RE: Dr Stamey on PSA - May 2004

[Guest guest]

I think this is the BIG problem with prostate cancer. I know that

researchers are focusing on new markers as a main area of research.

The problem for men and their doctors is what if you are one of the men

with an aggressive cancer? Are we willing to let those men die because

we do not have the answers yet?

The new NCCN guidelines is the medical communities attempt to make the

process better. http://www.nccn.org/physician_gls/f_guidelines.html

Unfortunately The current news does not take into account the

information presented here. The debate seems to be related to PSA as a

screening device. It is an indicator that should be a sign of further

testing.

The important message is to me that MD's should not be so quick to

treat/biopsy not that the test is bad or useless. It is an inexpensive

first step.

Kathy Meade

Dr Stamey on PSA - May 2004

Most people who have been around PCa will have heard of Dr Stamey

and his views on over-diagnosis and over- treatment of this disease.

Three years ago he came out with this statement, which to the best of my

knowledge has not been challenged:

<snip> I believe that when the final chapter of this disease is written,

which is unlikely to be in my lifetime, never in the history of oncology

will so many men have been so overtreated for one disease. After all we

have a very small death rate from prostate cancer , which is less than

1%........Clearly we are overdiagnosing this disease. Uorlogy 58 (2),

2001<snip>

He and his team have presented another paper at the AUA conference which

you can read up here

http://www.ajc.com/health/content/shared-auto/healthnews/-pro/518850.htm

l

This is a quote that sums up the article:

<SNIP> Stanford University researchers say PSA (prostate specific

antigen) levels bear little relationship to the severity of a cancer

these days. They presented their finding May 9 at the American Urology

Association's annual meeting in San Francisco. " We need to recognize

that PSA is no longer a marker for prostate cancer, " said study author

Dr. A. Stamey, a professor of urology at Stanford University

School of Medicine. " We urgently need to find a new marker for prostate

cancer, and that marker must be proportional to how much cancer you

have. " " We have been so thorough and effective in screening for prostate

cancer over this 20-year period that PSA no longer has a relationship to

prostate cancer, " Stamey said. " Because we all develop the cancer, we're

now removing prostates from men whose cancer is so small that they do

not need the procedure. We're finding all these little cancers that are

never going to be a danger to the patient. " " In smaller cancers, the PSA

test is not relevant anymore, " Stamey explained. " You might as well

biopsy a man because he has blue eyes. " <SNIP>

All the best

Terry Herbert

in sunny Kalk Bay, South Africa

Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No

conventional treatment. Present PSA 6.25:fPSA 38% My site is at

www.prostatecancerwatchfulwaiting.co.za

It is a tragedy of the world that no one knows what he doesn't know, and

the

less a man knows, the more sure he is that he knows everything. Joyce

Carey

[Guest guest]

In Quebec Fernand Labrie has used a combination of PSA test and DRE in a

successful population screening programme. His latest paper summary is below

and it is quite evident that screening followed by timely treatment saves

lives, so really, what the blazes is Stamey on about! If these men were not

screened there would have been 60+ extra deaths in the randomized arm of the

treatment group.

True, 10 men still died in that arm of the group and this problem of a

'minority within a minority' is not adequately dealt with by screening and

the treatment procedures that Labrie has to offer alone, but that is a

different matter (and one that I venture to say am dealing with in a novel

way).

>The problem for men and their doctors is what if you are one of the men

with an aggressive cancer? Are we willing to let those men die because

we do not have the answers yet?

If Kathy would like to contact me privately on this I can provide her to

means of access to my manuscript on the subject.

Here is the study that gives the lie to Stamey's view. It is one of a long

list of work done by Labrie over the last quarter century and policy makers

in every country should take note. Cheers, Sammy.

Labrie F, Candas B, Cusan L, Gomez JL, Belanger A, Brousseau G, Chevrette E,

Levesque J. Screening decreases prostate cancer mortality: 11-year

follow-up of the 1988 Quebec prospective randomized controlled trial.

Prostate. 2004 May 15;59(3):311-8. PMID: 15042607

Oncology and Molecular Endocrinology Research Center and Departments of

Medicine and Radiology, Laval University Medical Center (CHUL), and Laval

University, Quebec, Canada. fernand.labrie@...

PURPOSE: This clinical trial is aimed at evaluating the impact of prostate

cancer screening on cancer-specific mortality. SUBJECTS AND METHODS:

Forty-six

thousand four hundred and eighty-six (46,486) men aged 45-80 years

registered in the electoral roll of the Quebec city area were randomized in

1988 between

screening and no screening. Screening included measurement of serum

prostatic specific antigen (PSA) using 3.0 ng/ml as upper limit of normal

and digital

rectal examination (DRE) at first visit. At follow-up visits, serum PSA only

was used. RESULTS: Seventy-four (74) deaths from prostate cancer occurred in

the

14,231 unscreened controls while 10 deaths were observed in the screened

group of 7,348 men during the first 11 years following randomization. Median

follow-up of screened men was 7.93 years. A proportional hazards model

of the age at death from prostate cancer shows a 62% reduction (P < 0.002,

Fisher's exact test) of cause-specific mortality in the screened men (P =

0.005). These results are in agreement with the continuous decrease of

prostate cancer mortality

observed in North America. Copyright 2004 Wiley-Liss, Inc.

