ALERT

PROSTATE CANCER ALERT - ACTION NEEDED BY NOVEMBER 1

The U.S. Preventive Services Task Force has issued a draft recommendation for comment that would eliminate the use of PSA blood tests for prostate cancer screening.

WE URGE A QUICK RESPONSE TO THIS DRAFT BY NOVEMBER 1ST SENT TO THE TASK FORCE & YOUR SENATORS AND CONGRESSMEN TO STOP THE IMPLEMENTATION OF THIS RECOMMENDATION.

Go to www.obcolefoundation.org for more details and background.

ACTION needed by November 1st Stop the implementation of eliminating the use of PSA blood tests for prostate cancer screening!

Please send a short letter or postcard recommending NOT to end the PSA testing (with your own comments from the points referred to above) to:
DR. ROBERT CROSBY • c/o USPSTF
540 Gaither Road • Rockville, MD 20850

OR

Comment at the following web form: http://www.uspreventiveservicestaskforce.org/uspstf_form3/

AND

send your letter or postcard to Senator Robert Casey at the following address (or call/fax or by going to his website: http://casey.senate.gov/contact/).
SENATOR ROBERT P. CASEY, JR.
393 Russell Senate Office Building
Washington, D.C. 20510

Phone: (202) 224-6324 • Toll Free: (866) 802-2833
Fax: (202) 228-0604

We urge that you also contact your local Congressman if possible as well. Please email to pbunting2003@yahoo.com or mail us a note that you replied to this.

Go to www.obcolefoundation.org for more details and background.

AUA Responds to New Recommendations on Prostate Cancer Screening

Association urges men to speak with their physicians about the value of prostate cancer testing

LINTHICUM, MD, October 7, 2011–The American Urological Association (AUA) today released the following statement in response to the U.S. Preventive Services Task Force draft recommendations on the use of the prostate-specific antigen (PSA) test. The statement is attributed to AUA President Sushil S. Lacy, MD:

The American Urological Association (AUA) applauds the U.S. Preventive Services Task Force for its interest in reviewing the use of the prostate-specific antigen (PSA) test. However, we are concerned that the Task Force’s recommendations will ultimately do more harm than good to the many men at risk for prostate cancer both here in the United States and around the world. The AUA’s current clinical recommendations support the use of the PSA test, and it is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging or risk assessment and monitoring of prostate cancer patients.

Not all prostate cancers require active treatment and not all prostate cancers are life threatening. The decision to proceed to active treatment is one that men should discuss in detail with their urologists to determine whether active treatment is necessary, or whether surveillance may be an option for their prostate cancer.

The AUA is currently preparing a new clinical guideline on this topic, and has convened a panel of experts to review not only the use of the PSA test, but also early detection of prostate cancer overall, taking into account the new tests and diagnostics that are becoming available. Until there is a better widespread test for this potentially devastating disease, the USPSTF – by disparaging the test – is doing a great disservice to the men worldwide who may benefit from the PSA test.

For more information about the AUA’s position on the early detection of prostate cancer, or to arrange an interview with an expert urologist, please contact the AUA Communications Office at 410-689-3932.

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 18,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.

Latest Comments from the National Alliance of State Prostate Cancer Coalitions (NASPCC)

The Panel glosses over the findings of the ERSPC and Goteborg Trials, and only cursorily mentions the drawbacks of the PLCO Trial on which it heavily relies. A trial such as PLCO with significant cross-over and contamination has suspect, UNRELIABLE results (not to mention that the results were still premature). Therefore there is an apparent bias or the appearance of a potential bias.

The issue of a sub-group of high-risk patients should have been singled out with specific Recommendations as well. No stratification of risk is addressed whatsoever. The AUA Guidelines enourage a baseline PSA at age 40 to assess risk for developing prostate cancer. The PSA is a reasonable way to do that.

While there may be men who are treated for clinically indolent cancer, that should be their "informed" decision to do so. If men are not tested, and no diagnoses are ever made (clinically indolent OR clinically significant PCa) then those men with potentially lethal prostate cancer will be deprived of a chance for timely treatment and cure. In short, "over"diagnosis should not be equated with overtreatment; instead a disconnect should be established. Most importantly, to suggest that the test would be fine if a man has prostate symptoms begs the point and potentially hurts men, since by the time there are symptoms of prostate cancer it is usually in an advanced state.

