Re: Quality-of-Life Effects of Prostate-Specific Antigen Screening

[Guest guest]

Just say "NO" ! to any procedure until you know what you are getting into. I say the same thing about bungie jumping.I don't have a problem with PSA screening used as a tool to inform a man about the possibilities or probability of having prostate cancer. I do have a problem with the medical industry not supplying enough information so that a rational decision can be made. I suspect very few if any of us prostate cancer survivors really had the pros and cons of what a high PSA could mean or what any treatment results could be expected. He who has had any type of prostate cancer treatment and has been ecstatic about his quality of life afterwards -- hold up your hand !! I have never met anyone that has had a better quality of life after any type of procedure be it radiation, surgery, cryo, etc.The industry has a cash cow and it are us. Sounds like something Pogo would say.HenryQuality-of-Life Effects of Prostate-Specific Antigen ScreeningN Engl J Med. 2012 Jul 15;367(7):595-605, EAM Heijnsdijk, EM Wever, A Auvinen, J Hugosson, S Ciatto, V Nelen, M Kwiatkowski, A Villers, A Paez, SM Moss, M Zappa, TLJ Tammela, T Makinen, S Carlsson, IJ Korfage, M-L Essink-Bot, SJ Otto, G Draisma, CH Bangma, MJ Roobol, FH Schröder, HJ de KoningTAKE-HOME MESSAGEResults from a follow-up study examining the benefits and risks associated with PSA screening for prostate cancer indicate that the risks in terms of loss of quality-of-life years may outweigh its benefits.SUMMARYOncologySTAT Editorial TeamIn recent years, much controversy has surrounded the benefits of prostate-specific antigen (PSA) screening in detecting and ultimately managing prostate cancer. Reports on the harms and benefits of PSA screening have been highly inconsistent due to limited results from randomized screening trials. In some cases, up to 56% of PSA screen-detected tumors would have never resulted in clinical symptoms, but these overdiagnosed cancers are frequently treated, with associated risks of adverse effects. Thus, Heijnsdijk and colleagues, utilizing data from the European Randomized Study of Screening for Prostate Cancer (ERSPC), examined the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening.In regard to QALYs, the investigators considered treatment-related complications, such as urinary incontinence, bowel dysfunction, and erectile dysfunction. QALYs were analyzed in both patients who were screened and those who were not screened. Based on a model developed by the investigators, it was predicted that annual screening would yield a total gain of 73 life-years. In addition, a relative increase of 40% in the number of prostate cancer diagnoses was predicted.). Ultimately, a total of 8.4 years were gained per prostate cancer death avoided.Although the investigators recognized the benefits associated with PSA screening, they also noted that these benefits may have been mitigated by the impact of screening on QALYs. They noted that the extension of screening to age 74 would result in an overall gain of 82 life-years and an increase in the number of prostate cancer deaths prevented from 9 to 11. However, after adjusting the number of life-years gained from screening relative to quality-of-life effects, the investigators predicted a 32% reduction in unadjusted life-years since only 56 QALYs would be gained, primarily due to the large number of overdiagnosed cases (48% of cancers detected via screening) and an additional 372 negative biopsies.That number projects to a 23% reduction from the predicted number of life-years gained. It is interesting to note that the 23% predicted reduction is higher than the 8% predicted reduction estimated for breast cancer screening.In closing, strategies to reduce overdiagnosis would be necessary before universal PSA screening can be advocated. The investigators found that the benefits associated with PSA screening were diminished by the loss of QALYs due to postdiagnostic long-term effects. They noted that their study results indicate how clinicians need to evaluate the benefit of PSA screening in regard to the overall reduction in prostate cancer mortality with the associated harms.Access this article »Summary written by the OncologySTAT editorial team

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[Guest guest]

Henry,I think you are being far too pessimistic about this. In my entire journey from diagnosis of highly aggressive prostate cancer in 2004 at age 75, through getting information from my doctors or on my own, through treatment by IMRT external radiation plus hormonal therapy, through recovery to my pre-diagnosis physical condition - which was good, I am ecstatically holding up my hand for the simple reason that I am still alive and well, in the bosom of my extended family.Manny RosenbaumSubject: Re: Quality-of-Life

