American Cancer Sociiety Position on PCa Screening

Dear William,

Recently there's been some media attention about the American Cancer Society
and our views on cancer screening that may have been confusing to some. We
wanted to be sure that as a valued supporter, you heard directly from us
about where we stand on this topic.

The bottom line? We know that screening saves lives and creates more
birthdays. We encourage women at average risk to get mammograms starting at
age 40, to get Pap tests as soon as they are sexually active or no later
than age 21, and both men and women at average risk to get screened for
colon cancer starting at age 50. You can find our complete screening
guidelines
<http://acs.r.delivery.net/r?2.1.3LO.2iH.11V%2aZg.C2WIqK..N.Cre8.2dU.bW89MQ%
5f%5fCLFMFLK0> here.

Scientific studies prove these tests' importance - and in fact, we know that
300 more birthdays are being celebrated each and every day thanks in part to
cancer screenings.

Yet we have long acknowledged that cancer screening isn't perfect. Sometimes
cancers get overlooked. Sometimes cancers get misdiagnosed. Sometimes
aggressive cancers can appear even after a clear screening test. It is
important to acknowledge these limitations, understand them, discuss them
with your doctor, and decide what is right for you.

We are committed to offering you the very best and latest information on all
issues related to cancer so that you can do your part to stay well. We are
constantly evaluating our screening guidelines based on current science, and
we may from time to time change our views and recommendations. There are
some cancers for which we don't currently recommend screening, such as
prostate cancer, because the benefits are unclear or unproven. We continue
to aggressively search for new and more effective ways to detect, prevent,
and treat these and all types of cancer.

Now that you know the facts, we hope you will help save even more lives by
passing this email on to all your friends and loved ones. Each life we touch
is another birthday we can help save.

Thanks for everything you do,

John R. Seffrin, PhD
Chief Executive Officer
American Cancer Society

From: Bill Doss [mailto:wdoss@surewest.net]
Sent: Friday, October 23, 2009 11:14 PM

Subject: FW: Screening Saves Lives (but not for prostate cancer)

Tonight I received the official word on ACS's position on prostate cancer
screening from the ACS's CEO, John R. Seffrin. In the email below, he
states the following, "There are some cancers for which we don't currently
recommend screening, such as prostate cancer, because the benefits are
unclear or unproven." There it is; from the horse's mouth (or maybe it came
from the other end of the horse).

The Oct. 22 Another Voice by University of Minnesota professor Gary
Schwitzer criticized Roswell Park's prostate cancer awareness campaign for
saying too little about the controversy about PSA as a screening test.
Roswell Park developed the PSA test for prostate cancer early detection and
management. PSA has revolutionized the ability to monitor prostate cancer,
but the test has many advantages and limitations when used for early
detection. Our researchers are working to improve the PSA test to
distinguish prostate cancers that are potentially aggressive and
life-threatening from those that are clinically insignificant.

I am enmeshed in the ongoing and appropriate debate about PSA and prostate
cancer; I chair the National Comprehensive Cancer Network's Prostate Cancer
Treatment Guidelines Committee and sit on the Network's Prostate Cancer
Early Detection Guidelines Committee. Network guidelines (available at
www.NCCN.org ) are the most widely used standards for cancer care. These
guidelines are updated at least annually and provide patients access to
recommendations by panels of experts that include patient advocates,
population scientists, urologists, radiation oncologists and medical
oncologists.

I concur with Schwitzer that PSA should not be used as a screening test. We
should use PSA, and it performs best if used, for early detection of
prostate cancer in men likely to die from an undiagnosed prostate cancer.

For example, if you're young and at high risk because you're African
American or have a father or brother with the disease, do not await more
large studies. If you're older, low risk and have a normal PSA, stop getting
the test when life expectancy falls to 10 years or less.

I believe younger and healthier men benefit from having prostate cancer
diagnosed when curable so they may evaluate all options for treatment
including active surveillance. We need not return to the pre-PSA era when
most men's prostate cancers were found when they were incurable.

