Here is the latest American Cancer Society Prostate Cancer Screening
Guidelines press release.
Please leave comments about these guidelines, by clicking to comment here
Update Reaffirms the Importance of Shared Decision-Making
ATLANTA –March 3, 2010 – Newly updated prostate cancer screening guidelines from
the American Cancer Society reaffirm the recommendation that men should discuss the
uncertainties, risks and potential benefits of screening for prostate cancer before deciding
whether to be tested. The update is the first since 2001 and was done as part of the
Society’s regular guidelines update process. It included a series of systematic reviews
focusing on the latest evidence related to the early detection of prostate cancer, screening
test performance, harms of therapy for localized prostate cancer, and shared and informed
decision making in prostate cancer screening.
The guideline is published online in advance of print publication in CA: A Cancer
Journal for Clinicians. The updated guidelines include these recommendations:
*Asymptomatic men who have at least a ten-year life expectancy should
have an opportunity to make an informed decision with their health care
provider about screening for prostate cancer after receiving information
about the uncertainties, risks, and potential benefits associated with
screening.
*Men at average risk should receive this information beginning at age 50.
Men at higher risk, including African American men and men with a first
degree relative (father or brother) diagnosed with prostate cancer before
age 65, should receive this information beginning at age 45. Men at
appreciably higher risk (multiple family members diagnosed with prostate
cancer before age 65) should receive this information beginning at age 40.
*Men should either receive this information directly from their health care
providers or be referred to reliable and culturally appropriate sources.
*Patient decision aids are helpful in preparing men to make a decision
whether to be tested.
*Prostate cancer screening should not occur without an informed decision
making process.
*Asymptomatic men who have less than a ten-year life expectancy based
on age and health status should not be offered prostate cancer screening.
*For men who are unable to decide, the screening decision can be left to the
discretion of the health care provider, who should factor into the decision
his or her knowledge of the patient’s general health preferences and
values.
“Two decades into the PSA era of prostate cancer screening, the overall value of
early detection in reducing the morbidity and mortality from prostate cancer remains
unclear,” said Andrew M. Wolf, M.D., Associate Professor of Medicine at the University
of Virginia Health System and Chair of the Advisory Committee. “While early detection
may reduce the likelihood of dying from prostate cancer, that benefit must be weighed
against the serious risks associated with subsequent treatment, particularly the risk of
treating men for cancers that would not have caused ill effects had they been left
undetected.”
The authors say in light of ongoing uncertainties, including the uncertain balance
between benefits and risks, involving men in the screening decision is crucial. “With
these newly updated recommendations, the American Cancer Society places even
stronger emphasis on shared decision making between clinicians and patients,” said Otis
Brawley, M.D., chief medical officer of the American Cancer Society. “The decision
whether to screen should be made with the help of a trusted source of regular care. Men
without access to regular care should not be tested unless high-quality informed decisionmaking
as well as appropriate counseling and follow-up care for those who test positive
can be assured. Without those, community-based screening should not be initiated.”
“Previous guidelines from the American Cancer Society and other organizations
have discussed the importance of informed decision making for men who are considering
prostate cancer screening, however this update is the first to provide details regarding
what information about screening is needed for informed decision-making to occur,” said
Alan G. Thorson, M.D., F.A.C.S., volunteer president of the Society. “For that reason,
the updated ACS guidelines delineate the core elements of information necessary for men
to engage meaningfully in this decision, and encourage inclusion of this information in
patient discussions and decision aids.”
The guidelines also includes updated clinical recommendations regarding
screening tests, intervals, and follow up of abnormal results for those men who choose to
be screened after considering the possible benefits and risks. The guidelines acknowledge
the limited contribution of digital rectal exam (DRE) to prostate cancer early detection
and state that screening can be performed using PSA with or without the DRE. The
guidelines recommend annual screening for men whose PSA level is 2.5 ng/ml or higher,
but state that screening intervals can be safely extended to every two years for men
whose PSA is less than 2.5 ng/ml. The guidelines affirm that a PSA level of 4.0 ng/ml or
higher remains a reasonable threshold to recommend referral for further evaluation or
biopsy for men at average risk of developing prostate cancer; for PSA levels between 2.5
and 4.0 ng/ml, health care providers should consider an individualized risk assessment
that incorporates other risk factors for prostate cancer in the referral decision.
