PSA test unreliable says inventor of procedure

PSA test unreliable says inventor of procedure Discover magazine's issue just out, The Year in Science,top 100 stories, pg 30 goes into this further, especially stating that "...detecting prostate cancer is not always in the patient's best interest.Once cancer is diagnosed, most men opt for treating it either with radiation OR removal of the prostate. This leads to impotence, urinary incontinence, AND otherunpleasant side effects," Stamey reported in the October issue of the Journal of Urology that the PSA test is currently predictive of cancer in only 2% of cases." "80% OR more of men over 70 die with but NOT FROM-prostate cancer." here's an early report on Stamey's work from a site with lots of good health info: eALERTS - Sunday, September 19, 2004 PSA Test For Prostate Cancer Is Unreliable Says Inventor Of Procedure Sep 16, 2004 Author: Christopher Barr Source: Naturally Speaking The not so merry-go-round AND round This past weekend a stunning story appeared about the common PSA blood test procedure for prostate cancer. The inventor of the procedure, Dr. Thomas A. Stamey, noted that the test is not reliable. The timing of this declaration in the midst of this 'Prostate Cancer Awareness Month' makes the announcement even more stunning. Dr. Stamey AND his colleagues examined more than 1,300 removed prostates over a 20 year period with the conclusion that the extensive use of PSA screening commonly performed is unwarranted. Stamey AND colleagues put forth that prostate cancer is over-treated, AND that prostate cancer death is uncommon in elderly males. Yet more stunning Another story later the same day by another major news service downplayed the significance of the story with a generic notation of the finding coming from 'Stanford University researchers'. Strangely, the article did not note that the lead study author among the researchers was the man who developed the procedure. Dr. Stamey later is identified by name but still without the prominent notice that this man was the developer of the very procedure that was being debunked. Another doctor from the National Cancer Institute offered agreement. Dr. Howard L. Parnes said, "Lots of the cancers we diagnose don't need to be diagnosed. Far more men die with prostate cancer than of prostate cancer." Stamey noted that prostate cancer is rarely fatal AND usually poses no major danger. He also noted that significant risks such as impotence came from unnecessary treatments due to PSA testing. Yet more stunning still Then at the beginning of this week the very same news service ran a story putting forth that PSA testing should be done even more frequently than is currently done. Apparently they don't keep up with their own news stories. The second story noted that the threat of prostate cancer could not be overstated! Much was made of various drug, radiation AND surgical options. A very small mention was made about the Stamey study. An even smaller mention was made about selenium as a prostate cancer preventative. There was no mention of the extensive 10-year study concluded 8 years ago with 200 micrograms of selenium daily that noted a 63 per cent reduction in prostate cancer. Drugs, radiation AND surgery were prominently noted without mention of side effects. The newly discredited PSA testing was prominently promoted as well. Nutrition barely rated the tiniest of mentions. Changing gears Perhaps most stunning of all is the announcement just prior to this publication that the FDA has finally admitted to a suicide link with antidepressant drug usage among children AND teenagers. Readers of this column read of this link last month. Nice to see the FDA catch up … somewhat. The FDA may have moved up to low gear though it is hard to tell. The FDA researchers made a notation that there were no suicides in drug trials. They continue to ignore the hanging suicide of Traci Johnson early this year during the drug trial for the anti-depressant Cymbalta. That story was reported exclusively in this column last month right before the national story broke about a cover up regarding antidepressants linked to suicides. The FDA approved that same Cymbalta last month. It was approved at the same time for stress urinary incontinence as well. Last week Cymbalta was approved for a third usage with diabetics. Maybe the FDA has yet to get all the way out of reverse. לקוח מתוך: http://askwaltstollmd.com/archives/cancer/315121.html

לא לבדוק PSA? לא להתייחס לבדיקות PSA שכבר נעשו? גובי? דר' אריאלי?

