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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2006Prostate cancer research
Hi all, I have got a question. A few universities in the UK are currently doing a research on prostate cancer, and they have written to 100,000 men all over the coutry to volunteer for an ASP test. I have received a request as well. Although in my opinion it is obvious that medical research should be supported, I'm a bit concerned about any consequences. The information sheet mentions that 1 out of 10 men will have a positive ASP result, which then will have to be examined. This amounts to 10,000 men out of 100,000. 8 or 9 men out of these 10 will found to have a false positive result (big relief, of course).My concern is that I might belong to these 8 or 9 men and that I will have to undergo unnecessary tests and even unnecessary surgery. This risk is clearly pointed out in the information sheet. Over the past ten years I have been cutting out articles on prostate cancer out of newspapers, so I have a basic knowledge of this subject. I also did some research on the internet. I'm 61, healthy (as far as I know), I have no prostate problems (touch wood), and there is no family history of prostate cancer. What shall I do? Sign up for the research (which I would have done right away if there weren't any consequences), or just leave it? If I had not been asked to take part in this research, I would not have asked my GP for an ASP test. Thanks, Tom > Hi all, > [quoted text clipped - 27 lines] > > Tom I assume that they are talking about PSA screening. I've never heard of an ASP test, but if it is something different, you should let us know a nd explain just what it is supposed to be. With respect to PSA screening, there is ongoing debate in the medical community about how useful it is. In the US, the great majority of urologists think it is useful in finding and curing early prostate cancers. Some other doctors, particularly epidemiolgists question this. The evdence so far does provide some evidence supporting the idea that screening helps, but it is really pretty complicated. So far there hasn't been a carefully controlled statistical test. For a disease like prostate cancer, which can take a long time to develop and can have different courses depending on age and other factors, it is hard to design a test the results of which will be universally accept. But there is one underway at present in the US, and the results should be out several years from now. I would be surprised if there were one simple answer coming out of it. It might very well turn out, for example, that testing is valuable in a certain agre range or for certain men but not generally. In the UK, it has been common practice not to screen for prostate cancer and not generally to treat it aggressively. A good argument can be made that this is the proper course for older men among whom the great bulk of prostate cancer is diagnosed. But it may not be the best strategy for younger men, say 50 to 70. It may be that medical authorities in the UK want to run their own test. If so, they will try to collect a large population of volunteers, divide them randomly in two groups matched on all relevant ciriteria, and screen half and not the others. So if you join the study, you may end up in the control group rather than the group getting the relevant procedure or testing. Whether or not you want to join seems a matter of whether you want to hlep satisfy a scientific question of some importance. > Hi all, > [quoted text clipped - 27 lines] > > Tom You're > a decade overdue for annual PSA checkups anyway ... a common problem in Europe. Why not get it within the study? No one can MAKE you do anything to your body you don't WANT done, but if I had a significant PSA, I'd DEMAND to know why -- infection, prostate hypertrophy, or cancer -- because they need to be treated. If tests ruled out the first two, I'd DEMAND a biopsy, and if it were positive, I'd DEMAND some sort of treatment even if it were just close long-term observation. That study just MAY have saved your life if your PSA test leads to the discovery of prostate cancer, because it's often been developing for many years before you feel any symptoms ... and once we feel symptoms we're often screwed. Similarly, I'm never willing to settle for what you said about your health: "As far as I know". I DO know about my health, to the extent it's possible, because most maladies can be detected and treated early with much better outcome. For example, as soon as I discovered that erectile dysfunction of any degree is highly correlated with atherosclerosis, I began considering a cardiovascular workup with a specialist, especially because I ate WAY too much saturated fat for 40 years. But four simple lab tests made from one blood draw cleared me of atherosclerosis, so that threat is no longer significant. I can rattle off a very long list of other health problems I KNOW I don't have, based on many tests. That's important for many reasons, including that it has -- I hope -- saved my life. At least twice. And I don't know how the UK media handle medical reporting, but in the U.S. the media's medical reporting is a joke. A two-page medical press release here can be condensed into one sentence: "Some blokes did some sort of study that probably involved prostate cancer; Google their names and topic for facts." I.P. > > ... > > The information sheet mentions that 1 out of 10 men will have a [quoted text clipped - 7 lines] > > so I have a basic knowledge of this subject. I also did some research > > on the internet. ... If you've been clipping newspaper articles for ten years (not the best place to get information by the way), you clearly have some concern about prostate cancer. It looks to me like you have a 90% chance of putting those concerns to rest, at least for the time being, by getting the test. In other words you are much more likely to be relieved by participating in the study than to be upset by it. > > I'm 61, healthy (as far as I know), I have no prostate problems (touch > > wood), and there is no