Dr Stamey on PSA - May 2004

Most people who have been around PCa will have heard of Dr Stamey

and his views on over-diagnosis and over- treatment of this disease.

Three years ago he came out with this statement, which to the best of my

knowledge has not been challenged:

<snip> I believe that when the final chapter of this disease is written,

which is unlikely to be in my lifetime, never in the history of oncology

will so many men have been so overtreated for one disease. After all we

have a very small death rate from prostate cancer , which is less than

1%........Clearly we are overdiagnosing this disease. Uorlogy 58 (2),

2001<snip>

He and his team have presented another paper at the AUA conference which

you can read up here

http://www.ajc.com/health/content/shared-auto/healthnews/-pro/518850.htm

l

This is a quote that sums up the article:

<SNIP> Stanford University researchers say PSA (prostate specific

antigen) levels bear little relationship to the severity of a cancer

these days. They presented their finding May 9 at the American Urology

Association's annual meeting in San Francisco. " We need to recognize

that PSA is no longer a marker for prostate cancer, " said study author

Dr. A. Stamey, a professor of urology at Stanford University

School of Medicine. " We urgently need to find a new marker for prostate

cancer, and that marker must be proportional to how much cancer you

have. " " We have been so thorough and effective in screening for prostate

cancer over this 20-year period that PSA no longer has a relationship to

prostate cancer, " Stamey said. " Because we all develop the cancer, we're

now removing prostates from men whose cancer is so small that they do

not need the procedure. We're finding all these little cancers that are

never going to be a danger to the patient. " " In smaller cancers, the PSA

test is not relevant anymore, " Stamey explained. " You might as well

biopsy a man because he has blue eyes. " <SNIP>

All the best

Terry Herbert

in sunny Kalk Bay, South Africa

Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No

conventional treatment. Present PSA 6.25:fPSA 38% My site is at

www.prostatecancerwatchfulwaiting.co.za

It is a tragedy of the world that no one knows what he doesn't know, and

the

less a man knows, the more sure he is that he knows everything. Joyce

Carey

[Guest guest]

Sammy,

Amongst the many things I have learned since being diagnosed almost 8 years

ago is the fact that Abstracts of studies, whilst useful as pointers, cannot

be taken as proof of anything without a bit of analysis. It may be that you

have analysed the latest Labrie study, in which case you can perhaps respond

to the following points.

1. Forty-six thousand four hundred and eighty-six (46,486) men were enrolled

in the study. This abstract refers to 14,231 unscreened controls and 7,348

in the screened group, a total of 21,579 men. By my calculation that means

that almost 25,000 of the original men are not accounted for - that's 53% of

the group. The significance of this point is that we need to know if the

drop out rate between screened and unscreened men is similar. Because if it

is not, if for example, as one might expect, more men dropped out of the

unscreened than the screened group, then it is material to know the fate of

the men who dropped out.

2. It would also be of interest to know precisely what parameters were put

on the men on the unscreened group. Were they denied all medical

investigation? Were they ever even given a DRE (Digital Rectal Examination)

or were they just left until the disease manifested itself through symptoms?

These issues would clearly have some impact on their disease specific

mortality rate.

3. Does the study give any overall mortality rates or merely the disease

specific rates? This point is pertinent. As was shown in the Holmberg paper,

although surgery produced a lower disease specific mortality rate, there was

no statistical difference in the overall mortality rate between the men who

did not have surgery and those who did. Many of the treatment procedures are

capable of producing iatrogenic illness and death and this would have a

tendency to lower the disease specific mortality rate.

4. The statement in the abstract <snip> These results are in agreement with

the continuous decrease of prostate cancer mortality observed in North

America.<snip> is misleading. The prostate cancer mortality in the US did

NOT continuously decline from 1988, the start of this study. On the

contrary, it continued to rise until 1992 before commencing to decline. The

SEER figures I have only go to 1998, the year before the end of the period

in this Labrie report. At that time the disease specific mortality rate was

a little below that of 1976. Until we understand why the mortality rate was

rising, despite the enormous increase in incident rates following the

introduction of PSA testing, it would seem premature to claim that there is

any direct relationship between the steps taken in this study and the

claimed reduction in mortality rates.

