General fitness, health and nutrition · Public discussion

Prostate test 'all but useless'

john · 2004-09-12T14:08:43+00:00

http://www.guardian.co.uk/medicine/story/0,11381,1302085,00.html Prostate test 'all but useless' Researchers say men put at risk of impotence Sarah Boseley, health editor Saturday September 11, 2004 The Guardian Thousands of men may have unnecessarily undergone an invasive operation to remove their prostate, sometimes suffering impotence and incontinence as a result, because of a screening test which was yesterday written off as all but useless. The PSA test is a blood test that measures levels of prostate specific antigen, a protein produced by the prostate gland. It will tell doctors that a man has a prostate cancer, but scientists in the US said yesterday that in many cases the man can live with the cancer and the treatment may be worse than the cure. "The PSA era is over," said researchers at Stanford University school of medicine in their paper in the Journal of Urology. The team studied prostate tissues collected over 20 years, from the time it first became standard to remove prostates in response to high PSA levels. Thomas Stamey, who led the research, said they concluded that the test indicated nothing more than the size of the prostate gland. "Our study raises a very serious question of whether a man should even use the PSA test for prostate cancer screening any more," he said. Professor Stamey said he had also come to believe that the PSA test was not a useful predictor of the amount or severity of prostate cancer. He said raised levels of the protein only reflected a condition known as benign prostatic hyperplasia - a harmless increase in prostate size. Tumours found 20 years ago were generally so large they generated PSA levels high enough to provide a reasonably good measure of cancer severity. But he said that, as screening became more commonplace, many cancers were being caught earlier and were usually smaller, not generating sufficient PSA to be a good indicator of severity. He said prostate cancer was a disease all men got if they lived long enough so, given the excuse to carry out a biopsy, doctors were most likely going to find cancer. Prof Stamey said the PSA was still useful in monitoring patients after removing the prostate as an indicator of cancer that had spread to other parts of the body. "Our job now is to stop removing every man's prostate who has prostate cancer," he said. "We originally thought we were doing the right thing, but we are now figuring out how we went wrong. Some men need prostate treatment but certainly not all of them." There have been more doubts over the PSA test in the UK, with the result that the NHS has opted to give men information to allow them to choose to have it if they are concerned, rather than instituting a national screening programme. But an increasing number of doctors are doing it. Chris Hiley of the Prostate Cancer Charity said a PSA test that proved positive was likely to lead to a biopsy, and since 80% of men in their 80s and even 8% of men in their 20s had prostate cancer, it was quite likely that cancer would be detected. Men without symptoms who chose to have a test in the first place were probably then more likely to opt for surgery rather than the "watchful waiting" that some experts advocate. "The intuitively obvious thing is that if you can get in and take the prostate out, things will be fine and dandy, but large numbers of men will be having operations they don't need," said Dr Hiley. Some will be impotent and incontinent because of the nerves that are severed to remove the prostate and any cancerous tissue. No other test will detect a cancer in a man without symptoms, and some of those with symptoms will be inoperable. Some 10,000 men die of prostate cancer each year.

Started by john · 12 September 2004 · Last activity 12 September 2004 · 2 posts · 353 views

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Original section: General fitness, health and nutrition
Published: 12 September 2004
Last activity: 12 September 2004
Original author: john
Posts: 2
Discussion status: Public discussion
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Original post
john
Archived post

