Tag Archives: prostate screening

ECRI reviews prostate cancer research

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The ECRI Institute’s new review of recent research on the utility of off-label prescription of Finasteride in the prevention of prostate cancer (PDF) presents research and clinical guidelines. Its bibliography and research review may be useful for anyone considering a follow-up to Gina Kolata’s recent New York Times piece on cancer prevention. Finasteride blocks an enzyme that aids the proliferation of prostate cancer cells. It’s used to reduce the size of enlarged prostates and, under the name Propecia, to treat male pattern baldness.

A large trial on finasteride, known as the Prostate Cancer Prevention Trial (PCPT), was published in 2003. The 18,882 men (asymptomatic, with normal PSA levels, 55 years of age or older) enrolled in the trial were randomly assigned to receive either finasteride or placebo for 7 years. … The authors of the trial reported that finasteride reduced the incidence of prostate cancer from 24.4% to 18.4%; however, the incidence of high-grade prostate cancers was 25.6% higher in the finasteride group than the placebo group. The clinical significance of these findings is unclear and has been widely debated.

The impact of prophylactic finasteride on long-term mortality and quality of life was not reported by the PCPT. Two models forecasting the impact of finasteride on mortality in participants in the PCPT were published. Grover et al. predicted that for every 1,000 men treated with finasteride, a total of 20 life-years (0.02 years per individual) would be saved, and Lotan et al. predicted that men treated with finasteride would, on average, gain 1.7 months of life.

The ECRI release was prompted by Kolata’s piece in The New York Times which questions why drugs that have been proven to prevent cancer are not being taken while many potentially harmful (and useless) supplements are. Kolata mentioned the Finasteride case in addition to similar examples involving breast cancer prevention drugs.

According to its Web site, the nonprofit ECRI Institute “dedicates itself to bringing the discipline of applied scientific research to healthcare to discover which medical procedures, devices, drugs, and processes are best to enable improved patient care.” The acronym ECRI has been adopted as the organization’s full name, but used to stand for “Emergency Care Research Institute.”

Cancer society’s messages on screening conflict

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The New York Times‘ Gina Kolata reports that the American Cancer Society, a longtime defender of early detection and cancer screening, is planning to release an online message next year “to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.”

MRI
MRI entrance, photo by Scott & White Healthcare via Flickr.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

The ACS’ change of heart on breast and prostate screening was inspired, in part, by a recent analysis published in JAMA.

In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.

In an interesting side note, Kolata includes a quote from Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York, that shows a different perspective on media coverage of the screening debate.

“I am concerned that the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline,” Begg said. “The fact that population screening is no panacea does not mean that it is useless,” he added.

Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations. In the statement, Brawley says ACS “stands by its recommendation that women age 40 and over should receive annual mammography” and that its recommendation that men consult with their doctors to “make an informed decision about whether or not prostate cancer early detection testing is right for them. ”

The LA Times‘ Booster Shots blog has more, as does NPR’s health blog.

Schwitzer: One-sided push for screening wrong

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

On his Schwitzer health news blog, University of Minnesota journalism professor, HealthNewsReview.org editor and AHCJ member Gary Schwitzer reminds journalists – in particular, CNN’s Howard Kurtz and Larry King – that even when you’re talking to prostate cancer survivors about screening for the disease, it’s “wrong to use a network television platform to give one-sided advice to an entire population of men without giving balancing information on harms.”

Reminding journalists that PSA screening might not always be a good thing, Schwitzer quotes the U.S. Preventative Services Task Force:

Potential harms from PSA screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis (the identification of prostate cancer that would never have caused symptoms in the patient’s lifetime, leading to unnecessary treatment and associated adverse effects). Much uncertainty surrounds which cases of prostate cancer require treatment and whether earlier detection leads to improvements in duration or quality of life.

Urological group pushes PSA screenings

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Cancer Letter‘s Paul Goldberg reports that the American Urological Association released a list of best practices that included beginning prostate screening at age 40 (see page 3 of this PDF for the announcement).

It came, Goldberg reports, “Less than a month after the New England Journal of Medicine published trial results that point to overdiagnosis and low or no benefit from screening men over the age of 50.” The American Cancer Society says it “does not support routine testing for prostate cancer in men at average risk at this time.”

Meanwhile, Cancerwise’s Julie Penne looked at the American Urological Association’s partnership with the NFL and a Houston event at which partnering doctors screened 37 men between the ages of 31 and 77.”

Recently, M. D. Anderson and the American Urological Association (AUA) teamed up to screen 37 NFL retirees from the Houston area as part of a 10-city series that the NFL Player Care Foundation initiated to address the medical needs of retired players. The M. D. Anderson screening… was the seventh site in the year-long tour that has held screening events in Kansas City, Atlanta, Dallas, Tampa Bay, Washington, D.C., and Canton, Ohio, the home of the NFL Hall of Fame.

Other than a UPI story and the aforementioned blog post, the initiative doesn’t seem to have attracted much attention, though University of Minnesota professor and AHCJ member Gary Schwitzer posted his reaction. Unfortunately, overshadowed by H1N1, the AUA’s new guidelines and the controversy surrounding them have gotten little attention as well. The Los Angeles Times‘ Shari Roan offers a roundup of the issues.