Men with newly diagnosed prostate cancer who come to Roswell Park are
counseled:

1. Don't panic. Prostate cancer grows slowly and is usually highly curable.

2. Don't rush into decisions. Every man and every cancer is different.

3. Get a third or fourth opinion if necessary to arrive at a decision that
makes you feel good.

Roswell Park also established a High Risk Prostate Cancer Clinic for men who
have an elevated PSA and would like a Roswell Park expert to evaluate their
results and recommend steps. Most importantly, two-thirds of men with
elevated PSA values do not have cancer. Sometimes another biopsy may be
necessary but often a simple repeat PSA, elimination of non-cancer
conditions that cause PSA elevations or careful discussion of risks and
benefits obviate the need for more biopsies.

James L. Mohler, M. D., is associate director for Translational Research;
chairman, Department of Urology; and professor of Oncology, Roswell Park
Cancer Institute.

http://www.buffalonews.com/149/story/843252.html

In addition read the blog discussion about Rosewell Park's awareness
campaign

http://prostatecancerinfolink.net/2009/10/19/medpage-slams-roswell-park-canc
er-institute And get a link to Gary Schwitzer's original public comments.

Do you think that this is the future of criticism of awareness programs?
Have we refined our message based on current evidence or does it need to be
refined?

Kathy

__._,_.___

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ACI's Dr Otis Brawley on PSA Testing & Mammograms

American Cancer Society Stands by Its Screening Guidelines; Women Encouraged to Continue Getting Mammograms
Statement of Otis W. Brawley, M.D., Chief Medical Officer, American Cancer Society in Response to New York Times Article on Cancer Screening

Atlanta – October 21, 2009 – “Today’s New York Times article ‘In Shift, Cancer Society Has Concerns on Screening’ indicates that the American Cancer Society is changing its guidance on cancer screening to emphasize the risk of overtreatment from screening for breast, prostate, and other cancers.

“While the advantages of screening for some cancers have been overstated, there are advantages, especially in the case of breast, colon and cervical cancers. Mammography is effective – mammograms work and women should continue get them. Seven clinical trials tell us that screening with mammography and clinical breast exam do reduce risk of breast cancer death. This test is beneficial in that it saves lives, but it is not perfect. It can miss cancers that need treatment, and in some cases finds disease that does not need treatment. Understanding these limitations will help researchers develop better screening tests. The American Cancer Society stands by its recommendation that women age 40 and over should receive annual mammography, and women at high risk should talk with their doctors about when screening should begin based on their family history.

“The bottom line is that mammography has helped avert deaths from breast cancer, and we can make more progress against the disease if more women age 40 and older get an annual mammogram.
“Since 1997 the American Cancer Society has recommended that men talk to their doctor and make an informed decision about whether or not prostate cancer early detection testing is right for them. This recommendation also still stands.

“Cancer is a very complex and complicated disease. The American Cancer Society makes evidence-based cancer screening recommendations, and strives to provide clear messages about cancer screening to patients and doctors. Our guidelines are constantly under review to evaluate them as new evidence becomes available. Simple messages are not always possible, and over-simplifying them can in fact do a disservice to the very people we serve.”

The American Cancer Society combines an unyielding passion with nearly a century of experience to save lives and end suffering from cancer. As a global grassroots force of more than three million volunteers, we fight for every birthday threatened by every cancer in every community. We save lives by helping people stay well by preventing cancer or detecting it early; helping people get well by being there for them during and after a cancer diagnosis; by finding cures through investment in groundbreaking discovery; and by fighting back by rallying lawmakers to pass laws to defeat cancer and by rallying communities worldwide to join the fight. As the nation’s largest non-governmental investor in cancer research, contributing about $3.4 billion, we turn what we know about cancer into what we do. As a result, more than 11 million people in America who have had cancer and countless more who have avoided it will be celebrating birthdays this year. To learn more about us or to get help, call us anytime, day or night, at 1-800-227-2345 or visit cancer.org.

# # #

AUA PCa Treatment Guidelines

From the AUA report, the section about PSAV. I agree that It is one of the tools that a doctor uses for determination of the need for a biopsy but the literature is not definitive and whatever we say we need to be balanced.

PSAV is primarily used to detect prostate

cancer, whereas PSADT is primarily used in the post treatment setting as a surrogate marker of

outcome. Some investigators have suggested that a PSA rise of 0.75 ng/mL or greater in a year is

reason for concern in patients with a PSA level >4.0 ng/mL (Carter 1992). While a PSAV of

0.75 ng/ml per year has been recommended for men with PSA values between 4-10 ng/ml,

several studies suggest that lower PSAV thresholds of 0.4 ng/ml per year may improve prostate

cancer detection for younger men and for those with PSA levels below 4.0 ng/ml (Moul 2007,

Loeb 2007, D’Amico 2004, Carter 2006). To correctly measure PSAV, use of at least three PSA

values over a time period of at least 18 months is recommended (Carter 2006, D’Amico 2004).