The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J. Department of Urology, School of Medicine, Stanford University, Stanford, California 94305, USA. [email protected] PURPOSE: We assessed how well preoperative serum prostate specific antigen (PSA) reflects the largest cancer in consecutive untreated radical prostatectomies during the last 20 years at Stanford University. MATERIALS AND METHODS: A total of 1,317 consecutive radical prostatectomies were divided into 4, 5-year periods between August 1983 AND July 2003, AND examined sequentially in 3 mm step sections by 1 pathologist. The largest cancer AND 5 other histological variables in each prostate were measured. Preoperative clinical stages were tabulated for each 5-year period. Means, Pearson correlation coefficients, % change AND multiple regression were used to compare selected variables. RESULTS: Most parameters decreased linearly during the 20 years, including palpable nodules on digital rectal examination from 91% to 17%, mean age from 64 to 59 years, mean serum PSA from 25 to 8 ng/ml, AND index (largest) cancer volume from 5.3 to 2.4 cc. Percent Gleason grade 4/5 of the largest cancer averaged 27% to 35% AND prostate weight 44 to 53 gm. Contrasting August 1983 to December 1988 with January 1999 to July 2003, 6 histological cancer parameters had statistically significant relationships to serum PSA in the first period. In the last 5 years serum PSA was related only to prostate size. CONCLUSIONS: Serum PSA was related to prostate cancer 20 years ago. In the last 5 years serum PSA has only been related to benign prostatic hyperplasia. There is an urgent need for serum markers that reflect the size AND grade of this ubiquitous cancer.

PCa Commentary The Prostate Specific Antigen Has Become Less Informative Over The Past 20 Years. (December 2004) Drs. Stamey, McNeal et al have offered a significant AND consequential observation that the serum PSA level, especially in the range of < 10 ng/mL, no longer is reflective of prostate cancer, but only of benign prostate hypertrophy. Their important report, “The Prostate Specific Antigen Era in the United States is Over for Prostate Cancer: What Happened in the Last 20 Years?” (J Urol, Oct. 2004) documents their observations based on 1317 radical prostatectomy specimens. The issue under evaluation was “how well preoperative serum prostate specific antigen (PSA) reflects the largest cancer in consecutive untreated radical prostatectomies during the last 20 years at Stanford University.” At its essence this article presents a challenge to the validity of the premise underlying PSA screening. Stamey maintains that “current evidence from the last 10 years is convincing that the relationship between prostate cancer AND serum PSA is tenuous at best, especially with serum PSA less than 10 ng/mL...”. They interpret their data as showing that there are “serious limitations in the relationship of serum PSA to prostate cancer volume AND Gleason grade 4/5 cancer”, rendering PSA currently “misleading in the diagnosis of prostate cancer”. As is well recognized, the characteristics of diagnosed prostate cancer have markedly changed over 20 years. The researchers categorized their findings into four 5-year periods. In the earliest 5-year period, beginning in 8/1983, the PSA level at diagnosis was highly significantly related to the largest cancer, AND to the presence of capsular penetration, positive lymph nodes, seminal vesicle invasion, AND to the percent of Gleason grade 4/5 in the largest cancer. In the most recent period, 1/1999-7/2003, the statistically significant relationship in these associations has been lost. The differences in prostate cancer characteristics between the first AND last period, no doubt due to extensive screening, are not surprising AND reveal the changing face of prostate cancer. The percent of palpable cancers on DRE decreased from 90.8% to 16.7%; the mean serum PSA at diagnosis dropped from 24.7 to 8.14 ng/mL; AND the mean volume of the largest cancer shrank from 5.33 to 2.44 cc. Positive lymph node discovery decreased from 12.5% to 0.0%, AND seminal vesicle invasion decreased from 23% to 5.4%. Notably, however, there was no significant change in prostate weight, 46.5 gm at first AND 43.5 gm in the last period, which continued to be reflected by the PSA level. The “nuts AND bolts” of Stamey’s argument lie in the calculations reflected in Table 4: ”Comparison of Pearson correlations of preoperative serum PSA with radical prostatectomy morphology in the first AND last periods”. [Courtesy of Google: the Pearson coefficient measures the strength of a linear relationship between two variables, with a value of 0 (range -0.3 to +0.30) showing little OR no association; +0.3 to +0.7 a weak association; AND +0.7 to 1.0 a strong positive association.] The table shows that for the largest cancer the coefficient decreased from 0.659 to 0.148; for capsular penetration it declined from 0.539 to 0.033; for % seminal vesicle invasion - 0.437 to 0.069; AND finally, for % Gleason grade 4/5 in the largest cancer the decrease was 0.274 to 0.031. By the last 5-year period there was “no correlation of [the preoperative] serum PSA with any morphological variable except prostate weight. An observation relevant to the increasing awareness that adverse histology may be present very early in the life history of some cancers was the finding that despite the observed transition over time to smaller, lower PSA cancers, 83% of which were eventually T1c compared to 7% at first, the percent with Gleason grade 4/5 showed a 13% increase from 31% to 35%! In the background of Stamey’s argument - AND referred to in the article - is the data obtained by Sakr (Eur Urol,30:138,1996) who examined the prostates of accidental death victims of a wide range of ages. He found that the prevalence of invasive prostate cancer increased from 8% in 20 year old men to 80% in men in their 70’s. Interestingly, the presence of HGPIN showed narly identical increasing figures for prevalence with aging. Conclusions from the Stanford data suggest that in the current setting the PSA value no longer gives useful guidance for the detection of “significant” cancers. “This means that any excuse to biopsy the prostate has an excellent, age dependent chance of being positive.” The authors’ overall conclusion was that “What is urgently needed is a serum marker [in the PSA range of 2 to 10 ng/mL] for prostate cancer that is truly proportional to the volume AND grade of this ubiquitous cancer, AND solid observations on who should AND who should not be treated...”. Bottom Line:: If we are persuaded by Stamey’s argument that the “PSA today as a basis for diagnosing AND treating prostate cancer is related only to the amount of benign prostatic hypertrophy in the prostate”, where do we go from here?

