Please check out the new $1.00 test under the Experimental Drugs for advanced Prostate Cancer.

The U .S. Preventive Services Task Force has made the recommendation to stop using the PSA, here are some of the many stories that have been posted on the internet for you to read and then you can decide if you should have a PSA or not for yourself.  This is too important for us to just ignore, please read them all and let your voice be heard.

For everyone’s information here is a list of the 16 Current members of U.S. Preventive Services Task Force, just in case you want to contact them.

The USPSTF comprises primary care clinicians (e.g., internists, pediatricians, family physicians, gynecologists/obstetricians, and nurses). Individual members' interests include: decision modeling and evaluation; effectiveness in clinical preventive medicine; clinical epidemiology; the prevention of high-risk behaviors in adolescents; geriatrics; and the prevention of disability in the elderly.

Current members of the Task Force are listed below. They have recognized expertise in prevention, evidence-based medicine, and primary care.

Virginia A. Moyer, M.D., M.P.H. (Chair)
Professor, Pediatrics 
Baylor College of Medicine, Houston, TX 
Chief, Academic Medicine Service, Texas Children's Hospital

Michael L. LeFevre, M.D., M.S.P.H. (Co-Vice Chair)
Professor, Department of Family and Community Medicine
University of Missouri School of Medicine, Columbia, MO

Albert L. Siu, M.D., M.S.P.H. (Co-Vice Chair) 
Professor, Geriatrics and Palliative Medicine
Mount Sinai School of Medicine, New YorkNY

Kirsten Bibbins-Domingo, Ph.D., M.D.
Associate Professor, Medicine, Epidemiology, and Biostatistics 
University of California, San Francisco, CA 
Co-director, UCSF Center for Vulnerable Populations 
San Francisco General Hospital

Adelita Gonzales Cantu, Ph.D., R.N.
Assistant Professor, Family and Community Health Systems
University of Texas Health Science Center, San AntonioTX

Susan J. Curry, Ph.D.
Dean, College of Public Health
Distinguished Professor, Health Management and 
Policy
University of IowaIowa CityIA

Glenn Flores, M.D.
Professor, Pediatrics and Public Health
University of Texas Southwestern, Dallas, TX
Director, Division of General Pediatrics
UT Southwestern Medical Center and Children's Medical Center of Dallas

David C. Grossman, M.D., M.P.H.
Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative
Professor of Health Services and Adjunct Professor of 
Pediatrics
University of Washington, SeattleWA

George J. Isham, M.D., M.S.
Medical Director and Chief Health Officer
HealthPartners, MinneapolisMN

Rosanne M. Leipzig, M.D., Ph.D
Professor, Geriatrics and Adult Development, Medicine, Health Policy
Mount Sinai School of Medicine, New York, NY

Joy Melnikow, M.D., M.P.H.
Professor, Department of Family and Community Medicine
Director, Center for Healthcare Policy and Research
University of California Davis, Sacramento, CA

Bernadette Melnyk, Ph.D., R.N., C.P.N.P./P.M.H.N.P.
Associate Vice President for Health Promotion, Chief Wellness Officer, and Dean
College of 
Nursing 
Ohio State University, ColumbusOH

Wanda K. Nicholson, M.D., M.P.H., M.B.A.
Associate Professor, Obstetrics and Gynecology
Director, Diabetes and Obesity Core Center for Women's Health Research
University of North Carolina School of Medicine, Chapel Hill, NC

Carolina Reyes, M.D., M.P.H.
Medical Director, Maternal and Fetal Medicine
Virginia Hospital Center, ArlingtonVA

J. Sanford (Sandy) Schwartz, M.D., M.B.A.
Leon Hess Professor of Medicine, Health Management, and Economics
University of Pennsylvania School of Medicine and Wharton School, Philadelphia, PA

Timothy J. Wilt, M.D., M.P.H.
Professor,Department of Medicine, Minneapolis VA Medical Center
University of MinnesotaMinneapolisMN

Current as of September 2011

Healthy men shouldn't get prostate test, panel says

Healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives overall and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.

By GARDINER HARRIS

The New York Times

Healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives overall and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.

The draft recommendation by the U.S. Preventive Services Task Force, due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older.

There are 44 million such men in the United States, and 33 million of them have already had a prostate-specific antigen, or PSA, test — sometimes without their knowledge — during routine physicals. The task force's recommendations are followed by most medical groups.

Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, triggering controversy. The recommendation to avoid the PSA test is even more forceful and applies to healthy men of all ages.

"Unfortunately, the evidence now shows that this test does not save men's lives," said Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. "This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does."

Prostate cancer strikes more than 218,000 U.S. men each year. About 28,000 die of it, making it the most common cancer and second-leading cancer killer among men, behind lung cancer.

Advocates for those with prostate cancer promised to fight the recommendation. Baseball's Joe Torre, financier Michael Milken and Rudolph Giuliani, former New York City mayor, are among tens of thousands of men who believe a PSA test saved their lives.

The task force can also expect resistance from some drug makers and doctors. Treating men with high PSA levels has become a lucrative business. Some in Congress have criticized previous decisions by the task force as akin to rationing, although the task force does not consider cost in its recommendations.