12 September 2004, 14:08 UTC #1

http://www.guardian.co.uk/medicine/story/0,11381,1302085,00.html
Prostate test 'all but useless'
Researchers say men put at risk of impotence
Sarah Boseley, health editor
Saturday September 11, 2004
The Guardian
Thousands of men may have unnecessarily undergone an invasive operation to
remove their prostate, sometimes suffering impotence and incontinence as a
result, because of a screening test which was yesterday written off as all
but useless.
The PSA test is a blood test that measures levels of prostate specific
antigen, a protein produced by the prostate gland. It will tell doctors that
a man has a prostate cancer, but scientists in the US said yesterday that in
many cases the man can live with the cancer and the treatment may be worse
than the cure.
"The PSA era is over," said researchers at Stanford University school of
medicine in their paper in the Journal of Urology.
The team studied prostate tissues collected over 20 years, from the time it
first became standard to remove prostates in response to high PSA levels.
Thomas Stamey, who led the research, said they concluded that the test
indicated nothing more than the size of the prostate gland. "Our study
raises a very serious question of whether a man should even use the PSA test
for prostate cancer screening any more," he said.
Professor Stamey said he had also come to believe that the PSA test was not
a useful predictor of the amount or severity of prostate cancer.
He said raised levels of the protein only reflected a condition known as
benign prostatic hyperplasia - a harmless increase in prostate size.
Tumours found 20 years ago were generally so large they generated PSA levels
high enough to provide a reasonably good measure of cancer severity. But he
said that, as screening became more commonplace, many cancers were being
caught earlier and were usually smaller, not generating sufficient PSA to be
a good indicator of severity.
He said prostate cancer was a disease all men got if they lived long enough
so, given the excuse to carry out a biopsy, doctors were most likely going
to find cancer.
Prof Stamey said the PSA was still useful in monitoring patients after
removing the prostate as an indicator of cancer that had spread to other
parts of the body.
"Our job now is to stop removing every man's prostate who has prostate
cancer," he said. "We originally thought we were doing the right thing, but
we are now figuring out how we went wrong. Some men need prostate treatment
but certainly not all of them."
There have been more doubts over the PSA test in the UK, with the result
that the NHS has opted to give men information to allow them to choose to
have it if they are concerned, rather than instituting a national screening
programme. But an increasing number of doctors are doing it.
Chris Hiley of the Prostate Cancer Charity said a PSA test that proved
positive was likely to lead to a biopsy, and since 80% of men in their 80s
and even 8% of men in their 20s had prostate cancer, it was quite likely
that cancer would be detected. Men without symptoms who chose to have a test
in the first place were probably then more likely to opt for surgery rather
than the "watchful waiting" that some experts advocate.
"The intuitively obvious thing is that if you can get in and take the
prostate out, things will be fine and dandy, but large numbers of men will
be having operations they don't need," said Dr Hiley. Some will be impotent
and incontinent because of the nerves that are severed to remove the
prostate and any cancerous tissue.
No other test will detect a cancer in a man without symptoms, and some of
those with symptoms will be inoperable. Some 10,000 men die of prostate
cancer each year.

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Robert
Archived post

12 September 2004, 18:56 UTC #2

"john" <[email hidden]> wrote in message
news:[email hidden]...
Quoted message said:
http://www.guardian.co.uk/medicine/story/0,11381,1302085,00.html
Prostate test 'all but useless'
Not really an accurate statement. The more accurate statement would be the
prostate test is ok when you are able to understand it and useless when you
don't understand it.
Quoted message said:

Researchers say men put at risk of impotence
Not from the test but from the surgery.
Quoted message said:

Sarah Boseley, health editor
Saturday September 11, 2004
The Guardian
Thousands of men may have unnecessarily undergone an invasive operation to
remove their prostate, sometimes suffering impotence and incontinence as a
result, because of a screening test which was yesterday written off as all
but useless.
Inaccurate statement. Men had surgery because they had cancer and the
treatment for cancer is surgery. It is not the test but the accepted
protocol for prostate cancer treatment that should be questioned which has
nothing to do with the test.
Quoted message said:

The PSA test is a blood test that measures levels of prostate specific
antigen, a protein produced by the prostate gland. It will tell doctors

that
Quoted message said:
a man has a prostate cancer, but scientists in the US said yesterday that

in
NO. It was never and has never been specific for prostate cancer as BPH
patients and prostatitis patients also have elevated PSA levels.
Quoted message said:
many cases the man can live with the cancer and the treatment may be worse
than the cure.

That has nothing to do with the test but within the context of the disease.
Quoted message said:

"The PSA era is over," said researchers at Stanford University school of
medicine in their paper in the Journal of Urology.
Not really, only a re-evaluation on how to use it properly.
Quoted message said:

The team studied prostate tissues collected over 20 years, from the time

it
Quoted message said:
first became standard to remove prostates in response to high PSA levels.
It was never standard to remove prostates in response to high PSA levels. It
was standard to remove prostates when cancer was present. Misleading
statement that has never been true.
Quoted message said:
Thomas Stamey, who led the research, said they concluded that the test
indicated nothing more than the size of the prostate gland.
Doctors have known that for many years as BPH and cancer patients are quite
familiar with their PSA levels.
"Our study
Quoted message said:
raises a very serious question of whether a man should even use the PSA

test
Quoted message said:
for prostate cancer screening any more," he said.
Why????
Don't blame the test for picking up cancer patients when you don't know what
to do with these same patients as far as treatment.
Quoted message said:

Professor Stamey said he had also come to believe that the PSA test was

not
Quoted message said:
a useful predictor of the amount or severity of prostate cancer.
What else is new??? Not new at all. Some prostate cancer patients have a
normal PSA when detected by other means. It was meant to screen for cancer
and the severity of prostate cancer was never intended.
Quoted message said:

He said raised levels of the protein only reflected a condition known as
benign prostatic hyperplasia - a harmless increase in prostate size.
Most doctors have known this since day one. The biopsy was always considered
as definitive.
Quoted message said:

Tumours found 20 years ago were generally so large they generated PSA

levels
It is not only a single PSA value but the raise in PSA level over time that
helps in distinguishing BPH from cancer. You see a greater raise in level
with cancer over time compared to BPH which goes up slower.
Quoted message said:
high enough to provide a reasonably good measure of cancer severity. But

he
Quoted message said:
said that, as screening became more commonplace, many cancers were being
caught earlier and were usually smaller, not generating sufficient PSA to

be
Quoted message said:
a good indicator of severity.
"Screening" means exactly that and any test you want to use to screen for
anything must be sensitive to pick up all the patients. Specificity is a
test that is used next to provide "specificity" or definitive diagnosis.
Quoted message said:

He said prostate cancer was a disease all men got if they lived long

enough
Quoted message said:
so, given the excuse to carry out a biopsy, doctors were most likely going
to find cancer.
That has nothing to do with the PSA. A biopsy is definitive for prostate
cancer. If you don't want to find out if a person has cancer or not then
don't do a screen for it and don't do a biopsy under any circumstances. That
is a change in thinking with prostate cancer and it's importance which has
nothing to do with the PSA test.
Quoted message said:

Prof Stamey said the PSA was still useful in monitoring patients after
removing the prostate as an indicator of cancer that had spread to other
parts of the body.

It is also used in females who can get a malignant transformation of the
small amount of prostate tissue they have. Prostate tissue, not prostates.
Quoted message said:

"Our job now is to stop removing every man's prostate who has prostate
cancer," he said. "We originally thought we were doing the right thing,

but
Quoted message said:
we are now figuring out how we went wrong. Some men need prostate

treatment
Quoted message said:
but certainly not all of them."
That has nothing to do with the PSA test. It is a recommendation not to do a
PSA test because they feel it is normal to have prostate cancer with age and
they don't know what to do with young men with cancer. The problem lies with
the statement that "some men need prostate treatment but certainly not all
of them".
You need to diagnose all men with prostate cancer and then decide which ones
to treat or not. That is a contradictory statement in which they don't want
to know who has cancer by doing a PSA test in the first place. Some prostate
cancers are agressive and spread quickly. Look at Frank Zappa who died early
in life from prostate cancer. If it had been found early it could have been
treated properly.
Quoted message said:

There have been more doubts over the PSA test in the UK, with the result
that the NHS has opted to give men information to allow them to choose to
have it if they are concerned, rather than instituting a national

screening
Quoted message said:
programme. But an increasing number of doctors are doing it.
In short they are ignoring the agressive prostate cancers in the young and
wait until symptoms occur when it might be too late.
Quoted message said:

Chris Hiley of the Prostate Cancer Charity said a PSA test that proved
positive was likely to lead to a biopsy, and since 80% of men in their 80s
and even 8% of men in their 20s had prostate cancer, it was quite likely
that cancer would be detected.
It was being used as a screen for cancer and if you don't want to know then
don't order one. Don't order one and then say you don't know how to
interpret the test.
They are saying that the PSA is too sensitive in picking up PC that they
need to go back to only testing when symptoms occur or something less
sensitive. The test was invented for an early sensitive detection and now
they don't like it because it is too sensitive.
Men without symptoms who chose to have a test
Quoted message said:
in the first place were probably then more likely to opt for surgery

rather
Quoted message said:
than the "watchful waiting" that some experts advocate.

Another contradictory statement. "Watchful waiting" can only occur after one
has caught it and detected it. You can not have watchful waiting if a PSA
test was not done in the first place.
They want to have it both ways.
Quoted message said:

"The intuitively obvious thing is that if you can get in and take the
prostate out, things will be fine and dandy, but large numbers of men will
be having operations they don't need," said Dr Hiley. Some will be

impotent
Quoted message said:
and incontinent because of the nerves that are severed to remove the
prostate and any cancerous tissue.
The question is do men with cancer always need to have surgery and that has
nothing to do with the PSA test.
Quoted message said:

No other test will detect a cancer in a man without symptoms, and some of
those with symptoms will be inoperable. Some 10,000 men die of prostate
cancer each year.

Damn what a contradictory statement again. So get rid of the PSA and you are
left with "some of those with symptoms will be inoperable".

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