family history of prostate cancer. What shall I > > do? Sign up for the research (which I would have done right away if > > there weren't any consequences), or just leave it? If I had not been > > asked to take part in this research, I would not have asked my GP for > > an ASP test. I never asked my GP for the PSA test. But she sent me for other routine tests for a physical exam and a lab technician added a check to the box that said PSA. I asked her why she did that when the doctor didn't order it and she answered, at your age (57 at the time) you should have a test. That person probably saved my life. Knowing what I know now, I recommend that you get the test. > .... Why not get it within the study? No one can MAKE you > do anything to your body you don't WANT done... That sounds right to me. If the test comes out positive, no one can make you get a biopsy, but I bet you'll want one. I didn't want one. I was sent to a urologist who said that with my PSA there was only a 15% chance that I had cancer. I thought, Why am I doing this? I'm not sick? This is ridiculous. It's just testing for the sake of testing. But the docs insisted that a biopsy was warranted and I gave in. Guess what? I did have cancer. And it turned out to be a significant case with a big ugly tumor and a worse prognosis than I initially thought. If you do have a high PSA and a biopsy shows that you have cancer then you can still refuse treatment and, in some cases, that's probably the right thing to do. But don't you want to make that choice rather than have it made for you by chance and fate? > ... > And I don't know how the UK media handle medical reporting, but in the > U.S. the media's medical reporting is a joke. A two-page medical press > release here can be condensed into one sentence: "Some blokes did some > sort of study that probably involved prostate cancer; Google their names > and topic for facts." Right. If you do get a high PSA reading, throw away your newspaper clippings and get hold of an authoritative book about prostate cancer and read the real facts. Good luck. Alan >> > ... >> > The information sheet mentions that 1 out of 10 men will have a [quoted text clipped - 71 lines] > > Alan Hi Leonard, I. P. and Allan, Thank you very much indeed for your replies! They have helped me a lot. First of all, the research deals with finding the best way of treating localised prostate cancer before it causes any problems. The first step is to take a blood sample for testing (ASP). (I have partly quoted the letter enclosed with the information sheet). No, the volunteers won't be divided randomly in two groups. 100,000 men are being examined for localised prostate cancer. I have decided to take part in the research. Your arguments are sound and solid and I have made an appointment with the hospital for later this month. Indeed, why not getting a PSA checkup now? And of course I have been concerned on and off about getting prostate cancer over the past years. And indeed, why not putting them to rest? It would be foolish not to do so. Another equally important point for my decision is to support medical research. Time, money and energy is being spent on something that, hopefully, will benefit millions of men in the future, therefore it's my duty to take part. With "As far as I know" I meant that we do not always know what's going on in our body. A friend of mine of my age, 61, was driving across Germany a few week ago and while being on the motorway he suffered a stroke. He crashed and is now in hospital badly injured, apart from his stroke. Another example: a friend told me way back that his father who was in his late sixties had got a complete medical checkup. His doctor told him that his test results were excellent and that he would surely live till a hundred. So this chap went home very pleased and told his son, and you know what happened next? After telling his son the father dropped dead! No, in my family there runs a cut-interesting-articles-out-of-magazines/newspapers gene. In every generation there is one who does this. In my family it's me. Not only about prostate cancer, but also about other deseases, computers, history, art, aircraft, etc. I know that articles on health are not very well written, but they do give the latest information on the treatment of a particular disease. That's why I keep them as reference for the future. Some of them turn out to be useless, like this one: on 23 January 1998 The Times (in the UK) published a nine-line article on prostate cancer advance. It says, and I quote: "Men whose blood contains a substance called IGF-1 are four times more likely to develop it". I may be wrong, but I have never heard of IGF-1 after this again. Thanks again, you have really been a great help! Take care, and I wish you good health. Bye, Tom > ... > Another equally important point for my decision is to support medical > research. Time, money and energy is being spent on something that, > hopefully, will benefit millions of men in the future, therefore it's > my duty to take part. > ... Well said! By volunteering for this you may indeed benefit millions of others. Many clinical trials have trouble enrolling enough patients to meet their research objectives. It has resulted in slower progress than would otherwise be possible. Enrolling in well designed and run trials is useful and does help the entire community. I also believe that, in the majority of cases, it does no harm to the patient and may do some good. Good luck. Alan >> ... >> Another equally important point for my decision is to support medical [quoted text clipped - 17 lines] > > Alan Cheers! I forgot to mention that this research (called ProtecT study) also asks volunteers to make their bloodsample and tissues of any biopsies available to another related project, called ProMPT study. This study tries to identify which aspects of our biological and genetic make-up might affect the factors that contribute to whether or not an individual gets prostate cancer. So all in all, this is a comprehensive and important study. Bye, Tom |
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