A prostate cancer patient in Wales has decided to take action himself to expand availability of prostate cancer screening. But the interesting thing to The “New” Prostate Cancer InfoLink were the comments of The Prostate Cancer Charity when asked about this initiative.
To get the details of this story, have a look at WalesOnLine. Reg Williams — the patient — is “exploring the possibility of using a mobile PSA testing machine which can give a result in just 20 minutes” and “He hopes to be able to offer the test throughout Wales in the absence of a national screening programme.” Wales ( a part of the UK west of most of England) has a population of about 2.9 million. According to Cancer Research UK, there were 2,249 cases of prostate cancer diagnosed in Wales in 2005.
When asked about this initiative, Anna Jewell, head of policy and campaigns at the Prostate Cancer Charity, is supposed to have said:
The Prostate Cancer Charity understands the strong views held by many people that a PSA-based screening programme should be introduced.
The charity does not currently support a PSA-based national screening programme for prostate cancer because the test is not a reliable screening tool and, as yet, there is no scientific evidence that such a programme would save lives.
The introduction of a national screening programme for prostate cancer using the PSA test, at this stage, would suggest to men that screening for prostate cancer would be of benefit to the majority of men in the UK and that it would save lives.
This would not necessarily be the case, as a screening programme for prostate cancer using the PSA test could cause more harm than good to some men.
This is because some healthy men would be diagnosed with a cancer, through the screening programme, and go on to receive treatment – and experience the associated side effects – for a harmless cancer that would otherwise have gone undetected during their lifetime.
Furthermore, the evidence currently available does not clearly show that a screening programme, using the PSA test, would save lives.
The “New” Prostate Cancer InfoLink has commented on this mindset before. It is a problem that reflects not the risks of screening and diagnosis but the risks of consequential behavior of patients and (most importantly) their doctors. A diagnosis of prostate cancer is not and should not be sign that every patient needs to rush out and get invasive treatment. It is a sign that there is a problem that needs to be carefully assessed and managed, but if you don’t get screened, you don’t know the risk. So how can you assess or manage it with care?
What surprises The “New” Prostate Cancer InfoLink is to hear this viewpoint expressed by one of Europe’s foremost prostate cancer advocacy organizations. We all understand that there are significant risks associated with prostate cancer screening. Two of those risks are:
- That men who are diagnosed with early stage disease get treatment that isn’t necessary
- That men aren’t diagnosed sufficiently early to get potentially curative therapy that they need
But, with appropriate action, this problem is manageable … if men get screening and they and their doctors get educated about understanding the risk along the way!
The management of prostate cancer comes with many, many options. One of the most important (and most under-utilized) is active surveillance. If physicians don’t promote this form of management to appropriate patients, and explain exactly why it is appropriate, there is a problem — and at the moment there is such a problem!
Filed under: Diagnosis, Management, Risk Tagged: | risk, screening, Wales
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Mike, although I agree that more needs to be done with active surveillance, a diagnosis of cancer creates so much anxiety for the patient and family that a large percentage of men are getting treated, not because they have a significant change in their cancer, but rather they can’t cope psychologically. So to say it is fine to screen but not treat still results in over treatment. The comments from the UK are accurate for stating the facts as they are I think that having this person offer any screening is not unreasonable as long as people are clearly told there is no evidence that it works at this time.
Gerry: I agree … with the proviso that I think there is a real obligation on the part of the physician community to think much harder about what they say to newly diagnosed patients and how they say it — especially when those patients are 70+ with low risk, early stage disease.
My concern is that by making a big deal over screening or not screening we are over-emphasizing the wrong issue, which is really the issue of how one manages the problem of the diagnosis (as a patient and as a doctor).
We all seem to be ignoring something that I wrote about elsewhere on the main site. In most of the Western world today, a Dx of early stage, low to intermediate risk disease is actually relatively normal. So if it is now normal, why do we all still all insist on behaving as though it is some sort of crisis? I think it’s re-education time!
:O)