להלןשם המאמר (הוסיפו את המרכאות הכפולות בהתחלה ובסוף): "THE PROSTATE SPECIFIC ANTIGEN ERA IN THE UNITED STATES IS OVER FOR PROSTATE CANCER: WHAT HAPPENED IN THE LAST 20 YEARS"

Dr. Thomas Stamey, professor of Urology at Stanford, is credited with first promoting PSA blood tests for screening prostate cancer. NOTE: The transcript below is of Dr. Stamey's responses only. Well, 20 years ago, in 1983, we started a lot of research on PSA. AND in fact, we published our first real paper in the New England Journal of Medicine, about '87, we saw it all in '83, but I think it was published in '87 where we showed a direct relationship between the level of the PSA in the blood AND the prostate it was removed here, in this institution afterwards. And I realized in the spring of this year, that I had 20 years of data that I could go back on. AND just ask the questions in four consecutive five year periods, what was serum PSA related to. Now you have to know that every prostate that's removed here comes to my lab, where it's cut in three millimeter sections AND my own pathologist, Dr. McNeil, who's in my lab, reconstructs the cancer in every detail. Of which the most important one is to measure the size of the largest cancer. And so all I did was say, let's look at PSA in four to five year periods, starting in '83 AND ending January 1 of this year. AND just look at the relationship of the largest cancer to the level of the blood PSA that was drawn before the prostate was removed, AND usually within a week OR two. And so what we found was that about 50 percent were related in the 83-88 period. But it's a straight line down AND in the last five years, it's now only two percent. Only two out of 100 men, whose prostates have been removed for cancer, can we show a relationship between the blood PSA AND the size of the cancer. And what is driving PSA since it is no longer cancer is actually the benign enlargement in the prostate. Almost all men over 50, begin to develop troubles urinating, which is caused by the benign enlargement in the gland. And so, as I look back over these same 20 years, every five year period, there was a strong relationship of PSA to the size of the gland, the benign enlargement. So in truth, PSA, ever since the beginning, has been primarily related to the benign enlargement in men. But in those early years, '83, for the 10 years after '83, the cancers was large enough, that they were also, they also had a relationship to the PSA. So in the last 10 years now, it is so small AND in the last five years it's only two percent. AND so what that says is that we cannot rely on PSA today to tell us anything about prostate cancer. AND my lab out here, with two PhD's AND one's an MD, we're all breaking our backs to find a new marker in the blood for prostate cancer. AND that's what we've got to come up with. PSA is absolutely a marker for the benign enlargement of the prostate. AND it's been so for the last 20 years. But 10 to 15 years ago, it also had a partial relationship to the cancer in about 40 to 50 percent, half of all men. But now even that has fallen. So that today, PSA just simply has no relationship to prostate cancer, except for two percent of the time. And that's why I entitled that paper, it was published in October, in the Journal of Urology, that the PSA era is over. No longer does PSA tell us anything about the prostate cancer before it's removed. Now PSA will always be a good marker because it's only produced by the prostate. So it's a good marker after the prostate is removed OR if you radiate the prostate. Anyway you go to treat the prostate, PSA will reflect the efficacy of that therapy. But as a… diagnostic marker, it's now only related two out of the 100 times to the prostate that you removed. Well it's based on absolute, hard data. AND that's why I don't mind, I don't mind making it. But it also is important that PSA was not as good as we all thought it was. Now, let me make a, make two very important points. One is, I feel that every patient should be told by his urologist, that every man develops prostate cancer, dependant on his age. We know that it starts in the twenties where eight percent of men have prostate cancer. AND it goes up until 50 years later, 80 percent have prostate cancer. So that says we all have, we all will develop prostate cancer, age dependant. So any excuse that you use to put needles into the prostate, we'll find prostate cancer, age dependant. So that's point number one, we all develop it. In fact, this is the same in blacks AND whites. Mo difference. Mow, but the good news that every patient should be told, is that at the end of the road, despite all of us developing it, the death rate from prostate cancer is only 226 men per 100,000 men over the age of 65. It's so small under 65 that the National Cancer Institute often doesn't even report