Effects of Prostate-Specific Antigen ScreeningTo: Date: Tuesday, August 28, 2012, 5:26 PMJust say "NO" ! to any procedure until you know what you are getting into. I say the same thing about bungie jumping.I don't have a problem with PSA screening used as a tool to inform a man about the possibilities or probability of having prostate cancer. I do have a problem with the medical industry not supplying enough information so that a rational decision can be made. I suspect very few if any of us prostate cancer survivors really had the pros and cons of what a high PSA could mean or what any treatment results could be expected. He who has had any type of prostate cancer treatment and has been ecstatic about his quality of life afterwards -- hold up your hand !! I have never met

anyone that has had a better quality of life after any type of procedure be it radiation, surgery, cryo, etc.The industry has a cash cow and it are us. Sounds like something Pogo would say.HenryQuality-of-Life Effects of Prostate-Specific Antigen ScreeningN Engl J Med. 2012 Jul 15;367(7):595-605, EAM Heijnsdijk, EM Wever, A Auvinen, J Hugosson, S Ciatto, V Nelen, M Kwiatkowski, A Villers, A Paez, SM Moss, M Zappa, TLJ Tammela, T Makinen, S Carlsson, IJ Korfage, M-L Essink-Bot, SJ Otto, G Draisma, CH Bangma, MJ Roobol, FH Schröder, HJ de KoningTAKE-HOME MESSAGEResults from a follow-up study examining the benefits and risks associated with PSA screening for prostate cancer indicate that the risks in terms of loss of quality-of-life years may outweigh its benefits.SUMMARYOncologySTAT Editorial TeamIn recent years, much controversy has surrounded the benefits of prostate-specific antigen (PSA)

screening in detecting and ultimately managing prostate cancer. Reports on the harms and benefits of PSA screening have been highly inconsistent due to limited results from randomized screening trials. In some cases, up to 56% of PSA screen-detected tumors would have never resulted in clinical symptoms, but these overdiagnosed cancers are frequently treated, with associated risks of adverse effects. Thus, Heijnsdijk and colleagues, utilizing data from the European Randomized Study of Screening for Prostate Cancer (ERSPC), examined the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening.In regard to QALYs, the investigators considered treatment-related complications, such as urinary incontinence, bowel dysfunction, and erectile dysfunction. QALYs were analyzed in both patients who were screened and those who were not screened.

Based on a model developed by the investigators, it was predicted that annual screening would yield a total gain of 73 life-years. In addition, a relative increase of 40% in the number of prostate cancer diagnoses was predicted.). Ultimately, a total of 8.4 years were gained per prostate cancer death avoided.Although the investigators recognized the benefits associated with PSA screening, they also noted that these benefits may have been mitigated by the impact of screening on QALYs. They noted that the extension of screening to age 74 would result in an overall gain of 82 life-years and an increase in the number of prostate cancer deaths prevented from 9 to 11. However, after adjusting the number of life-years gained from screening relative to quality-of-life effects, the investigators predicted a 32% reduction in unadjusted life-years since only 56 QALYs would be gained, primarily due to the large number

of overdiagnosed cases (48% of cancers detected via screening) and an additional 372 negative biopsies.That number projects to a 23% reduction from the predicted number of life-years gained. It is interesting to note that the 23% predicted reduction is higher than the 8% predicted reduction estimated for breast cancer screening.In closing, strategies to reduce overdiagnosis would be necessary before universal PSA screening can be advocated. The investigators found that the benefits associated with PSA screening were diminished by the loss of QALYs due to postdiagnostic long-term effects. They noted that their study results indicate how clinicians need to evaluate the benefit of PSA screening in regard to the overall reduction in prostate cancer mortality with the associated harms.Access this article »Summary written by the OncologySTAT editorial team

____________________________________________________________53 Year Old Mom Looks 33The Stunning Results of Her Wrinkle Trick Has Botox Doctors Worriedconsumerproducts.com

[Guest guest]

It has been four weeks since I had my prostate removed. My quality of life is already better than before the surgery. For

years I suffered from BPH (enlargement of the prostate). I would wake up four or five times each night to urinate. I had to take drugs to help

reduce the size of the prostate or at least slow its growth. The drugs reduced the quality and quantity of my sex life. When I did get an erection, it didn't last long. When the biopsy showed cancer, the decision was easy, cut it out. I

traveled over 1,000 miles to have the prostate removed. Wanted someone who had done it thousands of times and published good results. A robotic radical prostatecomy was done and I spend one night in the hospital. All surrounding tissue was free of cancer and the final Gleason was 3 + 3 = 6. A week later the catheter was removed and I flew home. For

the first two weeks after the catheter was removed, I would leak a little. By week three, the leaks were gone. With help from Viagra, I had

my first prostate free erection at the end of the fourth week. It was the best erection (and sex) I had in years. I am hoping with time, the Viagra will not be required or the amount can be reduced. I no longer wakeup in the night to urinate. When I pee, my stream is strong. I

am so glad the prostate is gone. It caused problems for years and I don't miss it. One final word of advice, if you are going to have your prostate removed, find the very best surgery you can. The local urologist will not have the same results as doctors who just remove prostates. Charlie D. To: ProstateCancerSupport Sent: Thursday, August 30, 2012 2:49 PM Subject: Re: Re: Quality-of-Life Effects of Prostate-Specific Antigen Screening