The Panel needs to consider the reduction in mortality in ERSPC and Goteborg Trials. It further needs to come to the correct conclusion as to why there has been a stage migration at diagnosis since the inception of PSA and why there has been a reduction in mortality overall (if those men would not have died of their disease anyway, as the Panel is saying). And why there has been an increase in deaths from prostate cancer from 2009-2011, with more deaths from PCa than from breast cancer in those years? If most prostate cancer was insignificant we would not be seeing that. Most importantly a D Recommendation will scare men away from asking for a PSA (with or without an informed discussion), will excuse primary care physicians from offering the PSA, will lead to a lack of insurance coverage for the test, even where specifically requested by the patient, and will lead to deaths in those men who have potentially lethal disease which will not be timely diagnosed and treated.

As President of the National Alliance of State Prostate Cancer Coalitions (NASPCC), I see firsthand what happens when men have not had a timely diagnosis of their prostate cancer and they are dealing with advanced, eventually metastatic disease. Knowledge is power; let's have the correct, impartial and unbiased messaging in place so that men can make THEIR OWN decision whether they want to be tested and then, if they are diagnosed with prostate cancer they can make THEIR OWN decision in conjunction with their physician whether they are appropriate candidates for Active Surveillance. This will establish a disconnect between diagnosis and automatic treatment. Don't scare men away with tales of manhood lost; dead men can't have sex either. A "D" Recomendation will scare men away from asking for the PSA test, will offer physicians a reason not to offer it, and men with potentially lethal disease will be deprived of an opportunity for necessary timely treatment. And don't let men think that they can wait until they experience prostate symptoms - if they do have prostate cancer this usually means they have advanced disease. Lastly, the Panel needs to make a stronger Recommendation for testing for high-risk men: African-American men and those with a positive or an indeterminate family history of prostate cancer. Death from prostate cancer is a miserable way to die.

U.S. Government Fails American Men in the Fight Against Prostate Cancer

ZERO is asking prostate cancer patients, survivors and advocates to join the call for transparency as the United States Preventive Services Task Force, an independent panel appointed by the federal Department of Health and Human Services, moves to eliminate prostate cancer testing for all men.

The new USPSTF guidelines rate PSA testing for all men “D,” meaning there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. This decision contradicts prostate cancer testing recommendations from medical and professional organizations, including the National Comprehensive Cancer Network and American Urological Association.

Today's decision of no confidence on the PSA test by the U.S. Government condemns tens of thousands of men to die if families are to believe the out-of-date evidence presented by the USPSTF. A decision on how best to test and treat for prostate cancer must be made between a man and his doctor, not a panel that doesn’t include a urologist or medical oncologist. Read more about the story on MSNBC and take action by writing to your elected officials and the media using the links below!

TELL THE GOVERNMENT TO STAY OUT OF YOUR EXAM ROOM. WRITE YOUR SENATORS AND REPRESENTATIVE TODAY! MAKE YOUR VOICE HEARD! SEND A LETTER TO THE EDITOR OF YOUR LOCAL NEWSPAPER.

National Alliance of State Prostate Cancer Coalitions (NASPCC) Statement

We at the National Alliance of State Prostate Cancer Coalitions (NASPCC), a member organization of the Prostate Cancer Roundtable, heartily endorse the use of PSA for men beginning at age 40 (35 if high-risk). It's the best test we currently have for prostate cancer and, in conjunction with a digital rectal examination it should be offered until more sensitive/specific biomarkers are approved by the FDA. If you don’t test men at all and thereby fail to make any diagnoses, you are missing those patients with potentially lethal prostate cancer who in fact require immediate treatment. Knowledge is power. Testing for and diagnosing prostate cancer does not have to lead to “over-treatment”; men with clinically insignificant prostate cancer can select Active Surveillance, and those with aggressive cancer can be treated.

Balancing the possible sexual side effects of treatment against the saving of a life is a no-brainer. After all, dead men can't have sex either. Ms. Merel Grey Nissenberg, President, NASPCC, 7825 Fay Avenue, Suite 200, La Jolla, California 92037, Tel. 858-459-0631

Correspondence from Merel Grey Nissenberg, President NASPCC

Dr. Moyer - Surely you're not serious in leading the USPSTF Panel to suggest that only when there are urologic symptoms is it time (and permissible) to obtain a PSA on a patient! While I realize that you treat children in your practice, not men with prostate cancer, you must or should know that by the time a man has symptomatic prostate cancer, the disease is advanced and without hope of cure. I find it irresponsible to suggest that symptomatology is the threshold for performing the test. I am a woman professional and also President of the National Alliance of State Prostate Cancer Coalitions (NASPCC.org). In my work in the field of prostate cancer I am apparently more familiar with the disease than the epidemiologists, family practice and other physicians on the panel, none of whom treats prostate cancer. Additionally, even though the Task Force notes the crossover and contamination of PLCO, as well as its reliance on outmoded treatment modalities, it chooses to base its proposed Recommendations partly on those premature and inconclusive results, while ignoring ERSPC and the Goteborg studies that showed clear survival benefits to PSA testing. So perhaps the Task Force is also unable or unwilling to correctly interpret the data.