The update included a complete review of the evidence. The American Cancer
Society’s Prostate Cancer Advisory Committee, composed of independent researchers,
clinicians and lay people, examined systematic reviews done by scientific experts at
Emory University, Rollins School of Public Health, met to hear presentations by experts
both on the Committee and by invited outside experts, and deliberated the evidence
before making its final recommendations. The guideline underwent peer review before
going before the American Cancer Society volunteer Board of Directors for approval.
The authors conclude by noting the urgent need for better ways to detect and treat
early-stage prostate cancer, particularly the need to distinguish between cancers that do
not require treatment and those that are aggressive, to help “tip the balance clearly in
favor of screening. Until that time, however, it will remain incumbent on health care
providers and the health care system as a whole to provide men with the opportunity to
decide whether they wish to pursue early detection of prostate cancer.”
Please leave comments about these guidelines, by clicking to comment here
To: The House Committee on Oversight and Government Reform
Re: “Prostate Cancer: New Questions About Screening and Treatment”
March 4, 2010
We wish to thank the Committee for allowing us to present four important issues, on behalf of the thousands of men, their loved ones and their families, whom Malecare serves.
Founded in 1998, Malecare is our country’s first and leading Gay men’s cancer survivor support group and advocacy national nonprofit organization. All who work for Malecare are volunteers. Malecare publishes the worlds’ largest multi-lingual prostate cancer focused website, malecare.org and several online support groups. Malecare is noteworthy for facilitating the largest grass roots prostate cancer survivor advocacy effort in over ten years. The Petition to make Prostate Cancer a National Priority currently has over 16,300 signatures of Americans who ask this Committee to increase federal funding for prostate cancer research.
Malecare has four unique programs, focused on men diagnosed in their thirties and forties, African American men, Gay men and men diagnosed with advanced disease, relevant to the Committee’s discussion on prostate cancer screening and treatment.
Malecare’s ”Prostate Cancer under 50” is our country’s only psycho-social support program for men diagnosed in their thirties and forties. We’ve seen approximately 700 men benefit from our program, with more men enrolling every day. From our experience, we can suggest that men diagnosed in their thirties and forties are more likely to die from prostate cancer than men diagnosed later in later years. We ask the Committee to support promotion of prostate cancer information to all men from age 35 and up, during medical consultations.
Our New Dad program teaches patrenting skills to young African American experiencing their first child. Integrated in our parenting skills workshops and website is the need for early vigilance around health care. Mixed messages about screening and access to healthcare diminish our capacity to help young African American men find reason to ask about prostate cancer during personal medical consultations. We ask the Committee to support promotion of prostate cancer awareness in our African American community.
Malecare is our country’s only national nonprofit focused on psycho-social support for men with advanced and terminal stage prostate cancer. Advanced prostate cancer is not curable. Approximately 27,000 American men died from prostate cancer in 2009 and comparable numbers will continue to die, every year, until there is a durable, morbidity free treatment or cure.
End stage treatments present debilitating morbidity and degrees of hope measured in days, weeks and months. Often, men learn of drugs and treatment protocols that might help, but are not yet available as they wait for outcomes of clinical trials and FDA approval. We ask the Committee to work with the FDA to create a mechanism for early and compassionate access to investigational or yet to be approved drugs and treatment protocols.
Current debate seems to have shifted focus towards those who live with their disease rather than those men who die from their disease. We need to refocus our consideration of prostate cancer towards helping those most likely to die from prostate cancer. We ask the Committee to support increased funding and promotion for research into end stage treatment.
