Dutch Women and the Death of American Men

For almost a decade now we have been examining the details of prostate cancer, PCa. PSA has its ups and downs but for testing for aggressive PCa it is a tool, albeit one which we have shown has some issues. More tools are coming on line almost monthly, as we have also examined.

Now this week in Nature we have some Dutch woman, it appears, opining on having American men adhere to the USPTF guidelines. Now if an American man said that about breast cancer we would have an uproar! But men, well they have outlived their usefulness after a certain age perhaps.

The author states:

These findings raised two questions. First, is it possible to reduce prostate-cancer mortality if the PSA test is introduced as a screening tool? And second, is it possible to reduce the side-effects of PSA screening, including overdiagnosis? To address these questions, two randomized trials — one in the United States and one in Europe — were initiated. Both trials have reported on the effect of PSA testing on prostate-cancer mortality several times over the years, and have always contradicted each other (although it is generally accepted that within the US trial contamination substantially limited researchers' ability to identify a clinically significant screening benefit). This lack of consensus and the considerable risk of overdiagnosis associated with PSA-based screening are the main reasons that screening for prostate cancer is still highly controversial, and why there are so few population-based government-initiated screening programmes.

 We had argued that both tests were flawed. The reasons; simple, they used a 1990s test metric which we now know needs to be modified and the European tests were spaced too far apart. Thus in some ways the test is akin to monitoring melanoma in such a fashion that you excise the lesion only when it bleeds and if you do that mortality is no different than watchful waiting. I do not think so.

The author concludes:

The time has come to actually implement the evidence-based guidelines into clinical practice. Medical associations should better communicate the best practice around PSA testing and strengthen the education of doctors — particularly general practitioners (GPs) who are usually the first point of contact, but are rarely up to date with the latest publications. GP requests for testing should be actively monitored to ensure the message is understood, rather than waiting for registry data to see if there has been an effect.

 The evidence is quite complex. We examined a case a couple of month back and demonstrated that one test after another gave conflicting results. I would agree that most Primary Care physicians are not attuned to dealing with the results but in the US we then send them to a Urologist to see what to do next. They should be the definitive gatekeepers.

Let's try to keep men alive on an equal footing, please.

And by the way, another woman in Nature seems to bemoan the PSA test. This writer states:

Part of the shift is a result of advances in screening, which are helping doctors to zero in on aggressive cancers that need the most attention. Among the new strategies is a tool called the prostate health index (PHI), which measures three types of PSA. According to some research, the PHI is three times more specific than the standard PSA test, an improvement that reduces the number of unnecessary biopsies. Doctors around the world also now factor in a tumour's Gleason score, which assesses aggressiveness based on the way that cancer cells look under a microscope. And researchers are continually re-examining the level at which the quantity of PSA in the blood should be considered abnormal. Some evidence, for example, supports the idea that the threshold for concern should be raised from its present value of 3–4 nanograms per millilitre to 10 nanograms per millilitre. Beyond PSA, scientists are also using magnetic resonance imaging to guide biopsies making false negatives less likely, as well as genetic tissue tests to screen for biomarkers that signal a cancer's degree of aggressiveness. These tests can be expensive, and health-insurance companies in the United States do not necessarily cover them. Many are so new, Barry adds, that there are insufficient data on outcomes. Rushing to accept newer tests before sound trial evidence arrives, in other words, might bring a repeat of the troubled PSA era all over again.

 In my opinion perhaps these should be written by professionals and not what appears as "a freelance journalist". Afterall this is Nature not Men's Health. Just an opinion.