All the best

Terry Herbert

in sunny Kalk Bay, South Africa

Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No conventional

treatment. Present PSA 6.25:fPSA 38%

My site is at www.prostatecancerwatchfulwaiting.co.za

It is a tragedy of the world that no one knows what he doesn't know, and the

less a man knows, the more sure he is that he knows everything. Joyce

Carey

Re: Dr Stamey on PSA - May 2004

In Quebec Fernand Labrie has used a combination of PSA test and DRE in a

successful population screening programme. His latest paper summary is below

and it is quite evident that screening followed by timely treatment saves

lives, so really, what the blazes is Stamey on about! If these men were not

screened there would have been 60+ extra deaths in the randomized arm of the

treatment group.

True, 10 men still died in that arm of the group and this problem of a

'minority within a minority' is not adequately dealt with by screening and

the treatment procedures that Labrie has to offer alone, but that is a

different matter (and one that I venture to say am dealing with in a novel

way).

>The problem for men and their doctors is what if you are one of the men

with an aggressive cancer? Are we willing to let those men die because

we do not have the answers yet?

If Kathy would like to contact me privately on this I can provide her to

means of access to my manuscript on the subject.

Here is the study that gives the lie to Stamey's view. It is one of a long

list of work done by Labrie over the last quarter century and policy makers

in every country should take note. Cheers, Sammy.

Labrie F, Candas B, Cusan L, Gomez JL, Belanger A, Brousseau G, Chevrette E,

Levesque J. Screening decreases prostate cancer mortality: 11-year

follow-up of the 1988 Quebec prospective randomized controlled trial.

Prostate. 2004 May 15;59(3):311-8. PMID: 15042607

Oncology and Molecular Endocrinology Research Center and Departments of

Medicine and Radiology, Laval University Medical Center (CHUL), and Laval

University, Quebec, Canada. fernand.labrie@...

PURPOSE: This clinical trial is aimed at evaluating the impact of prostate

cancer screening on cancer-specific mortality. SUBJECTS AND METHODS:

Forty-six

thousand four hundred and eighty-six (46,486) men aged 45-80 years

registered in the electoral roll of the Quebec city area were randomized in

1988 between

screening and no screening. Screening included measurement of serum

prostatic specific antigen (PSA) using 3.0 ng/ml as upper limit of normal

and digital

rectal examination (DRE) at first visit. At follow-up visits, serum PSA only

was used. RESULTS: Seventy-four (74) deaths from prostate cancer occurred in

the

14,231 unscreened controls while 10 deaths were observed in the screened

group of 7,348 men during the first 11 years following randomization. Median

follow-up of screened men was 7.93 years. A proportional hazards model

of the age at death from prostate cancer shows a 62% reduction (P < 0.002,

Fisher's exact test) of cause-specific mortality in the screened men (P =

0.005). These results are in agreement with the continuous decrease of

prostate cancer mortality

observed in North America. Copyright 2004 Wiley-Liss, Inc.

Dr Stamey on PSA - May 2004

Most people who have been around PCa will have heard of Dr Stamey

and his views on over-diagnosis and over- treatment of this disease.

Three years ago he came out with this statement, which to the best of my

knowledge has not been challenged:

<snip> I believe that when the final chapter of this disease is written,

which is unlikely to be in my lifetime, never in the history of oncology

will so many men have been so overtreated for one disease. After all we

have a very small death rate from prostate cancer , which is less than

1%........Clearly we are overdiagnosing this disease. Uorlogy 58 (2),

2001<snip>

He and his team have presented another paper at the AUA conference which

you can read up here

http://www.ajc.com/health/content/shared-auto/healthnews/-pro/518850.htm

l

This is a quote that sums up the article:

<SNIP> Stanford University researchers say PSA (prostate specific

antigen) levels bear little relationship to the severity of a cancer

these days. They presented their finding May 9 at the American Urology

Association's annual meeting in San Francisco. " We need to recognize

that PSA is no longer a marker for prostate cancer, " said study author

Dr. A. Stamey, a professor of urology at Stanford University

School of Medicine. " We urgently need to find a new marker for prostate

cancer, and that marker must be proportional to how much cancer you

have. " " We have been so thorough and effective in screening for prostate

cancer over this 20-year period that PSA no longer has a relationship to

prostate cancer, " Stamey said. " Because we all develop the cancer, we're

now removing prostates from men whose cancer is so small that they do

not need the procedure. We're finding all these little cancers that are

never going to be a danger to the patient. " " In smaller cancers, the PSA

test is not relevant anymore, " Stamey explained. " You might as well

biopsy a man because he has blue eyes. " <SNIP>

All the best

Terry Herbert

in sunny Kalk Bay, South Africa

Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No

conventional treatment. Present PSA 6.25:fPSA 38% My site is at

www.prostatecancerwatchfulwaiting.co.za

It is a tragedy of the world that no one knows what he doesn't know, and

the

less a man knows, the more sure he is that he knows everything. Joyce

Carey