"We're disappointed," said Thomas Kirk, of Us TOO, the nation's largest advocacy group for prostate-cancer survivors. "The bottom line is that this is the best test we have, and the answer can't be, 'Don't get tested.' "

But that is exactly what the task force is recommending. There is no evidence that a digital rectal exam or ultrasound is effective, either. "There are no reliable signs or symptoms of prostate cancer," said Dr. Timothy Wilt, a member of the task force and a professor of medicine at the University of Minnesota. Frequency and urgency of urinating are poor indicators of disease, because the cause is often benign.

Slow-growing cancer

The 16-member independent task force is organized by the Health and Human Services Department to regularly assess preventive medical care. Its recommendations have a widespread impact, especially on what services Medicare and private insurers pay for. The group's influence was enhanced by the new federal health-care law, which will base some of its requirements for coverage on the group's ratings.

The PSA test, routinely given to men 50 and older, measures a protein — prostate-specific antigen — that is released by prostate cells, and there is little doubt that it helps identify the presence of cancerous cells in the prostate. But a vast majority of men with such cells never suffer ill effects because their cancer is usually slow-growing. Even for men with fast-growing cancer, the PSA test may not save them, because there is no proven benefit to earlier treatment of such invasive disease.

As the PSA test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, 1 million men received surgery, radiation therapy or both who would not have been treated without a PSA test, according to the task force.

Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both. As a result of these complications, the man who developed the test, Dr. Richard Ablin, has called its widespread use a "public-health disaster."

Not knowing what is going on with one's prostate may be the best course, because few men live happily with the knowledge that one of their organs is cancerous. Autopsy studies show that a third of men ages 40 to 60 have prostate cancer, a share that grows to three-fourths after age 85.

PSA testing is most common in men older than 70, and it is in that group that it is the most dangerous, because such men usually have cancerous prostate cells but benefit the least from surgery and radiation. Some doctors treat patients who have high PSA levels with drugs that block male hormones, although there is no convincing evidence that these drugs are helpful in localized prostate cancer. They often result in impotence, breast enlargement and hot flashes.

Of the trials conducted to assess the value of PSA testing, the two largest were in Europe and the United States. Both "demonstrate that if any benefit does exist, it is very small after 10 years," according to the task force's draft recommendation statement.

The trial in Europe had 182,000 men from seven countries who either got PSA testing or did not. When measured across all of the men in the study, PSA testing did not cut death rates in nine years of follow-up. But in men ages 55 to 69, there was a very slight improvement in mortality. The U.S. trial, with 76,693 men, found PSA testing did not cut death rates after 10 years.

'Screening saves lives'

Dr. Eric Klein of the Cleveland Clinic, an expert in prostate cancer, said he disagreed with the task force's recommendations. Citing the European trial, he said, "I think there's a substantial amount of evidence from randomized clinical trials that show that among younger men, under 65, screening saves lives."

Other experts agreed with Klein.

Brantley Thrasher, of the University of Kansas Medical Center, said, "It appears to me that screening is accomplishing just what we would like to see: diagnose and treat the disease while it is still confined to the prostate and, as such, still curable."

Otis Brawley, chief medical officer at the American Cancer Society, would not comment on the recommendations but said: "I have long been concerned,that some supporters of prostate-cancer screening have overstated, exaggerated and, in some cases, misled men about the evidence supporting its effectiveness."

The task force's recommendation applies only to healthy men without symptoms. The group did not consider whether the test is appropriate in men who already have suspicious symptoms or those who have already been treated for the disease. The recommendations will be open to public comment next week before they are finalized.

Dr. Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence in Britain, said he was given a PSA test several years ago without his knowledge. He then had a biopsy, which was negative. But if cancer had been detected, he would have faced an awful choice, he said: "Would I want to have it removed, or would I have gone for watchful waiting with all the anxieties of that?" He said he no longer gets the test.

But Dan Zenka, a spokesman for the Prostate Cancer Foundation, said a high PSA test result led him to have his prostate removed, a procedure that led to the discovery that cancer had spread to his lymph nodes.

His organization supports widespread PSA testing. "I can tell you it saved my life," he said.

Material from The Washington Post is included in this report.

 

FOR IMMEDIATE RELEASE: October 07, 2011

Contact:
Wendy Waldsachs Isett, AUA

410-689-3789, wisett@AUAnet.org

AUA RESPONDS TO NEW RECOMMENDATIONS ON PROSTATE CANCER SCREENING

Association urges men to speak with their physicians about the value of prostate cancer testing

LINTHICUM, MD, October 7, 2011–The American Urological Association (AUA) today released the following statement in response to the U.S. Preventive Services Task Force draft recommendations on the use of the prostate-specific antigen (PSA) test. The statement is attributed to AUA President Sushil S. Lacy, MD:
The American Urological Association (AUA) applauds the U.S. Preventive Services Task Force for its interest in reviewing the use of the prostate-specific antigen (PSA) test. However, we are concerned that the Task Force’s recommendations will ultimately do more harm than good to the many men at risk for prostate cancer both here in the United States and around the world. The AUA’s current clinical recommendations support the use of the PSA test, and it is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients.
Not all prostate cancers require active treatment and not all prostate cancers are life threatening. The decision to proceed to active treatment is one that men should discuss in detail with their urologists to determine whether active treatment is necessary, or whether surveillance may be an option for their prostate cancer.
The AUA is currently preparing a new clinical guideline on this topic, and has convened a panel of experts to review not only the use of the PSA test, but also early detection of prostate cancer overall, taking into account the new tests and diagnostics that are becoming available. Until there is a better widespread test for this potentially devastating disease, the USPSTF – by disparaging the test – is doing a great disservice to the men worldwide who may benefit from the PSA test.

