it expensive. This moved the United States Preventative Services Task Force (what this is I haven’t a clue) to issue a dire warning, the gist of which was – don’t use PSA for routine screening of low-risk men. My urologist thinks this is baloney.
Now along come results from an even bigger trial, the ERSPC (European Randomized Study of Screening for Prostate Cancer). This study had about 182,000 participants, who were followed (to date) for eleven years. The most significant result of this study was that there was a 21% reduction in prostate cancer deaths in the group that had their PSA checked regularly (as compared to the group who did not.) However, regular PSA measurement did (as in the PLCO trial) result in a lot of “overdiagnosis”; that is, about half the cancers detected by PSA screening would never have been fatal. So, presumably, PSA in this group saved a lot of lives, but caused an equal number of people time, discomfort and expense – not to mention scaring the hell out of them!
So what is an old man with an enlarged prostate to do? I’m absolutely not recommending anything, but I know I will damned well continue getting my PSA checked. Chance of avoiding premature death is worth a good deal of discomfort – and, of course, under Obamacare it will be FREE!
The latest edition of the Fred Hutch Newsletter (email) had an article on prostate cancer that, if I had been its author I would have headlined something like “OOPS! TOO LATE” The article reports results of research involving about 3400 men, about half of whom had been circumcised before their first sexual “encounter” – whereas, obviously, the other half hadn’t. The circumcised group had 15% fewer prostate cancers.
ReplyDeleteIt seems that some prostate cancers are caused by the consequences of sexually-transmitted disease or infection. To quote from the article:
Sexually transmitted infections may lead to prostate cancer by causing chronic inflammation that creates a hospitable environment for cancer cells. Other mechanisms may also be involved. Circumcision may protect against sexually transmitted infections, and therefore prostate cancer, by toughening the inner foreskin and by getting rid of the moist space under the foreskin that may help pathogens survive.
The reason for the “Oops” obviously is that this information comes too late – in many cases, way too late - to do most men reading this Comment any good. It (the research) may help young parents to make their decision as to whether circumcision is a good idea. I understand this is questioned by some.
The article appeared in the journal Cancer and was written by Dr. Jonathan Wright.
4/30/12
ReplyDeleteCleaning house does not keep me excited, so now and then I look for something to read. I am running out of reading material, but also I am running out of time to get this place (my Borrego Springs condo) properly mucked out – I leave in a few days. Under a pile of pillows in the corner (I tossed them there when I arrived a month ago) I found “Quest”, a publication of the Fred Hutchinson Cancer Research Center. On the first page was a little squib about a research project lead by Dr. Daniel Lin of U.W. and the Hutch, assisted by people from a half-dozen other institutions. They are attempting to identify urine-based biomarkers that will differentiate aggressive cancers from cancers referred to as “indolent“. (Funny name. I visualize a teen-aged cancer sitting around playing video games while its mother takes out the trash.) Anyway, it is certainly true that many men adopt the practice of “watchful waiting” in lieu of surgery and/or radiation. If this project pays off – and they say they are optimistic - watchful waiting could become a whole lot more feasible. Stay tuned.
Will wonders never cease? I have figured out how to deal with the tiny print used for articles in the NCI Cancer Bulletin. First, I run the cursor down the length of the article I want to read, simultaneously depressing a magic key that makes everything turn blue. Then I press CTRL + C, which I take to be the command “Copy”. Next I get up a blank Word page (I have known how to do this for some time.) Then I press CTRL-V, which I take to be the command “Vomit”. Whatever it actually means, the copied text is vomited onto the page. Finally, I repeat step one, turning the text blue, then change the size of the characters using a drop-down menu (see, I can use computer terms) at the top of the page. Magically, the text becomes large enough so that I can read it. As I said, will wonders never cease?
