Prostate cancer. They just don’t get it! #movembermadness

Prostate cancer and PSA testing is an emotive subject. Sadly the press are often unhelpful in regards to this with their regular survivor stories and not discussing the harder subject matter. Now the MOH has launched a prostate cancer awareness campaign. Which leads me to the question:  When is encouraging patients to get tested a screening programme?

http://www.stuff.co.nz/national/health/9450677/Prostate-cancer-campaign-ahead

http://www.scoop.co.nz/stories/PA1311/S00503/national-prostate-cancer-campaign-a-first-for-nz.htm

Men are being urged to pick up a new booklet from their GP and complete a checklist of symptoms.

It is the first part of a $4.3 million programme to raise awareness for prostate cancer.

That aims to see men getting diagnosed sooner and improving the rate of survival. (Its called lead time bias) 5 year survival in the US for prostate Ca is 95% but 71% in the UK. driven by PSA use and early diagnosis. Overall mortality is the same.

Men are being urged to pick up a new booklet from their GP and complete a checklist of symptoms.

Prostate checklist for men

Choosing whether to have a prostate check is an important decision. You need to have enough information to make the decision that is right for you and your loved ones.

If you answer ‘Yes’ to any of the following, talk to your doctor, nurse or health professional.

  Yes/No
I am peeing more often.*  
When I pee, I have trouble getting started or stopping.*  
I have poor urine flow or dribbling.*  
I often get up at night to pee.*  
I have blood in my urine.*  
I have pain in my lower back, hips or ribs.*  
I have a family history of prostate cancer and I’m 40 years old or more.  
I am 50 to 70 years old.  
I am concerned or want to know more.  

*Answering yes to any of these points may not mean you have cancer but you should get them checked by your doctor, nurse or health professional straight away.

The check assesses your risk of having it. The check will tell you how likely you are to have prostate cancer.

Checks usually involve a blood test – called a prostate-specific antigen (PSA)

Health Minister Tony Ryall said there was a need to get a “clear message” out there.

“Patients hadn’t always been given a consistent message, and that meant fewer men were being screened than should be.” (We shouldn’t be screening!)

This push is despite the huge move back in the use of PSA due to evidence showing its futility. All NZ males between 50-70 are being asked to see their doctor, nurse of health professional straight away! (this is around 400,000 men) currently new Zealand has high levels of PSA testing with 40% of males over 50 having had a test at some stage.

Professor Nacey said. “The causes of prostate cancer were still largely unknown, and it wasn’t practical to test every man over 50.”

Even the American Urological Association has pulled its guidelines back greatly. Recommending against screening those under the age of 54 and those over 70.

“Guideline Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man’s values and preferences.”

Despite these clear guidelines from “the specialists” the PSA test is being widely misused.

“Prostate Cancer Foundation of Australia survey found more than one in 10 men in their late 20s had a PSA test on the advice of a GP”

The booklet does mention the decision to have testing but then moves on to discuss all treatments and follow-up. In reality patients are being told having a PSA test is harmless and that they can make decisions afterwards. In reality once a patient has a positive PSA test the horse has bolted. The cascade of interventions has started. Very few choose not to have a biopsy which leads to further treatment for follow-up biopsy.

Should I have a blood test to check for prostate cancer?

Having a prostate check is your decision. Choosing whether to have a prostate check or not is an important decision to make.

A prostate check aims to reduce your chances of being harmed or dying from prostate cancer. While the PSA blood test and the DRE may be uncomfortable, there is no risk from having them. They do not harm you in any way.

Depending on your PSA and DRE results, you may need to make decisions about more tests and possibly treatments. The tests and treatments have benefits and risks (can cause harm). You need to understand what the benefits and risks are so you can make the right decisions for you and your family and whānau.

In summary I can’t understand why the huge push is on for prostate cancer screening. The MOH seems to be implementing a screening programme by stealth. It is not good enough for NZ men to be the guinea pigs in a trial which they do not enrol.

Finally amongst the Movember madness a number of good articles for lay people have been written including this one:

http://www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11150921

Ref:

Booklets an info sheets from MOH

http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/cancer/prostate-cancer

American Urological association.

http://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm

 

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