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Prostate cancer screening: a suitable case for ethical treatment, says Dutch specialist
October 22, 2001Men should be informed about the controversy over prostate cancer screening before having a test, ECCO 11 - the European Cancer Conference was told today (Thursday 25 October) in Lisbon.
Fritz H. Schröder, professor and chair of the Department of Urology, Erasmus University, Rotterdam, said that doctors should explain why prostate screening has divided the medical profession. He added, "Testing without providing this information is unethical."
Prostate cancer mostly affects men over the age of 65, most of whom usually die of something else, without even knowing they have it - very few die from the disease itself. But in 1996, prostate cancer accounted for 55,704 deaths in the European Union. After lung and colon cancer, it is the third most common cause of cancer death among men in the UK.
The blood test measures a substance called protein specific antigen (PSA) made by the prostate. Generally speaking, the higher the PSA level, the greater the chance of cancer. But some men with prostate cancer do not have high PSA levels. Conversely, two thirds of men with higher levels of PSA do not have prostate cancer. Non-malignant conditions involving enlargement or infection or inflammation of the prostate are also associated with high PSA levels.
Professor Schröder said that if even if ongoing screening studies were shown to reduce mortality, there would still be important outstanding questions, such as: -
How can anxiety and painful removal of tissue (for biopsy) be avoided in men who have an abnormal PSA test but no cancer?
How can the diagnosis of less or non-harmful cancers by avoided?
What is the impact of early diagnosis and aggressive treatment on quality of life?
Is the balance right between benefit and harm?
At present, treatment options when the disease has not spread to other parts of the body include surgical removal of the prostate; radiation therapy or "watchful waiting", in which PSA levels are monitored periodically, and the cancer is only actively treated if it grows quickly or causes problems. Research has yet to establish if one option is better than another, but the availability of testing in the USA led to a large increase in "radical prostatectomy", and to greater use of radiotherapy.
Professor Schröder said that besides issues such as quality of life after treatment in relation to the risk of disease, the side effects of treatment and the definition of "watchful waiting" were all "tightly connected to the question of whether screening should become health care policy".
He concluded: "Obviously, only the availability of (research) data will allow a complete risk benefit and cost analysis. We hope all these questions can be answered positively so that we can finally introduce a preventive measure into one of the most important disease entities of the male population.
"Meanwhile, powerful, early diagnostic tests cannot be withheld from well informed men. The accent here, however, has to be on well informed".
MR Communication and Analysis Ltd
The blood test measures a substance called protein specific antigen (PSA) made by the prostate. Generally speaking, the higher the PSA level, the greater the chance of cancer. But some men with prostate cancer do not have high PSA levels. Conversely, two thirds of men with higher levels of PSA do not have prostate cancer. Non-malignant conditions involving enlargement or infection or inflammation of the prostate are also associated with high PSA levels.
Professor Schröder said that if even if ongoing screening studies were shown to reduce mortality, there would still be important outstanding questions, such as: -
At present, treatment options when the disease has not spread to other parts of the body include surgical removal of the prostate; radiation therapy or "watchful waiting", in which PSA levels are monitored periodically, and the cancer is only actively treated if it grows quickly or causes problems. Research has yet to establish if one option is better than another, but the availability of testing in the USA led to a large increase in "radical prostatectomy", and to greater use of radiotherapy.
Professor Schröder said that besides issues such as quality of life after treatment in relation to the risk of disease, the side effects of treatment and the definition of "watchful waiting" were all "tightly connected to the question of whether screening should become health care policy".
He concluded: "Obviously, only the availability of (research) data will allow a complete risk benefit and cost analysis. We hope all these questions can be answered positively so that we can finally introduce a preventive measure into one of the most important disease entities of the male population.
"Meanwhile, powerful, early diagnostic tests cannot be withheld from well informed men. The accent here, however, has to be on well informed".
MR Communication and Analysis Ltd
Prostate Cancer Current Events and Prostate Cancer News RSSCarnegie Mellon researchers link health-care debate to risk of dying in US and Europe
The current health care debate in the United States is complicated. Trade-offs between heath care expenditures, lifestyle choices and life expectancy have been suggested but seldom clearly demonstrated.
New finding suggests prostate biopsy is not always necessary
Researchers at Wake Forest University School of Medicine and the University of Wisconsin-Madison have discovered that some elevated prostate-specific antigen (PSA) levels in men may be caused by a hormone normally occurring in the body, and are not necessarily a predictor of the need for a prostate biopsy.
Does prostate-specific antigen velocity help in early detection prostate cancer?
The November issue of European Urology, the official journal of the European Association of Urology, features an article focussing on prostate specific antigen (PSA) velocity and early cancer detection. It has been suggested that changes in PSA over time aid prostate cancer detection.
New Synthetic Molecules Trigger Immune Response to HIV and Prostate Cancer
Researchers at Yale University have developed synthetic molecules capable of enhancing the body's immune response to HIV and HIV-infected cells, as well as to prostate cancer cells. Their findings, published online in the Journal of the American Chemical Society, could lead to novel therapeutic approaches for these diseases.
Chemo-radiation before prostate removal may prevent cancer recurrence
Researchers in the Oregon Health & Science University Knight Cancer Institute and the Portland Veterans Affairs Medical Center have found a combination of radiation therapy and chemotherapy given before prostate removal is safe and may have the potential to reduce cancer recurrence and improve patient survival.
Blood vessels might predict prostate cancer behavior
A diagnosis of prostate cancer raises the question for patients and their physicians as to how the tumor will behave. Will it grow quickly and aggressively and require continuous treatment, or slowly, allowing therapy and its risks to be safely delayed?
Short-term hormone therapy and intermediate dose radiation increases survivial for early stage prostate cancer
Short-term hormone therapy given prior to and during intermediate dose radiation treatment for men with early stage prostate cancer increases their chance of living longer, compared to those who receive the same radiation alone.
Task force develops new radiation guidelines for brachytherapy
Radiation dose delivered to the prostate and nearby organs in every brachytherapy procedure should be carefully analyzed using post-implant CT or MRI and uniformly documented in every patient.
1 disease, not 1 demographic
The Asian continent has nearly four billion people living in 47 different countries, and each of these groups has their own unique set of health issues. But when they come to the United States, they're often lumped into one large demographic: "Asian/Pacific Islander."
Cancer survivors may not be getting the help they need to stop smoking
More than a quarter of cancer survivors who still smoke have not been advised to quit smoking by their health care providers in the last year, according to a study published by researchers at Fox Chase Cancer Center in the current issue of the Journal of General Internal Medicine.
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