Prostate PSA test found useless

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Prostate PSA test found useless

Postby Hartzell » 12 Sep 2004, 21:26

Cancer test useless

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 Friday 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.
-- http://www.taipeitimes.com/News/world/a ... 2003202684

Stanford researcher declares 'PSA era is over' in predicting prostate cancer risk
STANFORD, Calif. - The PSA test, commonly used as a screening tool for detecting prostate cancer, is now all but useless for predicting prostate cancer risk, according to Stanford University School of Medicine researchers. A study of prostate tissues collected over 20 years - from the time it first became standard to remove prostates in response to high PSA levels to the present - reveals that as a screen, the test now indicates nothing more than the size of the prostate gland.
"The PSA era is over in the United States," said Thomas Stamey, MD, professor of urology and lead author of the study published in the October issue of the Journal of Urology. "Our study raises a very serious question of whether a man should even use the PSA test for prostate cancer screening any more."

The PSA test measures prostate specific antigen, a protein normally produced by the prostate gland. Stamey published the original findings in 1987 in the New England Journal of Medicine showing that increased blood PSA levels could be used to indicate prostate cancer. However, through the years, Stamey has come to believe that the PSA test is actually not a useful predictor of the amount or severity of prostate cancer. He said elevated levels of that protein actually reflect a condition called benign prostatic hyperplasia, a harmless increase in prostate size.

Stamey explained the change in correlation over the years by noting that the tumors encountered 20 years ago were generally so large they generated PSA levels high enough to provide a reasonably good measure of cancer severity. Now that screening is more commonplace in this country, many cancers are being caught earlier and are usually smaller - not generating enough PSA to be a good indicator of severity.

Prostate cancer is the most common cancer in men. Stamey cited a 1996 study in which researchers examined the prostates of healthy men who died from trauma, finding that 8 percent of those in their 20s already had prostate cancer. The American Cancer Society estimates that nearly a quarter of a million cases of prostate cancer will be diagnosed in the United States this year alone, and one in six men will be diagnosed with the disease at some point in their lives. Stamey said prostate cancer is a disease "all men get if we live long enough. All you need is an excuse to biopsy the prostate and you are going to find cancer."

However, the risk of dying from prostate cancer is very low compared with lung cancer, which is the leading cause of cancer-related death in men, he said. "Almost every man diagnosed with lung cancer dies of lung cancer, but only 226 out of every 100,000 men over the age of 65 dies of prostate cancer, which is a rate of .003 percent," he said, referring to National Cancer Institute statistics.

Stamey explained the basic dilemma as such: men whose PSA levels are above 2 ng/ml frequently undergo biopsy, which will almost always find cancer, but this does not necessarily mean that prostate removal or radiation treatment is required. "What we didn't know in the early years is that benign growth of the prostate is the most common cause of a PSA level between 1 and 10 ng/ml," he said.

To figure out the PSA test's usefulness in determining which cancers warrant radiation or surgery, Stamey and his team from Stanford's Department of Urology set out to document what was actually found following prostate removal, such as the volume and the grade of the cancer - two indications of the cancer's severity. They then compared those findings to aspects that could be determined prior to surgery, such as how many of the cancers could be felt by rectal examination and the patient's blood PSA level.

For the study, they used prostate tissue samples collected by professor John McNeal, MD, who has examined more than 1,300 prostates removed by different urologists at Stanford in the last 20 years. The researchers divided McNeal's data into four five-year periods between 1983 and 2004 and looked at the characteristics of each cancer. They found that over time, there was a substantial decrease in the correlation between PSA levels and the amount of prostate cancer - from 43 percent predictive ability in the first five-year group down to 2 percent in the most recent one.

However, the Stanford researchers concluded that the PSA test is quite accurate at indicating the size of the prostate gland, meaning that it is a direct measure of benign prostatic hyperplasia. And Stamey pointed out that it is still very useful for monitoring patients following prostate removal as an indicator of residual prostate cancer that has spread to other parts of the body.

"Our job now is to stop removing every man's prostate who has prostate cancer," said Stamey. "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."

If the PSA test is no longer useful, the question remains as to the best course for detecting prostate cancer. Stamey recommends a yearly digital rectal exam for all men over 50. "If a cancer is felt in the prostate during a rectal examination, it is always a significant cancer and certainly needs treatment," he said.

Unfortunately, he added, even large cancers often cannot be felt during rectal examination. His group is currently working on finding a blood marker that could indicate more aggressive forms of the cancer that can invade the body.

Other researchers who contributed to this work are Mitchell Caldwell, Rosalie Nolley, Marci Hemenez and Joshua Downs. The study was funded by donations to Stamey's Prostate Cancer Research Fund at Stanford.

### Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.
-- http://www.eurekalert.org/pub_releases/ ... 090804.php

Prostate cancer tests useless
Press Association, Friday September 10, 2004

The PSA test commonly used to detect prostate cancer is now all but useless for predicting the risk of the disease, leading researchers have said.

The test measures for prostate specific antigen (PSA), a protein normally produced by the prostate gland.

Raised PSA levels can lead to men undergoing radical surgery and treatment, sometimes leaving them with serious long-term side-effects such as incontinence and impotence.

But experts have increasingly come to believe that the test leads to unnecessary treatment when men could be monitored and live with the cancer without it ever causing any problem.