those statistics. So, the bad news in a way, is that we all develop it, but the good news is that the death rate is so small, who wouldn't take their chances on 226 deaths per 100,000 men. AND it's a strong contrast with lung cancer, where almost everybody that develops lung cancer, it's all caused by smoking, you know, there are very few cures of lung cancer. Most people die of lung cancer that develop lung cancer. But prostate cancer, it's only 226 deaths per 100,000 men over 65, so you don't even have to start counting for men in their thirties AND forties AND fifties. What I wrote in this same paper that was published a couple of months ago, was that one thing that we should continue to do, AND every family doctor should do, is every man over 40, maybe 50, but somewhere in there, they need to start having a careful annual check of the prostate by finger examination of the rectum. Because you can feel the prostate through the rectum. So that would be a tragedy if that were stopped because if you feel a cancer it feels like your knuckle in a otherwise soft piece of tissue. They are always significant when you can feel them. So the problem is though, that since we all have it, it's very few that develop a palpable cancer. So, it doesn't solve the problem because you can have a serious cancer that you can't feel. But at least those you can feel, so every man should have an annual rectal, AND in fact, I suspect that's done routinely not just because of prostate cancer, but because of rectal cancer. A man needs a good rectal. So that should continue. Now outside of that, what we need, AND what my laboratories AND my PhD's out there work on everyday, somebody's got to come up with a new marker. But this marker's got to be something very unique. It can't just say you got prostate cancer, because we all got it. We know that. One famous institution puts men to sleep AND takes an average of 23 biopsies, where the prostate is-uh, is-uh about that size. so if you take 23 biopsies, you are going to find it. AND that's where you get into trouble. So, I think we are in trouble until we have a true marker in the blood, that will tell a man that he has prostate cancer, because I know he's got it, depending on his age, the statistics, the statistics of his age. But it's got to be a marker that will somehow reflect the amount of cancer he has. Then we would know we don't have to treat the fellas with a small amount of cancer, but somewhere along that increase in size. Certainly, we'll have to work that out once we have such a marker. But until we have a marker, a new marker, I'm not very optimistic. Because we have senators standing up saying, have you had your PSAs this year. We did our job selling that. But the facts are now, that was worthwhile 20 years ago. It's no longer worthwhile. Two percent. Well let me tell you I had some correspondence with Professor Klauss Rearborn, who's a chairman in Dallas at the medical school. He has just published a beautiful study showing that any man with a PSA between TWO AND 10, which is where we've been biopsying everybody, that's caused by benign enlargement of the prostate. AND my posters out there show it for the past 20 years. PSA is mainly been driven by benign, benign growth of the prostate. Alright, PSA will always be a good test once the prostate is treated because it's only produced by the prostate. So if you are radiating OR removing it, OR putting in seeds, it's an elegant marker for your efficacy of your therapy. It is not a diagnostic marker, because it's driven, it's caused by the benign enlargement of the prostate. That's right. We do not have a marker that has a porportionality to prostate cancer, while the prostate is left intact. PSA is caused by BPH, between twp AND 10. Oh yeah, but that's terribly rare. I mean, no question, PSA above 10, the man should have biopsies. But most all, I don't know what it is, but I've been... 90 percent of men, I don't know the exact percentage, it's gotta be huge, men under 50 have a PSA well under 10. AND that's where we've been biopsying. And in fact, there was a recent paper in the New England Journal by a very good investigator, from Walter Reed, who's a friend of mine. AND he biopsied men with a PSA under two right down to 0.5. AND what did he find? He found prostate cancer. Any excuse to biopsy the prostate will find statistically age dependent cancer. Well I think they should not have a biopsy. I think they should have a careful rectal exam once a year. Until we get a marker, that has, that's not driven by PPH. Every man needs to know that a PSA between 0.5, less than one, AND ten, is driven by benign enlargement of the gland AND not by the cancer. No reason to biopsy, but in fact a reason not to because you are going to find it, since we - depending on age. There's no question. In retrospect, I am guilty of