For more information about the AUA’s position on the early detection of prostate cancer, or to arrange an interview with an expert urologist, please contact the AUA Communications Office at 410-689-3932.

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 18,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.

 

Why block a cancer test that saves lives?

By Michael Milken,

Forty years ago, my mother-in-law learned from a mammogram at age 57 that she had breast cancer. We immediately sought the best available treatment. She lived for many happy years and enjoyed precious time with her grandchildren. Would she have died sooner without the mammogram? I don’t know. But here’s what I do know from four decades of working to accelerate progress against all life-threatening diseases: No screening test is perfect; well-informed patients consulting with their doctors are better equipped than a government agency to make decisions about their health; there are options other than screening everyone or screening no one; and finally, there’s no comfort in ignorance.

The U.S. Preventive Services Task Force (USPSTF), a panel supported by a congressional mandate, now recommends that healthy men not receive prostate-specific antigen (PSA) tests, which measure a protein in the blood produced by prostate tissue. I agree that the current PSA test is inexact and, in many cases, leads to overtreatment that can have terrible side effects such as incontinence and impotence. However, Foundation has led to the development of several new molecular markers that could soon complement or even replace the PSA test. These new tests, now in clinical trials pending approval from the Food and Drug Administration, should greatly improve diagnosis and treatment of prostate cancer. In the meantime, the USPSTF recommendation is a disservice to the majority of men. While it would eliminate some short-term health-care costs, long-term costs of treating metastatic disease would be higher. And some men will die. A recent European study showed that testing reduced deaths significantly among men ages 55 to 69. These relatively younger patients are the ones the recent recommendation would most likely exclude from testing because they more often appear to be healthy.

The PSA test doesn’t diagnose prostate cancer. But it can raise a red flag calling for a doctor-patient dialogue on medical options, risks, benefits and costs. We need to make better use of it, not ban it, and, as the American Cancer Society recommends, better inform patients of overtreatment risks.

When we founded the Prostate Cancer Foundation nearly two decades ago, more than 40,000 U.S. men died annually from the disease. That toll was expected to rise sharply as population grew and baby boomers aged. Instead, deaths have dropped closer to 34,000. What happened? For one thing, we’ve supported research that has produced more effective therapies. But also, through media, advocacy events and congressional testimony, we have delivered the message that men should talk to their doctors about a PSA test. And that loved ones should give the same message to the men in their lives.

There’s no precise way to know how many lives were saved by increased awareness that led to testing and how many by improved treatment. But experienced urologists tell me that before PSA tests, the vast majority of patients’ prostate cancer had already metastasized by diagnosis. Today, only about 20 percent of these diagnosed cancers have spread outside the prostate, partly because PSA tests provide early warning. We shouldn’t turn the clock back to the pre-PSA days.

The USPSTF recommendation could produce a cruel form of rationing in which the well-off and well-informed would get PSA tests while many of the poor wouldn’t. That could disproportionately affect African Americans, who have higher prostate cancer risk and death rates.

The argument against testing reflects the same false economy seen throughout America’s health system. Spending on care skyrockets while funding for screening, prevention and research drops. Out of each health-related dollar Americans spend, research by the National Institutes of Health represents little more than a penny; and the medical research programs of private industry, universities and governments together total just over a nickel.

Congress should consider research and funding for prevention an investment, not an expense. The Milken Institute estimates that America’s gross domestic product will be $5.7 trillion lower by mid-century if we don’t contain the containable consequences of chronic diseases. We can save trillions — more than enough to balance the federal budget — by losing weight, exercising, avoiding tobacco, using seat belts and getting regular tests such as PSAs, colonoscopies and mammograms.

The Prostate Cancer Foundation agrees with the American Urological Association that PSA screening provides important information for men and their doctors. In 1993, I was one of those “healthy” men the task force says should not be tested. At least I seemed healthy and felt fine. But I’d recently lost a friend to prostate cancer, so I asked for the test. The result was a reading six times the upper limit of normal. If I’d been kept in the dark by a federal task force, I might not have been here to write this.

Michael Milken is chairman of the Prostate Cancer Foundation and of FasterCures, a Washington-based center of the Milken Institute focused on all serious diseases.

 

From: Merel Grey Nissenberg [mailto:mgrey@ucsd.edu]
Sent: Saturday, October 08, 2011 9:53 AM
To:
'moyer@bcm.edu'
Subject: PSA - Misinterpretation

Dr. Moyer – Surely you’re not serious in leading the USPSTF Panel to suggest that only when there are urologic symptoms is it time (and permissible) to obtain a PSA on a patient! While I realize that you treat children in your practice, not men with prostate cancer, you must or should know that by the time a man has symptomatic prostate cancer, the disease is advanced and without hope of cure. I find it irresponsible to suggest that symptomatology is the threshold for performing the test. I am a woman professional and also President of the National Alliance of State Prostate Cancer Coalitions (NASPCC.org). In my work in the field of prostate cancer I am apparently more familiar with the disease than the epidemiologists, family practice and other physicians on the panel, none of whom treats prostate cancer. Additionally, even though the Task Force notes the crossover and contamination of PLCO, as well as its reliance on outmoded treatment modalities, it chooses to base its proposed Recommendations partly on those premature and inconclusive results, while ignoring ERSPC and the Goteborg studies that showed clear survival benefits to PSA testing. So perhaps the Task Force is also unable or unwilling to correctly interpret the data.