Now researchers at Stanford University School of Medicine in the US have declared: "The PSA era is over."

They studied prostate tissues collected over 20 years, from the time it first became standard to remove prostates in response to high PSA levels to the present.

The team led by Professor Thomas Stamey said in the Journal of Urology that, as a screening test, the PSA now indicated nothing more than the size of the prostate gland.

Prof Stamey said: "Our study raises a very serious question of whether a man should even use the PSA test for prostate cancer screening any more."

PSA screening has become more commonplace in the US. In the UK there is no formal screening programme for prostate cancer but the PSA test is being used increasingly by doctors.

Earlier this year cancer experts in the UK voiced concerns that the test was unable to distinguish between cancers which were "tigers" and those which were "pussycats", leading many into treatments they did not need.
-- http://www.guardian.co.uk/uklatest/stor ... 33,00.html
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Postby Dr Doom » 12 Sep 2004, 21:44

These doctors need to get their fingers out of their arses.
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Re: Prostate PSA test found useless

Postby robert_storey » 17 Dec 2004, 19:26

Hartzell wrote:Cancer test useless

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 Friday 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.
-- http://www.taipeitimes.com/News/world/a ... 2003202684


Interesting article, but this is just one researcher's opinion and it's not the Holy Grail. Unfortunately, I've recently had cause to become well-informed about prostate problems. I can tell you that the PSA test is alive and well and still being administered here in Taiwan. It's main drawback is that about 25% of prostate cancers do not cause a significant rise in PSA levels, so they go undetected. In other words, PSA isn't the end-all be-all test - you would still need a biopsy to confirm that cancer is present. The biopsy is considerably less fun than the PSA test, and just a little bit dangerous.

About the operation "radical prostatectomy" (complete removal of the prostate). Yes, it's controversial, especially for elderly men who have a difficult time recovering from the surgery, and would likely die of something else before the cancer killed them anyway. I think you could say this about a lot of invasive procedures that are routinely performed on the elderly. Is it worth putting a 78-year-old through a painful surgical procedure that requires a long recovery when it's likely they've only got a couple of years to live anyway?

But for a younger person, yes, a radical prostatectomy would seem to make sense, but only if it's done early enough before the cancer has spread. It's pretty much useless once the cancer gets into the lymph system (which it will if nothing is done). If the prostate gets removed in the early stage of the cancer, it's a 100% cure. That's nothing to sneeze at.

best regards,
Robert

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Postby MaPoSquid » 17 Dec 2004, 20:30

Intel's CEO, Andy Grove, discovered he had prostate cancer at a relatively young age (mid-50's). He wrote a long article explaining the various available procedures and their tradeoffs. I believe he also discussed the PSA test a bit, but it's been a few years since I read it.

Here's the start:
http://www.fortune.com/fortune/articles ... 77,00.html

Unfortunately, it looks like Forbes has restricted access to subscribers only, but it is available elsewhere on the web if you do a Google search.
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Postby sandman » 19 Dec 2004, 15:37

Dr Doom wrote:These doctors need to get their fingers out of their arses.

And ours.
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Postby sandman » 19 Dec 2004, 15:38

MaPoSquid wrote:Intel's CEO, Andy Grove, discovered he had prostate cancer at a relatively young age (mid-50's). He wrote a long article explaining the various available procedures and their tradeoffs. I believe he also discussed the PSA test a bit, but it's been a few years since I read it.

Here's the start:
http://www.fortune.com/fortune/articles ... 77,00.html

Unfortunately, it looks like Forbes has restricted access to subscribers only, but it is available elsewhere on the web if you do a Google search.

This book, Patient No. 1, is also available in incredibly wonderful Chinese, courtesy of my wife.
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Postby Gourd » 23 Dec 2004, 18:32

In response to this article, there is another one revealed that PSA marker is bounce and not associated with patients' survival and cure after radiation treatment. :noway:

PI, Eric M. Horwitz, MD, leads this resaerch team at Chase Cancer Center in Philadelphia, Pennsylvanis.
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Postby robert_storey » 23 Dec 2004, 22:19

Gourd wrote:In response to this article, there is another one revealed that PSA marker is bounce and not associated with patients' survival and cure after radiation treatment. :noway:

PI, Eric M. Horwitz, MD, leads this resaerch team at Chase Cancer Center in Philadelphia, Pennsylvanis.


Took me a little while to figure out what you were getting at. I found the article here:

http://www.docguide.com/news/content.ns ... 27006D990F

But that doesn't seem to change the fact that the PSA test would still be a useful diagnostic tool for many people.

cheers,
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Postby Gourd » 25 Dec 2004, 15:21

robert_storey wrote:
But that doesn't seem to change the fact that the PSA test would still be a useful diagnostic tool for many people.
Robert


I agree with you, definitely, PSA testing still could be applied to many persons, excepted some special conditions and cases. That's why more and more researcher are looking for molecular signatue or personalized medicie. Even there is still hurdle needed to be overcame.

Have a nice Christmas (and hope some of you are not in the East and Mideast Coast of States.......snow, sleet sweeping)
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Postby robert_storey » 01 Jan 2005, 14:18

I stumbled across this web page:

Optimal use of PSA & Radical Prostatectomy
http://www.prostate.org.au/mohler01.htm

I think it really sums up nicely the issue of when it is appropriate to use the PSA test, and when to consider going under the knife.

happy new year,
Robert

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