Re: End of PSA Era?
- From: "Rich256" <nospam@xxxxxxxxxxxx>
- Date: Thu, 14 Jul 2005 17:50:41 GMT
"george conklin" <george@xxxxxxx> wrote in message
news:qudBe.9783$aY6.682@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
>
> "Derek F" <lordpilrig@xxxxxxxxxxxxxxxxx> wrote in message
> news:db3j7m$ng4$1@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
> >
> >
> >
> > "george conklin" <george@xxxxxxx> wrote in message
> > news:578Be.2739$oZ.1492@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
> >> "My one wish with prostate cancer," says Dr. Thomas Stamey, a veteran
> >> researcher at Stanford University, "is that before a doctor does
anything
> >> aggressive, he would tell his patient that all men will develop the
> >> disease eventually." He pauses to let the bad news sink in. "The good
> >> news," he wants doctors to add, "is that the rate of dying from
prostate
> >> cancer is infinitesimal."
> >> Stamey has been in a reflective mood of late because of the growing
> >> realization, by him and others, that the screening test he helped
> >> discover is far less useful for detecting prostate cancer than many had
> >> once believed. In 1987, a team led by Stamey found that high levels of
> >> prostate-specific antigen (PSA) circulating in the blood were a strong
> >> indication of prostate tumors.
> >>
> >> Before then, the only way to detect prostate cancer was with a painful
> >> biopsy, and this is still used to confirm the disease. But with a
simple
> >> PSA test , doctors thought they could weed out men who don't need the
> >> more invasive procedure, as well as spot tumors at an earlier, more
> >> treatable stage.
> >>
> >> The test has proven a powerful draw: about half of all men over the age
> >> of 50 get annual PSA tests. Now, Stamey hopes that men will be open to
> >> the older means of screening for prostate cancer.
> >>
> >> "I don't think PSA adds very much," he says.
> >>
> >> The End of the PSA Era?
> >> These second thoughts stem from a troubling variety of evidence that
> >> suggests widespread testing is possibly causing more harm than good.
> >> Although death rates from prostate cancer are lower than they were
before
> >> PSA screening, these rates have also declined in countries where this
> >> type of testing is not commonly used.
> >>
> >> If one were to randomly biopsy men, as Dr. Wael Sakr of Wayne State
> >> University did on a group who were accidentally killed on the streets
of
> >> Detroit, about 8 percent of those in their 20s would have prostate
> >> cancer, with the rates steadily increasing as men age. Indeed, about 80
> >> percent will develop the disease by the age of 70.
> >>
> >> Some of these tumors are clearly dangerous. But most are slow moving,
and
> >> many prostate cancer patients can go 20 years without any need for
> >> treatment, according to a recent study led by Dr. Peter Albertson. With
> >> widespread PSA screening picking up these relatively benign tumors,
> >> Stamey fears that the tests are leading to unnecessary treatment and
> >> worry.
> >>
> >> "I've been as guilty as anyone else," he says.
> >>
> >> Not everyone is willing to give up on PSA screening quite yet.
> >>
> >> "We know it's not a perfect test," says Jamie Bearse, a spokesperson
for
> >> National Prostate Cancer Coalition, which advocates annual PSA
screening
> >> for men 40 years and older. Bearse is hopeful that newer screening
tests
> >> will prove more discerning. In the meantime, he says, the PSA test is
the
> >> best early detection option men have. "They would rather know, than not
> >> know."
> >>
> >> Normal vs. Abnormal PSA
> >> Yet it is increasingly hard to determine even a broad risk prediction
> >> from PSA testing. Traditionally, doctors used a PSA measurement of 4 as
a
> >> key cut off point: lower than 4 millimeters of PSA in the blood meant
> >> that men were considered cancer free, whereas higher or equal to 4
> >> suggested the need for a biopsy to confirm the disease.
> >>
> >> But looking at nearly 5,500 men who had a PSA test and then at least
one
> >> biopsy, researchers found this cutoff point often missed tumors or
> >> implied that men had cancers that weren't in fact really there,
according
> >> to recent results published in the Journal of the American Medical
> >> Association.
> >>
> >> Indeed, a PSA level of 4.1 millimeters accurately predicts only 20
> >> percent of prostate cancers and leads to false alarms about 6 percent
of
> >> the time. Lowering the threshold will detect more cancers, but at the
> >> price of causing men to undergo biopsies for no reason or finding many
> >> benign tumors that only need to be monitored. A PSA cutoff of 2.1, for
> >> example, would yield false readings more than 85 percent of the time to
> >> catch only slightly more than half of all tumors.
> >>
> >> The authors of the study, led by Dr. Ian Thompson of the University of
> >> Texas Health Science Center in San Antonio, call for a substantial
> >> "reeducation" effort on the increasingly murky role of PSA. "It will be
a
> >> challenge to the medical community to change the long held notion that
> >> there is a 'normal' PSA level," the authors write.
> >>
> >> Researchers still hold out hope for measuring PSA velocity, the rise of
> >> PSA over time that gives an indication if the tumor is growing. As an
> >> initial detection tool, Stamey says that doctors should return to
looking
> >> at increasing age, along with a family history of the disease, as a way
> >> of determining who may be at greater risk for prostate cancer and in
need
> >> of a biopsy to catch tumors early.
> >>
> >> Other than that, he adds, "We have as much a way of predicting who will
> >> need a biopsy based on looking at someone's eyes." Ongoing studies are
> >> continuing to look at whether PSA testing saves lives, and the American
> >> Cancer Society and other test supporters urge men to discuss the pros
and
> >> cons of screening with their doctors. But the creator of the PSA test
is
> >> calling for the end.
> >>
> >> "All men will develop a prostate cancer," says Stamey. "That's a
given."
> >>
> >>
> >
> >
>
> >I posted this in 1999 and the URL contains the rest of the thread.
> >
> > http://tinyurl.com/95o4z
> >
> > "Sitting around at the hospital after my last biopsy, I got into
> > conversation
> > with a passing doctor. He asked what I had been getting done. When I
told
> > him he exclaimed "PSA terrorism" He said that this was the conclusion in
a
> > paper by a Norwegian doctor. In other words he was saying that PSA
tests
> > were forcing men into biopsies and panicking them into treatments that
> > might
> > not be in their best interests.
> > Derek.
> >
>
> And unfortunately the situation remains totally unchanged since then
> because the needed research is not done.
>
Something I read recently indicated that more men die of Prostate cancer
than women of Breast Cancer. But, most die of Lung Cancer.
What I thought was missing was the age relationship. Were the men older
than women when they died?
.
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