MedPage slams Roswell Park Cancer Institute

And we have to say that we agree with Gary Schwitzer of MedPage that over-promotion of prostate cancer screening as implemented by Roswell Park’s media partners is no longer justifiable.

Unlike Mr. Schwitzer, we are not so sure whether it is the Roswell Rark Cancer Institute or their media partners who are really responsible for this over-promotion, but Roswell Park certainly needs to do a little homework. Mass screening of all men over the age of 40 (or 50) for risk of prostate cancer is no longer justifiable on the basis of data available today — which does not mean that testing of individuals is inappropriate.

What needs to happen today is that (a) men understand their potential risks for prostate cancer before they decide to have a PSA and a DRE and that (b) they have a sound understanding before they get that DRE and PSA test that there are real risks associated with the diagnosis and treatment of prostate cancer.

Some men — those at high risk for prostate cancer as a consequence of a family history or ethnicity — should quite certainly get annual PSA tests and DREs in order to monitor their risk for prostate cancer with care. For other men, however, annual testing may present undue risk of finding indolent disease.

It is imperative that we find a way to talk about prostate cancer risk that is much less based on the “fear factor” and much more focused on the reality that mass screening is probably not the most appropriate way to try to identify prostate cancer as a clinically significant condition that may affect men’s quality of life or their mortality. We need better tests, but in the meantime we also need a more thoughtful approach.

If one searches carefully through all of the information on the new web site of the Prostate Club for Men, you will indeed find all of the necessary provisios about risks and “talking to the doctor.” But the message that comes across to any naive reader is still that you need to get a PSA test and a DRE once you hit early middle age, and that simple message is not a good one anymore. The core message today needs to be one that emphasizes finding men at real risk of clinically significant prostate cancer, not just any prostate cancer. Explaining the difference between the two and making sure that a potential patient really understands that difference is critical to every subsequent decision that that patient may make!

The real pity here is that the Roswell Park Cancer Institute really is one of the best cancer care centers in the nation, but some people in their health education and communication departments need to sit down and look carefully at the available data and make sure that their media partners are not over-promising on what they are promoting.

7 Responses

  1. Many men do not go to the doctor until they have symptoms and when those symptoms are advanced. I have a friend who has extreme pain in his shoulder. It caused him major problems on Sunday. His wife said to me that maybe this might get him to go to the doctor, but he called me about 2 hours later and when I asked him if he was going to call the doctor on Monday, he responded “Well maybe, eventually.”

    This program pushes having a discussion with your doctor.

    The quotes from the article are “Men — and the women who love them — need to be proactive in understanding the risk factors and how to ‘aim for a cure’ through early detection” and “you will be making a commitment to discuss screening with your doctor, and, if deemed appropriate for you, have both a PSA test and digital rectal exam (DRE).”

    Maybe the real issue is with the doctors? Shouldn’t awareness programs be focused on getting men to the doctors to discuss their personal risk and both sides of the early detection debate? How can that personal discussion be shortened down to a sound bite for an awareness program? Isn’t it better to have men discuss screening with their doctor rather than getting the test without their knowledge which happens sometimes now? If they are asking questions isn’t that good? As the example of my friend above illustrates there are many men who don’t even go to the doctor. What would an appropriate awareness program look like?

  2. Perhaps the real problem is just the male mindset: “I don’t need to worry about any of this. I’m not sick.”

    Remember … the idea of going to a doctor isn’t just about prostate cancer. Most men don’t see a doctor regularly at all (until they really are sick). But prostate cancer is WAY down on the list of things that might kill them!

    Men need health awareness education, not just prostate cancer awareness! Your friend would seem to be a classic case example!

  3. Mike,

    I agree but for certain men it is important for them to talk to their doctors about prostate cancer. Also prostate cancer might be the push they need to get into the doctor’s office. Once there I would hope that the doctor would do a blood pressure, glucose, cholesterol, etc. I would like to see more younger faces in prostate cancer education. How many mammograms are done that are done that are negative? How many breast biopsies are done that are negative? As a woman if I get into the doctor’s office they don’t just look at my breasts. With a push to talk to your doctor about prostate cancer it can be a driver to get them into the office.

  4. When I read Kathy’s comment about her friend with severe shoulder pain, I was reminded of my Dad, who never went to the doctor until he “had to” and to the best of his wife’s knowledge, never had a PSA test or digital rectal exam.

    Over the course of several months, he too experienced increasing pain in his right shoulder. The pain was so debilitating that we once found him collapsed and whimpering in the backseat of our car, begging us to take him to a doctor. In too much pain to lie on his back for an MRI, Dad could not be diagnosed and his doctor “guessed” that might have a dislocated shoulder. He was given pain pills and sent home.

    I live out of town and one morning I received a call from Dad, who asked if I could use my connections (I work in health care) to get him into a major medical center near his home. I did, and guess what? He expired within 24 hours, still without a diagnosis. My family could not have been more shaken by the news that he had passed away.

    After an autopsy was performed, we discovered that my beloved, stubborn Dad had prostate cancer that had metastasized to the bone. For a long time after, my siblings and I were angry at Dad for not having that simple blood test that might have alerted him (and us!) to the fact that something was terribly wrong, something that might have been fixed.