ReplyDeleteSo, anyway, the latest NCI Cancer Bulletin has several stories which I will comment on as time allows. (I am on my way home from Borrego, drinking cheap wine in an expensive motel room as I write.) Tonight I want to analyze the article on prostate cancer. (Why do I keep returning to prostate cancer, when my focus is supposed to be ovarian cancer? Maybe because I have one? Or maybe because the editors of the NCICB are men, and they have them, too, and so lots of prostate cancer articles appear. Who knows?). Anyway. . . . .
To quote directly from the article:
Rates of self-reported prostate-specific antigen (PSA) screening for prostate cancer in men aged 75 or older did not change between 2005 and 2010, despite recommendations against routine prostate cancer screening in men of this age group issued by the U.S. Preventive Services Task Force (USPTF) in 2008. The findings, based on data from the Cancer Control supplements of the 2005 and 2010 U.S. National Health Interview Survey (NHIS), were reported in the April 25 issue of JAMA.
I guess the best comment here is….Duh?
Does USPTF really believe that, once you reach 75 you cease to worry about death and, more specifically, death from cancer? Hell, death is imminent and you think about it more than when you were young ! If PSA tests will help diagnose prostate cancer then of course we old duffers will want them. Demand them, even. And if you don’t get a PSA, then die of prostate cancer – there are legions of young, hungry layers poised to extract financial retribution from your urologist or primary care physician. These guys use PSA tests as a diagnostic tool – but also as a CYA maneuver. It’s human nature. Get real, USPTF!
Me, again. In the May 24th issue of the Wall Street Journal there is a marvelous commentary on the USPTF recommendations cited in the last Comment. The author, Tom Perkins, is 80 years old and suffers from a particularly aggressive form of prostate cancer. The cancer was discovered by PSA, and efforts to contain it - successful for "a few years"- are monitored by PSA. Perkins is pretty funny in his scathing disregard for the USPTF. His conclusions may not be totally valid (I tend to agree with him), but they are valuable and, moreover, fun to read. Maybe you can get his piece on-line. I'd repeat it here but I'd probably be violating some copyright law or other.
ReplyDeleteThe NCI Cancer Bulletin for August 7, 2012 contains several articles of interest, including one that represents another skirmish in the Prostate Cancer Wars, being fought (more-or-less politely) between the USPSTF (that’s the U.S. Preventative Services Task Force) and the combined might of American urologists, represented by the American Urological Association. The title of the article is “U.S. Prostate Cancer Incidence Falls after Change in Screening Recommendations”. This suggests that the USPSTF has the remarkable (and scientific inexplicable) ability to effect the rate at which cancer develops merely by presenting an omni-potent verbal manifesto. Further study of the article shows that what actually has fallen is the rate at which early stage prostate cancers are detected in old duffers my age. This is because – duh – the USPSTF recommends that urologists not screen men over 75 using the PSA antigen. What has fallen, then, is the rate of detection of early-stage prostate cancer in old guys relative to the rate of detection of all prostate cancers in younger men (who are screened using PSA), and to advanced-stage cancers in men over 75 (who presumably manifest their cancers by dying). The USPSTF seems to regard this as a triumph. I guess it is, if you are interested primarily in lowering the cost of health care nationwide. But if I find I have advanced prostate cancer after not having my PSA checked, I am going to have a hard time participating in the jubilation.
ReplyDeleteSee blog for 4/2/14. The war continues.
ReplyDeleteMore on this subject:
ReplyDeletehttp://ljb-quiltcutie.blogspot.com/2015/11/olaparib-not-wonder-drug-but-it-helps.html
This article makes the claim that prostate cancer is neglected (in terms of funding for research) relative to such female-specific cancers as OVCA and BRCA. My guess is that this is true but has a simple explanation: PRCA is an old man’s disease, and often slow-acting. The prevailing philosophy here may be, “Well, you’ve got to die of something.”
ReplyDeletehttp://www.advocate.com/commentary/2017/5/31/cancer-killing-men-wheres-research