Henry,I think you are being far too pessimistic about this. In my entire journey from diagnosis of highly aggressive prostate cancer in 2004 at age 75, through getting information from my doctors or on my own, through treatment by IMRT external radiation plus hormonal therapy, through recovery to my pre-diagnosis physical condition - which was good, I am ecstatically holding up my hand for the simple reason that I am still alive and well, in the bosom of my extended family.Manny RosenbaumSubject: Re: Quality-of-Life

Effects of Prostate-Specific Antigen ScreeningTo: Date: Tuesday, August 28, 2012, 5:26 PMJust say "NO" ! to any procedure until you know what you are getting into. I say the same thing about bungie jumping.I don't have a problem with PSA screening used as a tool to inform a man about the possibilities or probability of having prostate cancer. I do have a problem with the medical industry not supplying enough information so that a rational decision can be made. I suspect very few if any of us prostate cancer survivors really had the pros and cons of what a high PSA could mean or what any treatment results could be expected. He who has had any type of prostate cancer treatment and has been ecstatic about his quality of life afterwards -- hold up your hand !! I have

never met

anyone that has had a better quality of life after any type of procedure be it radiation, surgery, cryo, etc.The industry has a cash cow and it are us. Sounds like something Pogo would say.HenryQuality-of-Life Effects of Prostate-Specific Antigen ScreeningN Engl J Med. 2012 Jul 15;367(7):595-605, EAM Heijnsdijk, EM Wever, A Auvinen, J Hugosson, S Ciatto, V Nelen, M Kwiatkowski, A Villers, A Paez, SM Moss, M Zappa, TLJ Tammela, T Makinen, S Carlsson, IJ Korfage, M-L Essink-Bot, SJ Otto, G Draisma, CH Bangma, MJ Roobol, FH Schröder, HJ de KoningTAKE-HOME MESSAGEResults from a follow-up study examining the benefits and risks associated with PSA screening for prostate cancer indicate that the risks in terms of loss of quality-of-life years may outweigh its benefits.SUMMARYOncologySTAT Editorial TeamIn recent years, much controversy has surrounded the benefits of prostate-specific antigen (PSA)

screening in detecting and ultimately managing prostate cancer. Reports on the harms and benefits of PSA screening have been highly inconsistent due to limited results from randomized screening trials. In some cases, up to 56% of PSA screen-detected tumors would have never resulted in clinical symptoms, but these overdiagnosed cancers are frequently treated, with associated risks of adverse effects. Thus, Heijnsdijk and colleagues, utilizing data from the European Randomized Study of Screening for Prostate Cancer (ERSPC), examined the number of prostate cancers, treatments, deaths, and quality-adjusted life-years (QALYs) gained after the introduction of PSA screening.In regard to QALYs, the investigators considered treatment-related complications, such as urinary incontinence, bowel dysfunction, and erectile dysfunction. QALYs were analyzed in both patients who were screened and those who were not

screened.

Based on a model developed by the investigators, it was predicted that annual screening would yield a total gain of 73 life-years. In addition, a relative increase of 40% in the number of prostate cancer diagnoses was predicted.). Ultimately, a total of 8.4 years were gained per prostate cancer death avoided.Although the investigators recognized the benefits associated with PSA screening, they also noted that these benefits may have been mitigated by the impact of screening on QALYs. They noted that the extension of screening to age 74 would result in an overall gain of 82 life-years and an increase in the number of prostate cancer deaths prevented from 9 to 11. However, after adjusting the number of life-years gained from screening relative to quality-of-life effects, the investigators predicted a 32% reduction in unadjusted life-years since only 56 QALYs would be gained, primarily due to the large

number

of overdiagnosed cases (48% of cancers detected via screening) and an additional 372 negative biopsies.That number projects to a 23% reduction from the predicted number of life-years gained. It is interesting to note that the 23% predicted reduction is higher than the 8% predicted reduction estimated for breast cancer screening.In closing, strategies to reduce overdiagnosis would be necessary before universal PSA screening can be advocated. The investigators found that the benefits associated with PSA screening were diminished by the loss of QALYs due to postdiagnostic long-term effects. They noted that their study results indicate how clinicians need to evaluate the benefit of PSA screening in regard to the overall reduction in prostate cancer mortality with the associated harms.Access this article »Summary written by the OncologySTAT editorial team

____________________________________________________________53 Year Old Mom Looks 33The Stunning Results of Her Wrinkle Trick Has Botox Doctors Worriedconsumerproducts.com