    So I ask you: Still think talking to your doctor and having an annual physical is a bad idea? I think both actions are empowering, and yes, perhaps life-saving.

    Miss you, Dad!

  5. There is legitimate concern that widespread use of the PSA test may overdiagnose prostate cancer and put men at risk for complications from unnecessary treatments such as surgery and radiation. Roswell Park developed the PSA test for prostate cancer detection and management, and we are well aware of the test’s advantages and limitations. In fact, our researchers are working hard to improve the PSA test to make one better able to ferret out prostate cancers that are potentially aggressive and life-threatening.

    I chair the 24-member National Comprehensive Cancer Network (NCCN)’s Prostate Cancer Guidelines Committee. NCCN guidelines, which are based on scientific data, are the most widely used standards for cancer care in the world. I am also the Chair of the Department of Urology and the Senior Vice President of Translational Research at Roswell Park Cancer Institute.

    I feel very strongly that it is wrong to just give a patient a PSA test without consideration of how the results will be used. The test has to be given intelligently and shouldn’t just be a knee-jerk recommendation. If you’re at high risk for prostate cancer because you’re African-American or have a father or brother with the disease, do not wait for more studies and all the results to come in. Get the test. If you’re low risk and have a normal PSA, I would stop getting the test when my life expectancy fell to 10 years or less. Until then, I’d get the test every one or two years.

    Ironically, the Prostate Club for Men at Roswell Park was started because of the “heard-loud-and-clear” messages from many men in our community -– some of whom came to Roswell Park confused by “first time” elevated PSAs -– who said that they felt that they were being rushed into cancer treatment. Men with elevated PSAs who come to Roswell Park for answers are told three things: 1. Don’t panic. Elevated PSAs do not always mean cancer. 2. Don’t rush into decisions. 3. Get a second or third opinion and assure that recommendations you receive are vetted through current national guidelines and evidence-based medicine.

    Roswell Park also established a High Risk/Early Detection Prostate Cancer Clinic for men who have been told they have an elevated PSA, and who would like a Roswell Park expert to evaluate their results and recommend next steps. Many times, those “next steps” include “watching and waiting” (or active surveillance) which is recommended for men in whom evidence indicates that their cancer does not need to be treated.

    Talking to one’s doctor about screening is not the same as being treated, and we believe that Mr. Schwitzer muddies those issues. Is his takeaway message to men: Don’t talk to your physician? Prostate Club members are encouraged to be their own health advocates, to seek out the facts about prostate cancer and to have a discussion with their physicians about whether (and when) testing is appropriate for them. Many men do not even know what it means to be at “high risk” for prostate cancer.

    Prostate cancer screening is “quick and simple” -– deciding what to do with the information it yields is not. The American Cancer Society urges men “to have an opportunity to learn about the benefits and limitations of testing for the detection and treatment of early prostate cancer.” The Roswell Park position concurs: Come on guys, let’s talk.

  6. The “New” Prostate Cancer InfoLink would like to thank Dr. Mohler for his clarifications above.

    We wish to be EXTREMELY clear that our original article above was intended to stimulate discussion about the clarity of communication needed between a man and his physician in addressing the need for prostate cancer testing in individual patients as compared to the mass screening of prostate cancer.

    The problem we are faced with today is that way too many messages get boiled down to simple “do this” or “don’t do that” messages that may be sound in general but are not necessarily sound for the individual.

    Whether we like it or not, all men have an individual responsibility to manage their health care — in the interests of themselves and their families. Exercising that responsibility takes time and thought. It is not enough to go and do something just because it may get you a couple of ice hockey tickets.

  7. Excuse me folks!!!!!

    I was diagnosed with Stage III aggressive prostate cancer at age 51, and if it had not been for a friend and the prodding from my wife I would quite frankly be dead now, had it not been for a PSA test and follow up tests.The important factor is not the number on the report but the doubling time of your PSA number. This means more than one PSA test needs to be done.

    Remember also that if a doctor can find a nodule via a DRE then some kind of growth is already present and frankly I would rather know before we get to that stage.

    I was high risk and did not know it because unfortunately not all families are close and men just DO NOT discuss these issues even after diagnosis let alone beforehand.

    Frequently, as in my case, there are not any noticeable signs to look for and unlike breast or testicular cancer self-examination is not possible, so I implore you until such time as all of you can come up with a better way of diagnosing and have something positive to say then SHUT UP the negativity and let’s save lives.

    I am so sick of all the bickering about this test. I can tell you I have met hundreds of men who would not be here today had they not had a PSA test and wonder just how many lives saved it takes before you come down off your high horses and allow screening for this disease and have it paid for just as we do for mamograms!!! God forbid you should try and take this stance with women!!

    As far as discussing this with a man’s doctor, I tried and was told I was too young and after several bouts with my physician I told her it was my $25.00 and insisted it be done. NO my life has not been great since surgery, radiation, and hormone therapy but I am still on the green side of this planet and am not rushing to leave anytime soon.

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