Estimating PSAV with values spread over a longer interval is problematic because when

significant prostate cancer is present, PSA increases exponentially and a linear estimate of PSA

slope is less valid. The problem of using linear regression to estimate the slope of an

exponentially rising PSA can be easily overcome by calculating an average PSAV between 3

measures (the annualized PSAV between the first 2 measures plus the annualized PSAV between

the second 2 measures divided by 2). Some have suggested that PSAV cutpoints should be

lowered and age adjusted. Age-adjusted PSA velocities with threshold values of 0.25 ng/mL/yr

in men ages 40 to 59, 0.5 ng/mL/year in men ages 60 to 69, and 0.75 ng/mL/year for men over

70 years of age have been proposed (Moul 2007). Both age-specific PSA and age-specific PSAV

will increase the number of cancers detected, and both will also increase the number of younger

men undergoing biopsy. However, when added to total PSA, PSAV was not shown to be a useful

independent predictor of positive biopsy, , in the ERSPC and PCPT trials, or in other

analyses(Etzioni 2007, Wolters 2008, Vickers 2009).

As you said one of our objectives is to teach men that not all prostate cancers will cause their deaths and that for selected men AS is a good alternative.

The problem with many men is that the fear of death causes them to rush to treatment. We want them, unless they have an advanced cancer to slow down and become empowered to make good and personal treatment choices. We want to teach them how to effectively discuss the issues with their doctors. We can’t tell them what to do because each choice is very individualized. Part of that is to let them know that not all prostate cancer is clinically aggressive.

We also need to change the perception by society that all cancers will kill you without making it appear that no cancers will kill you. Not easy.

The word screening just means present/not present. Early detection of clinically significant prostate cancer helps to educate men that not all men will die from prostate cancer and at the same time focuses on the need that men have to know which cancer is aggressive and which is not.

Changing wording can be difficult at first but if all groups begin using the phrase it will become standard. The national groups have accepted the change and it’s is being discussed at both the ASCO and AUA meetings.

Kathy

USTOO meeting Monday, November 2 at 7:30 PM

Speaker: Dr. Charles (Snuffy) Myers

Subject: New developments in the war against prostate cancer.

ILocation: In case you have not been to our meetings recently, we are now meeting at the new Life With Cancer Center at 8411 Pennell Street where we have been gathering for the past year. For newcomers, one way to reach our meeting place is to take Route 50 West from inside the I495 Beltway. You pass under the Beltway and then under Gallows Road. After this you take a left at the very next stop light (Williams Drive). You then go to end of Williams Drive and take a right on Pennell Street. The new Life With Cancer Center is on the left (with plenty of parking) at the end of Pennell Street. If you are coming East on Route 50 from outside I495, you need to take a right on Williams Drive which is the last traffic light before you reach Gallows Road.

Looking forward to seeing everyone there. If you have any questions, call Ed Grove at 703-533-8334 or email him at eddyout@erols.com.

Kaiser Foundation Health Reform Proposals

To the CLC --

We have previously discussed the Kaiser Family Foundation analyses of health reform proposals, among the best tools for understanding the various plans. We wanted to let you know that the side-by-side comparison of health reform bills has been updated to include the Baucus proposal. The tool can be accessed from the home page of the Kaiser website, in the “New and Noteworthy” box. Also available on the website are an online tool that explains premium subsidies in the reform packages and summaries of the Medicare and Medicaid provisions of the Finance package.

All of these materials are available at http://www.kff.org/.

Welcome to Dick Gillespie's Blog

I want to welcome you to the new blog I have just started. My blog will focus on prostate care. I will be providing information which I receive from various sources which will be of interest to everybody who has prostate problems and issues. As leader of the UsTOO Chapter in Woodbridge, Virginia which is co-sponsored by the Westminster at Lake Ridge Continuing Care Retirement Community and Potomac Hospital, I hope to engage in open dialogue on topics which concern you as cancer survivors, spouses, and supporters.