Approximately 10% of all American men diagnosed with prostate cancer are men who have sex with men. Malecare is our country’s only cancer survivor support and advocacy national nonprofit focused on gay and bisexual men, and transgender women. Prostate cancer presents unique and only recently understood psycho-social challenges for gay men. Unfortunately, we are still in the dark about the disparities of prostate cancer incidence and outcomes of homosexual and heterosexual men.
Approximately 800,000 men in the United States are HIV positive, and innovative therapies have dramatically improved survival. Prostate cancer is a common malignancy in HIV-positive men. With improved therapies for HIV and increasing survival, the importance for screening and treating prostate cancer is increasing.
In a 2004 paper, Dr. Crum and her colleagues concluded that HIV-positive men aged 60-70 years had a higher rate of cancer diagnosis compared to an age-matched US general population rate. Dr. Hessol and her colleagues recently found that a cohort of HIV positive men in San Francisco had a significantly higher incidence of prostate cancer than the general population. In New York City, at the February 11, 2009 Gay Men and Prostate Cancer forum sponsored by the American Cancer Society, 50% of the audience self disclosed that they were both HIV positive and diagnosed with prostate cancer.
Many HIV positive men are receiving testosterone replacement and are not adequately being screened. If HIV truly does represent a risk for prostate cancer, then more rigorous screening may be necessary among men who have sex with men as a whole, and especially in those on testosterone replacement therapy. We ask the Committee that all funding for prostate cancer research include stipulations that men who have sex with men be identified and considered as a unique and significant cohort.
We thank the Committee for its leadership and for providing the opportunity to present four critical issues in prostate cancer regarding men diagnosed in their thirties and forties, African American men, Gay men and men presenting with late stage disease.
Radiation Accidents–Tell Us Your Story
By · CommentsRegulators and researchers can only guess how often radiotherapy accidents occur. With no single agency overseeing medical radiation, there is no central clearinghouse of cases. Accidents are chronically underreported, records show, and some states do not require that they be reported at all.
In June, The Times reported that a Philadelphia hospital gave the wrong radiation dose to more than 90 patients with prostate cancer — and then kept quiet about it. In 2005, a Florida hospital disclosed that 77 brain cancer patients had received 50 percent more radiation than prescribed because one of the most powerful — and supposedly precise — linear accelerators had been programmed incorrectly for nearly a year.
If you or a loved one have been subject to a radiation accident, please tell us your story: leave a reply by clicking Tell your story here.
Least Costly Alternative and Medicare
By · CommentsIrene Hayes, was denied payment of treatment prescribed by her physician and sued in federal court. Medicare had decided to only pay for the Least Costly Alternative (LCA), a treatment that her physician thought inadequate. As explained in the appellate court’s decision, under that policy, Medicare provides reimbursement for treatments only up to the price of their “reasonably feasible and medically appropriate” least costly alternatives. She won in federal district court, Medicare appealed the decision, and she won again in the Court of Appeals.
This is not just a victory for Irene Hayes but for Medicare beneficiaries everywhere, and especially for men who suffer from prostate cancer. Medicare has a history of using Least Costly Alternative to deny payment of more costly, but effective, treatment of prostate cancer.
Some fun is going on,which is also raising awareness of Prostate Cancer. Just write “briefs” , “boxers,” “jocks,” or “commando” in your status. Just the word, nothing else. It will be cool to see if this will spread Prostate cancer awareness. How long will it be, when people wonder why all the men describe their shorts in their status.”
We’re copying a worldwide effort started by Breast Cancer activists, who are updating their facebook status with their bra color. In the spirit of emulation being a sincere form of flattery, why not?
The American Urological Association (AUA)’s updated Prostate-Specific Antigen Best Practice Statement first at the annual meeting of the AUA in April, has been published in the November issue of the Journal of Urology.
The statement includes the controversial guidance that the prostate-specific antigen (PSA) test should be offered to men starting at the age of 40 years — which one critic has said is not supported by “any convincing evidence.”
The update also reiterates the AUA’s position that prostate cancer screening with PSA is a matter of individual choice.