Please understand the basics of prostate cancer before taking a stance that will prevent men who may have potentially lethal prostate cancer from receiving a timely diagnosis allowing curative treatment. Until better biomarkers are approved by the FDA, at least the PSA gives men a fighting chance. If they have insignificant disease, they can choose Active Surveillance. If they have aggressive or potentially lethal disease, they can choose treatment. But it should be their choice, which the Task Force would apparently like to strip from them.

Ms. Merel Grey Nissenberg, Esq., President, NASPCC  

New prostate cancer test advice overturns dogma

WASHINGTON -- Men finally may be getting a clearer message about undergoing PSA screening for prostate cancer: Don't do it.

They may not listen. After all, the vast majority of men over 50 already get tested.

The idea that finding cancer early can harm instead of help is a hard one to understand. But it's at the heart of a government panel's draft recommendation that those PSA blood tests should no longer be part of routine screening for healthy men.

The U.S. Preventive Services Task Force examined all the evidence and found little if any reduction in deaths from routine PSA screening. But it did conclude that too many men are diagnosed with tumors that never would have killed them and suffer serious side effects from resulting treatment.

That recommendation isn't final -- it's a draft open for public comment. But it goes a step further than several major cancer groups including the American Cancer Society, which urges that men be told the pros and cons and decide for themselves.

The new advice is sure to be hugely controversial. Already some doctors are rejecting it.

"We all agree that we've got to do a better job of figuring out who would benefit from PSA screening. But a blanket statement of just doing away with it altogether ... seems over-aggressive and irresponsible," said Dr. Scott Eggener, a prostate cancer specialist at the University of Chicago.

In the exam room, explaining the flaws in PSA testing has long been difficult.

"Men have been confused about this for a very long time, not just men patients but men doctors," said Dr. Yul Ejnes, a Cranston, R.I., internal medicine specialist who chairs the American College of Physicians' board of regents.

He turned down his own physician's offer of a PSA test after personally reviewing the research.

"There's this dogma ... that early detection saves lives. It's not necessarily true for all cancers," Ejnes said.

That's an emotional shift, as the American Cancer Society's Dr. Len Lichtenfeld voiced on his blog on Friday.

"We have invested over 20 years of belief that PSA testing works. ... And here we are all of these years later, and we don't know for sure," Lichtenfeld wrote. "We have been poked and probed, we have been operated on by doctors and robots, we have been radiated with fancy machines, we have spent literally billions of dollars. And what do we have? A mess of false hope?"

Too much PSA, or prostate-specific antigen, in the blood only sometimes signals prostate cancer is brewing. It also can mean a benign enlarged prostate or an infection. In fact, most men who undergo a biopsy for an abnormal PSA test don't turn out to have prostate cancer.

Screening often detects small tumors that will prove too slow-growing to be deadly -- by one estimate, in 2 of every 5 men whose cancer is caught through a PSA test. But there's no way to tell in advance who needs treatment.

"If we had a test that could distinguish between a cancer that was going to be aggressive and a cancer that was not, that would be fabulous," said Dr. Virginia Moyer of the Baylor College of Medicine, who chairs the task force, an independent expert group that reviews medical evidence for the government.

About 1 in 6 U.S. men will be diagnosed with prostate cancer at some point in their life. Yet the cancer society notes that in Western European countries where screening isn't common, 1 in 10 men are diagnosed and the risk of death in both places is the same. In the U.S., about 217,000 men are diagnosed with prostate cancer each year, and 32,000 die.

Why not screen in case there's a mortality benefit that studies have yet to tease out? The task force outlined the problem with that:

--Up to 5 in every 1,000 men die within a month of prostate cancer surgery, and between 10 and 70 more suffer serious complications.

--At least 200 to 300 of every 1,000 men treated with surgery or radiation suffer incontinence or impotence.

--Overall, Moyer said 30 percent of men who are treated for PSA-discovered prostate cancer suffer significant side effects from the resulting treatment.

Among the questions sure to be raised during the public comment period are how doctors should advise men with prostate cancer in the family or black men, who are at increased risk.

PSA testing also is used to examine men with prostate symptoms, and to check men who already have had prostate cancer. The new recommendation doesn't affect those uses.

Congress requires that Medicare cover PSA tests, at a cost of $41 million in 2009. Other insurers follow Medicare's lead, especially in light of conflicting recommendations.

Nor does the new recommendation mean that men who want a PSA test can't have one. If the rule is adopted -- something the government will review once the task force hears comments and finalizes its guidance -- it would just advise against doctors pushing it routinely.

"The truth is that like so many things in medicine, there's no one-size-fits-all," said Dr. Michael Barry of Massachusetts General Hospital who heads the Foundation for Informed Medical Decision-Making that backs ways to help patients make their own choices.



U.S. Panel Says No to Prostate Screening for Healthy Men

NEW YORK, NY, Oct 07, 2011 (MARKETWIRE via COMTEX) -- "Today, it feels we are taking a huge medical leap backward," says Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center. Dr. Samadi's comment comes on the heels of front page news in the New York Times that the U.S. Preventative Services Task Force (USPSTF) intends to release official guidelines next week against the use of the PSA blood test for healthy men of any age. "For many urologists and prostate cancer treatment experts worldwide, it's shocking," says Dr. Samadi. "We've worked tirelessly to teach men how important this test is." The PSA, prostate-specific antigen test, is currently recommended on an annual basis for men beginning at age 50; for high-risk men, African Americans or those with a family history, its age 40. "The test is our single best tool for detecting prostate cancer," stresses Dr. Samadi. "It is not perfect, but without it we have nothing. There is significant evidence that early prostate cancer detection and treatment saves lives, particularly in younger men." Dr. Samadi also believes that the PSA velocity, the trend of a man's PSA level over the years is the best tool for evaluating the cause of PSA level spikes.