that as much as anybody else. Absolutely, we've over-treated prostate cancer enormously. Because if only 226 men per 100,000, over the age of 65 die of this disease, even though we all got it, we can't go out AND treat everybody with it. Well, it's not necessarily aggressive when that does that. But since benign enlargement is the primary cause between a PSA of probably 0.5, less than 1, AND 10. But that benign enlargement, that takes years AND years for the PSA to go from 1, to 2, to 4, to 6. So prostate cancer can increase that it's called velocity, how fast the PSA is going up, so yes there is information if a man, his PSA is going up very rapidly, then that made should be biopsied right then. My concern is education. We people have got to know that the PSA between 0.2 AND 10, is caused everyday by BPH, by benign enlargement of the prostate. AND we've been following those PSA with a biopsy AND we find the cancer. But the cancer is not the cause of the PSA in that range. Well it's a huge problem. AND everybody's involved in it. So it's a, that's why, for the patient, one of the best solutions to tell you the truth, is for him not to have PSA. I mean I have colleagues, one very famous urologist in San Francisco, who is 10 to 15 years older than I am, AND that makes him quite old, AND he loves to stand up AND say "I've never had a PSA in my life." I mean he recognized that gets you, that gets you in towards a biopsy AND with that very low death rate, 226 per 100,000 over 65, AND even much, much less if you are younger than that. So, we've overdone it. AND I don't believe this issue will be solved until somebody gets a real marker. But it can't just say John Jones has got cancer. It's got to say John Jones has got three sugar cubes of cancer, you know the one, the one centimeter. But, so the marker has got to be a very good one. AND it's going to be very, very hard to do that. That's all my lab has worked on, have been for the last couple of years. But it's tough, we have not yet found a marker. AND we've spread out blood serums before AND after the prostate has been removed on big gels, looking for something there before AND disappeared afterwards. So far, we have not hit the jackpot. But somebody's got to. I'd tell them to get a rectal exam every year, starting probably at age 40. AND maybe a PSA every 10 years. Guessing, but you don't want to get a PSA too often. But our hope is for a new marker without any question. Well, I think if you go back 20 years ago, first of all, from '83 to '88, 95 percent of the cancers that we detected here at Stanford in my clinic, we felt on rectal exams. So that's what got us started. You'd feel the cancer, AND you would remove it, AND then we recognized that PSA was helpful in those we were feeling. But it's rare to feel the cancer today. They all feel normal, the prostate. But they'll all have microscopic cancer if you go to biopsy. But your point, clearly is supported by a huge industry, I mean physicians as well, AND the people who make the PSA test, the people who make the biopsy needles, the pathologists are part of it, they've got to read the biopsies. It's a huge, there's no telling how many billions of dollars are spent every year on prostate cancer. Because they would on any cancer if everybody has one. Like we do age related. But you know all you can do, I don't have any, I came on this because I had 20 years of frozen serums, AND I could look back 20 years AND do these studies. I wasn't looking to find this. It was just there. AND what really drives, what drives, absolutely drives PSA between 2 AND 10 is benign enlargement of the prostate. I was on the phone today with the guys in Dallas, that have been, that shown that beautifully. There's just no question that we've been biopsying the prostate because of benign enlargement. But you find cancer depending on your age. Well, no, well you know, it's going to be hard to change patterns of practice, especially when everybody's in on it. There's nobody to stand to gain except for the patient, by people recognizing the truth about these issues. AND he's the one that we should be worrying about.

gubi שלום מה שלומך ? אני שמח שמידי פעם אתה מוצא מעט זמן גם בשבילנו. אבל אני מברך אותך על כל כניסה שלך לפורום שלנו. בארץ מאבחנים מידי שנה כ-1500 מקרים חדשים שלך סרטן הערמונית . כל שנה מתים בארץ כ-700 איש עקב מלה זו. קצת קשה לי לומר שניתן להשוות את סרטן הערמונית לנזלת. מאז ומעולם היה הוויכוח מה עדיף לא לדעת ולא לבדוק ואז המחיר הוא גילוי של המחלה באיחור כאשר יש כבר גרורות ומוות תוך חודשים ספורים מול העובדה שאולי מגלים יותר מדי מקרים ואז יותר מדי חולים משלמים את המחיר של טיפולים מיותרים. לעניות דעתי, עם הנסיון האישי המזערי שרכשתי במשך כ-20 שנה, אני עדיין בדיעה שגילוי מוקדם של המחלה יכול להציל חיים והמציל נפש אחת כאילו הציל את העולם כולו. אבל כאמור זאת רק דעתי האישית בלבד וזאת התורה שאני מנסה להפיץ. ד"ר אריאלי