Please understand the basics of prostate cancer before taking a stance that will prevent men who may have potentially lethal prostate cancer from receiving a timely diagnosis allowing curative treatment. Until better biomarkers are approved by the FDA, at least the PSA gives men a fighting chance. If they have insignificant disease, they can choose Active Surveillance. If they have aggressive or potentially lethal disease, they can choose treatment. But it should be their choice, which the Task Force would apparently like to strip from them. Ms. Merel Grey Nissenberg, Esq., President, NASPCC

Response by Mona Ervin, Chair of the Board of Directors of the Maine Coalition to Fight Prostate Cancer

The United States Preventive Services Task Force (USPSTF) has this week released its recommendation that healthy men should no longer be offered a prostate-specific-antigen (PSA) blood test to screen for prostate cancer. Reasons put forth by the USPSTF for its recommendation are that the PSA test does not save lives, the test cannot tell the difference between cancers that are non-aggressive and those that are aggressive, and that patients are “over treated” which leads to serious side effects, including death.

What is this group and who are its members that they have such power to deny screening tests? The U.S. Preventive Services Task Force was first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ). It is supposed to be the leading independent panel of private-sector experts in prevention and primary care. The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.

Personally, I have an issue with a group that professes to be professionals who make decisions about a person’s life but does not have a single specialist involved in the recommendation process. Where were the urologists? The oncologists? The radiologists? Were any patient advocates on the task force? What of knowledgeable consumer advocates? These professional specialists were all absent from the USPST – the group that is making recommendations about a man’s health. Individuals who are not specialists in a field should not be making recommendations. As the partner of a 10 year prostate cancer survivor I believe that my husband and I have a better understanding of the disease and its nuances than a non-specialist clinician.

Another problem with the recommendations of the USPSTF is its choice of trials/studies that it reviewed and used as the basis for its recommendations. Using the U.S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and the European Study of Screening for Prostate Cancer, the task force concluded that the PSA is unreliable and does not appear to reduce the number of prostate cancer deaths. While some studies do indicate limited reliability of the PSA, others indicate a significant advantage to the PSA. Dr. Philip Kantoff, Director, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute has reported on clear data that testing and screening does save lives. The Goteborg Prostate Cancer Screening Trial (2010) also indicates “prostate cancer mortality was reduced by almost one half over 14 years.” Significantly, the report states that the results did not necessarily result in radical treatment. About 40% of the men diagnosed with prostate cancer in the screening group were placed on active surveillance. The European Randomized Study of Screening for Prostate Cancer (2009), the world’s largest prostate cancer study, also indicated a decrease in prostate cancer mortality of nearly 31%. Interestingly, the task force used this same study to base their recommendations. What this demonstrates is that statistics can be manipulated to represent a particular point of view.

This then begs the question – why the recommendation to do away with prostate cancer screening? Is it economically driven ? With fewer men being tested, diagnosed, and treated the federal government can save money, particularly because many of the men are of Medicare age. Is it economically driven by insurance companies who want to increase profits? Is it altruistically driven – the task force members truly care about what some term the painful, debilitating side effects of some prostate cancer treatments?

I find the recommendations to be repugnant and irresponsible, bordering on criminal. By virtue of its recommendations the USPSTF appears to trivialize the lives of over 32,000 American men who will die this year OF prostate cancer, not WITH prostate cancer. If as expected, insurance companies cease coverage for the PSA men will die. If a man wishes to have a PSA he will have to pay out of pocket for this life saving test. The wealthy will be able to afford this, the poor will not. In the current economy, millions of men are unemployed or underemployed; are homeless; receive food stamps and rely on food banks and soup kitchens to survive. Many go hungry. Will these men be able to afford a PSA? The answer is a resounding NO. Will men die as a result of these recommendations?

Finally, the USPSTF is the same group which two years ago recommended that women in their 40’s no longer have mammograms. Today the group is recommending that PSA screening not be offered to healthy men. What cancer will be next on the USPSTF chopping block? Lung cancer? Ovarian cancer? Testicular cancer? Skin cancer? Oral cancer?