The USPSTF is basing its recommendation on five clinical trials, stating that PSA screening does not save lives and leads to further testing and treatments resulting in negative side effects such as impotence and incontinence. These trials, however, are not without controversy. The Prostate, Lung, Colorectal, and Ovarian screening trial, a large American based study, failed to demonstrate a significant benefit in reducing prostate cancer mortality. This study's results were published prematurely without the sufficient follow up needed to demonstrate a benefit. Furthermore, over 50% of participants in the control group were screened during the study period, most likely obscuring differences between the study groups. A similar study was conducted in Europe, which followed over 200,000 men for a longer period. The European study observed a 20% reduction in prostate specific deaths in the screening group compared to the control. While the panel's recommendation will not immediately impact insurance or Medicare coverage of the test, it could in the future.

The panel appears to be in agreement with the test's success in detecting prostate cancer, but believes that information is useless without distinguishing between slow-growing, benign cancer and more advanced prostate cancer. Dr. Samadi thinks they're creating a dangerous proposition for healthy men. "Prostate cancer is a mostly asymptomatic disease. If we tell men not to get screened we're essentially saying, 'Yes, you may very well get prostate cancer and, yes, it might become painfully metastatic, but wouldn't it just be easier not knowing?' I doubt many men would go for such an offer," he says.  As a robotic prostatectomy expert, Dr. Samadi specializes in robotic-assisted removal of cancerous prostates. "To use treatment side effects as justification for not testing is illogical," Dr. Samadi says. "Sexual potency and urinary control are not guaranteed victims of prostate cancer treatment." Through robotic surgery, Dr. Samadi is able to take advantage of greatly enhanced vision and dissection precision that allows him to spare the nerve bundles that control these two important functions. For some men, the recovery period involves short-term sexual and urinary issues, but with early detection robotic surgery can cure men of their prostate cancer. For Dr. Samadi's patients that cure rate is 97 percent.  Dr. Samadi's position is supported by the American Urological Association, which released a statement today against the panel's impending recommendation, using phrases such as "great disservice" and "more harm than good." The USPSTF is the same group that caused a great stir two years ago by recommending that women under 50 not undergo annual mammograms.  "More than 32,000 U.S. men died from prostate cancer last year.  Without this test, we rob men of their window for a cure and that number will surely increase," cautions Dr. Samadi. More can be seen from prostate cancer expert, Dr. Samadi, on youtube.com/roboticoncology.

SOURCE: RoboticOncology.com   

Task Force Panel Will Urge Men To

Skip Prostate Screening, Reports Say

Oct 07, 2011

The U.S. Preventive Services Task Force is scheduled to issue this recommendation on Tuesday, but advance press reports indicate the expert panel will urge the federal government to change its current position to recommend that men under age 75 forgo this widely used test.

The New York Times: U.S. Panel Says No To Prostate Screening For Healthy Men
Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided (Harris, 10/6).

Los Angeles Times: Key Panel Will Urge Men To Skip Prostate Screening, Reports Say The task force, which sets disease prevention policies for the federal government, is scheduled to issue its new recommendations Tuesday, according to the Santa Monica-based Prostate Cancer Foundation. But the New York Times and a weekly newsletter known as the Cancer Letter reported Thursday that the task force would change its position on the widely used PSA test to recommend that men under age 75 forgo it (Roan and Brown, 10/6).

The Washington Post: Healthy Men Don't Need PSA Testing For Prostate Cancer, Panel Says Most men should not routinely get a widely used blood test to check for prostate cancer because the exam does not save lives and leads to too much unnecessary anxiety, surgery and complications, a federal task force has concluded. The U.S. Preventive Services Task Force, which triggered a firestorm of controversy in 2009 when it raised questions about routine mammography for breast cancer, will propose downgrading its recommendations for prostate-specific antigen (PSA) for prostate cancer on Tuesday, wading into what is perhaps the most contentious and important issue in men's health (Stein, 10/6).

The Wall Street Journal: Panel Faults Widely Used Prostate-Cancer Test
The U.S. Preventive Services Task Force will recommend a "D" rating for prostate specific antigen, or PSA, testing, said a person familiar with the draft document. A "D" rating means "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits," according to the group's website. It also is a recommendation to "discourage use" of test or treatment. The task force is set to make its proposal Tuesday, and then allow for a four-week comment period before issuing a final recommendation (Dooren and Burton, 10/7).

The Associated Press: Panel Advises Against Prostate Cancer Screening
No major medical group recommends routine PSA blood tests to check men for prostate cancer, and now a government panel is saying they do more harm than good and healthy men should no longer receive the tests as part of routine cancer screening. The panel's guidelines had long advised men over 75 to forgo the tests and the new recommendation extends that do-not-screen advice to healthy men of all ages. The recommendation by the U.S. Preventive Services Task Force, being made public on Friday, will not come as a surprise to cancer specialists (Neergaard, 10/7).

