Guest guest Posted April 2, 2004 Report Share Posted April 2, 2004 Screening 'works' only if it accompanied by timely treatment for those men detected with PC. That is the 'secret' of Prof. Labrie's success in Quebec. As I recall these studies, Labrie used a threshold PSA of 3 ng/ml plus DRE (either on its own is not sufficient to eliminate false + / - ) and then treated those men detected with hormonal blockade. It is an interesting story and after so many years of success one wonders why the USA and UK has not moved forward in step with the Canadians. Labrie's results are not skewed by 'lead time bias' because they are so mature, any 'bias' would be ironed out long ago. What you see is what you get & it is encouraging for those of us fortunate enough to be in the know and able to demand PSA testing when we need it, and not be fobbed of by some of the ridiculous excuses floating around for not having a PSA test. [ Like PSA testing / results / uncertainty can stress & traumatise a man -- presumably more so than being diagnosed with late incurable PC ? ] Sammy. Screening works! From Rick Ward, I don't think this made it to this list and this isimportant information. I think a 62% reduction in deaths is significantenough to make people think. KathyDr. Labrie has been in the forefront of hormonal manipulation, and PCascreening. Here's his latest update on the large and long following ofthe basic research that established 3.0 ng/ml as the breakpoint forscreening in Canada and most of Europe.http://tinyurl.com/2qys8Prostate. 2004 May 15;59(3):311-8.Screening decreases prostate cancer mortality: 11-year follow-up of the1988 Quebec prospective randomized controlled trial.Labrie F, Candas B, Cusan L, Gomez JL, Belanger A, Brousseau G,Chevrette E, Levesque J.Oncology and Molecular Endocrinology Research Center and Departments ofMedicine and Radiology, Laval University Medical Center (CHUL), andLaval University, Quebec, Canada.PURPOSE: This clinical trial is aimed at evaluating the impact ofprostate cancer screening on cancer-specific mortality. SUBJECTS ANDMETHODS: Forty-six thousand four hundred and eighty- six (46,486) menaged 45-80 years registered in the electoral roll of the Quebec cityarea 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 the14,231 unscreened controls while 10 deaths were observed in the screenedgroup of 7,348 men during the first 11 years following randomization.Median follow-up of screened men was 7.93 years. A proportionalhazards model of the age at death from prostate cancer shows a 62%reduction (P < 0.002, Fisher's exact test) of cause-specific mortalityin the screened men (P = 0.005). These results are in agreement with thecontinuous decrease of prostate cancer mortality observed in NorthAmerica. Copyright 2004 Wiley-Liss, Inc.PMID: 15042607 [PubMed - in process]Since Canada has national health care, the availability andaffordability of treatment is not an issue that skews the picture asmuch as it would in the US. However, RP is still far and away the "goldstandard" in Canada. Still, look at the remarkable reduction inmortality notwithstanding that there are many more innovative treatmentprotocols available in the US. Of course, hormonal manipulation isemployed in Canada more frequently.I think the key in this picture is the 3.0 "alert" level. There is nocontesting that early detection equates with better outcomes, IMO. And3.0 will get attention earlier in the PCa game than 4.0.Rick Ward Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2004 Report Share Posted April 3, 2004 I must thank Sammy for his thoughts on this subject. I too am mystified to the extent that the reasons given are a smoke screen tp cover other problems (cost or numbers of urologists) Best wishes Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 4, 2004 Report Share Posted April 4, 2004 , It really is puzzling and 'stressful' not having a proper answer to this. A couple of years ago I wrote to Muir Gray*and just over a year ago I addressed Mike s at a 'conference'. On both occasions I was given the courtesy to speak as it were, but the real COURTESY of a competant reply to my question why screening is not practiced in the UK if it saves llives has not been answered. Just a few weeks ago I got a reply from my MP after complaining to him about the 'smoke screen' and I get sent via him, the latest 'bumph' from government offices on why screening is not going to be implemented. The reasons are not worth repeating - just waffle and pap. Can't blame the MP because it is a 'technical matter' and we have to trust the experts (well that is the conventional wisdom that keeps out Democracy running). Gray sent me literally a textbook copy explanation of 'lead time bias' - we know that lead time bias in the Labrie studies has been ironed out by the age of the study. I actually spoke to him on the phone after that (# below). He said he had not heard of Labrie and would look into it. I have not heard from him since. s has not bothered to send a reply to my question, and neither have the organisers of the conference who promised to follow this question up. I feel a lot of government money is being wasted by way of 'initiatives' as Cancer Conferences and the so-called Expert Patient Plans. These initiatives involve sending patients & carers as delegates to expensive hotels for a couple of days to listen to how good the 'system' is and the great things it is doing - but it is really all sop and palliative - no real science or analysis behing the self congratulations and mutual back slapping. It may have a limited theraupetic value - a few people feel better by getting out and doing something (albeit at what expense!), but the meaningful content of the exercise in terms of the potential to make social change, is zero. I have been pretty quiet for the last eight years because I didn't want my young family cast in any public 'limelight' should I complain too loudly, but now we are growing up and I am willing to become more public. I feel it is important to let men know they are at risk if they do nothing about a prostate condition, and the best way to do something is to get regular testing plus appropriate and timely treatment. Someone made me think about this a lot when he challenged me on the 'facts' I had concerning young men and prostate cancer risk because he thought I was alarmist. I see the concern there but I do believe it is no good sticking our heads in the sand. Young men are at risk if they have PC, full stop. The risk is greater if they are not diagnosed and treated. I supplied about 4 references that are very strong, but the Djikman paper really sums it up with the graphs comparing 'age at PC diagnosis' and 'age at PC related death'. At the young end of the scale the lines for diagnosis and death practically overlap - there is no 'survival' to speak of for the majority of men under the age of fifty who are diagnosed with this disease. On the other hand, a man diagnosed at age seventy has got the best survival chances. The visual effect of the graph makes the difference very clear. Sammy. *National Screening Committee tel 01865 226833 RE: Screening works! I must thank Sammy for his thoughts on this subject. I too am mystified to the extent that the reasons given are a smoke screen tp cover other problems (cost or numbers of urologists) Best wishes Quote Link to comment Share on other sites More sharing options...
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