There is no single standard that applies to all men.
“The single most important message of this statement is that prostate cancer testing is an individual decision that patients of any age should make in conjunction with their physicians and urologists. There is no single standard that applies to all men, nor should there be at this time,” Peter Carroll, MD, said in a press statement in April.
Dr. Carroll is chair of the panel that developed the statement and is from the University of California, San Francisco.
Men should be informed about the “risks and benefits of prostate cancer screening before biopsy,” notes the newly published statement, which acknowledges that there is “strong evidence” that prostate cancer screening leads to overdetection and overtreatment.
http://www.medscape.com/viewarticle/713192″>http://www.medscape.com/viewarticle/713192
http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf
If we are to be successful as a cause, each of us needs to make a personal and heartfelt commitment to care about each other collectively… to see every man directly impacted by this disease, regardless of his experience both as it relates to his general human experience and his outcome as it relates to prostate cancer, as an ally and someone worthy of compassion… to respect and embrace our differences and diversity – and to act collectively… embracing all impacted by this disease as one family.
So let’s start here this Thanksgiving!
Let’s be thankful for the time with family and friends – it is limited for those men who have missed their opportunity for early detection and effective treatment and are struggling with advanced disease -and truly a gift to cherish.
Let’s also be thankful for physicians dedicated to promoting quality personalized healthcare that have spared some men from potentially devastating unnecessary side-effects associated with overly aggressive treatment of low risk disease.
Let’s commit collectively to advancing standards of care that support optimal quality and quantity of life for all men diagnosed with prostate cancer.
Happy Thanksgiving to you and your family!
Prostate Cancer Calendar 2010 with wives of Prostate Cancer patients, produced by the New Jersey Prostate Cancer Coalition is facing negative criticism for it’s purely heterosexual bias. Twelve New Jersey wives have posed nude for a prostate cancer awareness calendar
called, “Stand By Your Man: 12 Women in Support of a Cure for Prostate Cancer.”
With Gay and Bisexual men comprising fully 10% of all men diagnosed with prostate cancer, the calender actually hurts many men, who already feel unheard and disenfranchised from the prostate cancer survivor community,” says Darryl Mitteldorf, CEO of the national gay men’s cancerl survivor support and advocacy nonprofit, Malecare. “Surely, one month in their calender could have included a gay man’s partner, along with the wives..that would truly raise awareness for everyone.” said Mr. Mitteldorf.
info@malecare.com and 212-673-4920
Three leading prostate cancer doctors are volunteering with Malecare to answer your questions, online, at http://www.prostate canceradvice.org This website is just starting, so, please feel welcome to be among the first to get the ball rolling.
1: Geo Espinosa, N.D., L.Ac, CNS, RH (AHG) is the Director of the Integrative Urological Center at New York University Langone Medical Center.
2: Dr Charles “Snuffy” Myer is both Medical oncologist and prostate cancer survivor. He was a key player in creating AZT, Suranim, and Phenylacetate while working at the National Institute of Health.
3: Daniel P. Petrylak, M.D., Associate Professor of Medicine, and Program Director of the Genitourinary Oncology Section in the Division of Hematology/Oncology , Department of Medicine, Columbia University Medical Center.
Prostate Cancer Petition
By · CommentsYesterday, Doug Ulman from the Lance Armstrong Foundation delivered 65,000 signatures, from survivors and supporters of all kinds of cancers on a Peitition.
Our Petition to Make Prostate Cancer a National Priority has an amazing 16,000 signatures. The most successful prostate cancer grass roots effort in over ten years! Soon, I will be meeting with our leaders in Congress and the White House to ensure the voices of prostate cancer survivors are heard.
Will you help us reach our goal of 20,000 names? It only takes a moment to sign your name and share it with your friends, and every single name makes a difference: Sign your name and send the petition to your friends and family:
http://www.prostate cancerpetition. org
Where we stand on Prostate Cancer research funding is simple, and this is the critical moment to make your voice heard.