Bloomberg: Routine Prostate-Cancer Screening Should End Due To Risks, U.S. Panel Says
Prostate-cancer screening doesn't save enough lives to justify exposing men to risks of death, incontinence and impotence, a U.S. panel will say today in a report that sparked immediate criticism from patient advocates. The draft recommendations from the Health and Human Services Department’s Preventive Services Task Force may prompt insurers to stop paying for tests measuring PSA, a protein associated with prostate cancer at high levels. The panel will give the public four weeks to comment (Peterson and Fay Cortez, 10/6).

CBS: Common Prostate Cancer Test Seen As Unreliable
Almost 241,000 cases of prostate cancer and almost 34,000 resulting deaths are expected this year. Every year, thousands of Americans receive screening with a blood test called PSA in the hopes of detecting and treating prostate cancer early. But the test has come under fire in recent years, and next week a government task force is expected to make a startling announcement: men should not receive routine PSA screening. The PSA blood test has become more and more controversial over the past decade because it is notoriously poor at identifying cancer. The problem is that PSA can rise from causes other than cancer, such as infections and an enlarged prostate. And even when cancer is found, it may be growing so slowly that it never would have caused a problem (LaPook, 10/6).
 

Prostate Cancer, Statistics, and Psychology

Posted by Dr. Suzanne Koven October 7, 2011 08:27 AM

•"If you're the one who has a disease, then the chance of getting it is 100%"

This wry but true old observation about how we, as individuals, perceive statistics comes to mind whenever a new recommendation based on studies of thousands of patients is released. Next week, the United States Preventive Services Task Force will officially announce that it does not advise routine use of the prostate specific antigen (PSA) blood test to screen for prostate cancer.

The USPSTF's announcement will be seen by many as an example of medical progress; the use of research to spare men unnecessary testing and treatment with their accompanying side effects and costs. Many men, and their doctors, though, will react with a sense of uneasiness.

Why is it that new recommendations such as the one about PSA make us anxious?
A few thoughts:Trust is Challenged: Say you have a heart murmur. You've been taking antibiotics dutifully for decades before each visit to the dentist to prevent a life-threatening heart infection that can be caused when bacteria in the mouth enter the bloodstream during a dental procedure. Then, one day the
American Heart Association announces that you don't need to take the antibiotics anymore. You ask yourself how something that was necessary is, overnight, unnecessary. The doctor who prescribed all those antibiotics may wonder the same thing. If the old recommendation is now "wrong," then could the new one also be?

Everybody Knows Someone Who...Everybody knows somebody whose prostate cancer was picked up early by a PSA test. Every doctor has had that "somebody" as a patient. Doctors and patients alike worry that following a new recommendation to omit a test may cause that "somebody's" cancer to be missed. Also, our fear of a cancer diagnosis is such that we naturally focus on the diagnosis itself and not as much on the side effects of treatment or even on whether the treatment prolongs life.

It's Not About the Money (When it’s About Me): No one likes to think of himself or herself as a statistic, especially an economic statistic. When it comes to our health and the health of our families, we may not be moved by the argument of millions of dollars saved vs. the one life saved. Each of us thinks that one life is ours, and that no amount of money would be too much to save it--even for a test of questionable value.

So how will I handle the many questions I will be asked in the coming weeks by men who want to have PSA tests against the advice of the USPSTF? The way I've handled so many other announcements of new guidelines over the years regarding mammography, immunizations, estrogen replacement, and many other issues: I'll review the current recommendations, explain that they've evolved and will probably continue to evolve as more information becomes available, and acknowledge the discomfort that changing expectations can cause for patients and doctors alike. 

THE  USPSTF  DOWNGRADES  PSA   TESTING

USING  BAD  SCIENCE

By Joel

It has been in the news so I am sure that you are aware that the United States Preventive Services Task Force (USPSTF) has prepared a draft recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer.

The Task Force will be accepting comments on this draft recommendation statement beginning Tuesday, October 11, 2011, and running through November 8, 2011. It is vital that all of us as well as our family members and our friends post comments beginning this Tuesday, October 11th at this website:
http://www.uspreventiveservicestaskforce.org/tfcomment.htm

Despite the conclusions drawn by the USPSTF there is a lot of hard, scientific evidence that PSA screenings, along with digital rectal exams (DREs) do save lives. Just like mammograms which are plagued with the very same issues, PSAs save lives.

Malecare has joined with many of our friends from the other prostate cancer advocacy groups to speak with one clear voice about this issue. As a member of the Prostate Cancer Round Table, we will be issuing joint statements and calls to action to combat this misdirected policy, a policy that will cost many men their life.

Prostate cancer needs to be diagnosed early on, while it remains in the prostate gland. Once the disease leaves the gland there is NO cure. Advanced prostate cancer kills men, so our goal needs to be to stop men from developing advanced, metastatic prostate cancer.

According to an article in the New York Times, insurance companies are already reconsidering whether or not to cover PSA tests! According to the article both Aetna and Kaiser Permanente said it was unclear whether they would continue paying for the test. “We are currently reviewing the U.S. Preventive Services Task Force’s recent announcement on prostate cancer screening,” Jason Allen, a spokesman for Kaiser Permanente, said in an e-mail. “For our members who may have questions about the Task Force’s announcement, we encourage them to discuss the matter with their physicians.”

Our friends at Zero have prepared for the Round Table a number of scientifically based “talking points” that clearly demonstrate that PSA testing saves life. The talking points created by Kevin and Skip from Zero need to be repeated, again and again. The is an extract from their points: (thank you Kevin & Skip from Zero)

“ 44% decline in prostate cancer deaths
The Göteborg Randomized Population-based Prostate Cancer Screening Trial, a Swedish study partially funded by the National Cancer Institute, showed a 44 percent decline in prostate cancer deaths. This 20,000-man study was conducted during a 14-year period before PSA testing became prevalent in that country, thereby enabling the research to remain free of contamination issues such as those found in the PLCO study.

As a result of the Göteborg study, the National Cancer Institute in July 2010 acknowledged the “signification amount of contamination in the PLCO study because the men in the trial who had already undergone screening with a PSA test, which a number of researchers have said may preclude the (PLCO) trial from ever demonstrating a cancer-specific survival improvement.

Results of world’s largest randomized screening trial on prostate cancer:
The European Randomized Study of Screening for Prostate Cancer (ERSPC), which began in the 1992, involved more than 182,000 men (ages 50 to 74) in seven European countries who were followed over a 17-year period.

Four different analyses of the ERSPC data, based on an average 9 year follow-up review, show the following results due to PSA testing:

37% decline in prostate cancer deaths
By utilizing a control group of men from Northern Ireland, where PSA screening is infrequent, this research shows a 37 percent reduction in prostate cancer deaths when compared to men who were PSA tested as part of the ERSPC study. (European Journal of Cancer, Oct. 2009)

31% decline in prostate cancer deaths
This ERSPC analysis, which scrubs out data contamination issues and concentrates only on men who were actually PSA tested, shows a 31 percent reduction in prostate cancer deaths. (European Urology, July 2009)

27% decline in prostate cancer deaths

Another ERSPC analysis, also removing contaminated data, shows a 27 percent reduction in the prostate cancer death rate. (Reviews in Urology, Summer 2009)

20% decline in prostate cancer deaths
Preliminary ERSPC findings in early 2009 noted that PSA testing produced a 20 percent reduction in prostate cancer deaths. (New England Journal of Medicine, March 2009)

 

The PLCO Study – Flawed

A much smaller prostate cancer mortality study, called the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, begun in 1992 in the U.S., involved more than 76,000 men ages 55 to 74.

A 7-year follow-up review showed no decline in prostate cancer deaths.
Data contamination issues, such as (1) allowing non-PSA tested men to be counted as tested, (2) letting control group members receive the PSA test rather than remaining untreated, and (3) using a shorter follow-up review period (7 years) as compared to the ERSPC study (9 years or longer), (4) utilizing an outdated PSA level cut-off point (4.0 ng/mL) as compared to the ERSPC study (3.0 ng/mL), and (5) being unable to more accurately detect prostate cancer cases, are among the reasons given as to
 why this study failed to show any reduction in prostate cancer deaths. ( 7,8)

Another analysis of the PLCO study concluded:
“Methodologically, the European (ERSPC) study seems to be superior to the American (PLCO) study. (9)

 

 

 

 

 

 

 

 

Decline in Prostate Cancer Deaths Due to the PSA Test
Additional studies:

70% decline in prostate cancer death rate (10)
Randomized control trial of more than 46,000 men, ages 45 to 80, in Quebec from 1988 to 1996 reflected up to a 70 percent decline in prostate cancer deaths.
62% decline in prostate cancer death rate (11)
Study of 1,300 men, ages 50 to 64, in King County, Washington from 1993 to 2007 showed PSA testing led to this major decline in prostate cancer deaths.
33% decline in prostate cancer death rate (12)
University of Innsbruck, Austria study of men, ages 40 to 79, from 1996 to 1999, concluded this 33 percent decline was due to making the PSA test universally available.

17.6% decline in prostate cancer death rate (13)
In the U.S., after several decades of gradually increasing death rates reached a peak in 1993, the prostate cancer death rate declined 17.6 percent, at an annual rate of 4.4 percent between 1994 and 1997, as PSA testing became more common.
10.9% to 16.1% decline in prostate cancer death rate (14)
PSA testing cut prostate cancer deaths by 10.9 percent among African-American men beginning in 1993 and by 16.1% among white men beginning in 1992, with continuing declines through 1997 for both races.
9.6% decline in prostate cancer death rate 
(15)
In Canada, the age-standardized prostate cancer mortality rate fell 9.6 percent between 1991 to 1996 as a result of PSA testing.

Early Detection Is Key:
PSA Test Identifies Prostate Cancer Early, Before It Spreads
90% decline in advanced prostate cancer (16)
Due to PSA testing, 90 percent of all prostate cancers are caught before spreading to other areas of the body.
81.2% decline in advanced prostate cancer (17)
PSA testing is credited for the huge drop in advanced prostate cancer cases from 1997 to 2005.
75% decline in advanced prostate cancer (18)
Since the late 1980s, the PSA test has produced a 75 percent decline in advanced prostate cancer, more than for any other cancer.
* 70 to 80% decline in advanced prostate cancer (19)
Due to PSA testing, prostate cancer had not spread based on organ specimen samples.
65% decline in advanced prostate cancer (20)
Of 1,500 men with localized cancer followed between 1998 and 2002, those having regular PSA tests had a 65 percent chance of being diagnosed with a less aggressive form of cancer.
50% decline in advanced prostate cancer (21)
Rate of metastatic cancer fell more than 50 percent between 1990 to 1994 in U.S., and this is largely contributable to PSA testing.
41% decline in advanced prostate cancer (22)
Study shows that for every 25 men treated, one case of metastatic cancer will be prevented.
35% decline in advanced prostate cancer (23))
Toronto study of 700 men followed from 1999 to 2002 showed PSA testing reduced risk of metastatic prostate cancer by 35 percent.
Regular PSA testing leads to less advanced cases of prostate cancer (24,25)
Several leading studies show the PSA test reduces catches prostate cancer early, before becoming more aggressive and spreading to other areas of the body.

Prostate cancer deaths have fallen more than 40 percent since 1993, yet the American Cancer Society gives no credit to the PSA test. Even the American Cancer Society acknowledges a 40 percent decline in prostate cancer deaths since the PSA test became widely used in the mid-1990s. Rather than give credit to PSA testing, ACS says the reduction in prostate cancer deaths could be due to other factors such as diet and lifestyle.
Tell that to the thousands of men whose life has been saved by getting a PSA test.

REFERENCES:
1. “2006 Fact Book” National Cancer Institute, U.S. Dept. of Health and Human Services.
2. “Mortality results from the Göteborg Randomised Population-based Prostate Cancer Screening Trial.” The Lancet Oncology. July 1,2010. Hugosson, J. et al.
3. “Prostate cancer mortality in screen and clinically detected prostate cancer: Estimating the screening benefit.” European Journal of Cancer, October 3, 2009. Van Leeuwen, P.J. et al.
4. “Prostate cancer mortality reduction by prostate-specific antigen-based screening adjusted for nonattendance and contamination in the European randomised study of screening for prostate cancer (ERSPC).” European Urology, July 28, 2009. Roobol, M.J. et al.
5. “Randomized trials of prostate cancer screening.” Reviews in Urology, Summer 2009; 11(3):179-180. Loeb, S. et al.
6. “Screening and prostate-cancer mortality in a randomized European study.” New England Journal of Medicine, March 2009; 360(13): 1320-1328. Schroder, F. et al.
7. “Does PSA testing save lives? – A Critical Analysis of Two Randomized Trials.” Dr. Patrick C. Walsh. Johns Hopkins University. 2009.
8. “Lower detection of prostate cancer with PSA screening in US than in European randomized trial.” Journal of the National Cancer Institute, February 8, 2010.
9. “The screening of prostate cancer in 2009: Overview of the oncology committee of the French Urological Association.” Prog Urol, January 2010, 20(1):17-23.
10. “Screening decreases prostate cancer death: First analysis of the 1988 Quebec prospective randomized controlled trial.” Prostate, February 1999; 38(2):83-91, Labrie F. et al.
11. “Prostate cancer mortality in relation to screening by prostate-specific antigen testing and digital rectal examination: A population-based study in middle-aged men.” Cancer Causes and Control, 2007; 18(9): 931-937. Agalliu, Ilir et al.
12. “Prostate cancer mortality after introduction of prostate-specific antigen mass screening in the Federal State of Tyrol, Austria.” Urology, 2001; 58(3):417-24. Bartsch G. et al.
13. “American Cancer Society guidelines for the early detection of cancer. Update of early detection guidelines for prostate, colorectal, and endometrial cancers.” CA: A Cancer Journal for Clinicians, 2001; 51:38-44, Smith R.A. et al; “Cancer statistics,” CA: A Cancer Journal for Clinicians, 2001; 51:15-36. Greenlee R.T. et al.
14. “Implications of stage-specific survival rates in assessing recent declines in prostate cancer mortality rates.” Epidemiology. 2000; 11:167-170, Tarone R.E. et al.
15. “Downward trend in prostate cancer mortality in Quebec and Canada.” Journal of Urology, 1999;161:1189-91, Meyer F. et al.
16. “Cancer Facts & Figures 2008.” American Cancer Society.
17. “Study shows massive drop in risk for diagnosis with more advanced forms of prostate cancer,” ProstateCancerInfoLink.com, August 28, 2009
18. “Drop in Prostate Cancer Mortality Rates During PSA Screening Era,” Dr. Cecilia Lacks, Spring 2009, www.drcatalona.com
19. “Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: Results of a multicenter clinical trial of 6,630 men.” Journal of Urology, 1994; 151:1283-1290, Catalona W.J. et al.
20. “Annual PSA screening reduces risk of prostate cancer deaths,” Bio-Medicine, October 23, 2005
21. “Population-based prostate cancer trends in the United States: Patterns of change in the era of prostate-specific antigen.” World Journal of Urology. 1997; 15:331-335, Stephenson R.A. et al.
22. “Randomized trials of prostate cancer screening.” Reviews in Urology, Summer 2009; 11(3):179-180. Loeb, S. et al.
23. “Screening with prostate specific antigen and metastatic prostate cancer risk: A population-based case-control study.” Journal of Urology, August 2005. 172(2): 495-499. Kopen, J.A. et al.
24. “Consistent PSA Screening Results in Better Prognosis,” Brigham and Women’s Hospital (affiliate of Harvard Medical School) news release, August 12, 2008
25. “Physician Trust, Early Screening Reduces Disparities for Prostate Cancer,” ScienceDaily, July 29, 2009”

We need you to take action. Help save other men. Speak with your fellow survivors , friends, family, coworkers and neighbors. Explain to them the situation and enlist their cooperation. Speak with your local media and teach them about the realities of PSA testing. Point out that the traditional understanding, “garbage in, garbage out”, specifically applies to the PLCO Study that the USPSTF is basing its decisions on is simply bad science.

Joel T Nowak, M.A., M.S.W.

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