Guest guest Posted March 2, 2004 Report Share Posted March 2, 2004 Tue, 2 Mar 2004 08:01:12 -0500 HSI - Jenny Thompson Getting Specific Getting Specific Health Sciences Institute e-Alert March 2, 2004 ************************************************************** Dear Reader, If you're a man who has reached his 50th birthday, chances are your doctor has already checked your PSA level to determine the potential for prostate cancer. If you're one of the lucky ones, your PSA was normal. But if you're one of the truly fortunate ones, you have a doctor who knows the real value of the test and how to put it to its best use. An editorial in the British Medical Journal last month sized up the value of the PSA test with this comment: " At present the one certainty about PSA testing is that it causes harm. " It's not the test itself that causes harm, of course, it's the reaction to the test. Because when PSA is elevated, in most cases it's not time to act, it's time to be more cautious than ever. ----------------------------- Once is not enough ----------------------------- PSA - or prostate-specific antigen - is a protein that's naturally produced by the prostate gland. Prostate tumors typically cause an over-production of PSA, so when a blood test reveals an elevated level of the protein, it's a red flag that warns of possible cancer. The next step most doctors take is to recommend a biopsy. And this is where the trouble starts. Prostate biopsies are painful procedures that can result in bleeding and infection. But recent evidence shows that a great number of these biopsies are completely unnecessary. In a 2003 study from the Memorial Sloan-Kettering Cancer Center in New York City, researchers set out to determine if fluctuations in PSA levels would reveal a single PSA test result to be unreliable on its own. Over a 4-year period, the Sloan-Kettering team collected five blood samples each from nearly 1,000 men whose median age was 62 years. More than 20 percent of the subjects were found to have PSA levels high enough that many doctors would have recommended a biopsy. Half of those men, however, had follow-up tests with normal PSA levels. The Sloan-Kettering team concluded that an isolated PSA screening with an elevated level should be followed with an additional screening several weeks later before proceeding with further testing or a biopsy. This research backs up another study I told you about in the e-Alert " Under the Knife, Under the Gun " (7/23/02) in which doctors at the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle estimated that PSA screening may result in an over-diagnosis rate of more than 40 percent. ----------------------------- Testing... soup to nuts ----------------------------- As I've mentioned in previous e-Alerts, William Campbell Douglass, M.D., is no fan of PSA tests or their follow-up biopsies. Dr. Douglass refers to this one-two punch as, " the mainstream's slash-and-burn approach to prostate cancer. " In a Daily Dose e-letter Dr. Douglass sent out last September, he offered a more sensible and dependable way to screen for prostate cancer: A blood test called the anti- malignin antibody screen (AMAS). Anti-malignan antibody levels become elevated when any cancer cells are present in the body. Most importantly, these serum levels tend to rise early in the course of the disease, which means that cancer can sometimes be detected several months before other clinical tests might find it. With an accuracy rate of more than 95 percent, the AMAS test is also much more reliable than the PSA test. So given that PSA levels can fluctuate, the most prudent course for detecting prostate cancer would be a series PSA tests (as described in the Sloan-Kettering trial) taken in conjunction with the AMAS test. You can find out more about the AMAS test at amascancertest.com. And although Dr. Douglass calls the test " a remarkable breakthrough, " he also cautions that if the test is positive, you shouldn't let your physician rush you into surgery. He says, " Most cancers are slow-growing, and you need not panic into treatment. (The unfortunate fact is that if a tumor is fast-growing, mainstream therapies like chemotherapy and radiation will most likely be useless anyway.) " ----------------------------- More to come ----------------------------- Next week I'll follow up today's e-Alert with some information about prostate cancer prevention, and I'll share a remarkable e-mail from a member who was recently in Argentina, undergoing an experimental treatment for prostate cancer. This unique procedure just might be the future for the treatment of this disease. ************************************************************** To start receiving your own copy of the HSI e-Alert, visit: http://www.hsibaltimore.com/ealert/freecopy.html Or forward this e-mail to a friend so they can sign-up to receive their own copy of the HSI e-Alert. ************************************************************** ... and another thing Should you zig? How about zag? Up? Down? Sideways? After sending you the e-Alert " Same Story, Different Day " (2/17/04) concerning the latest HRT study that was abruptly shut down to protect the health of subjects enrolled in the study, I came across two articles that demonstrate the maddeningly mixed signals about HRT that women are receiving from the mainstream medical community. The first article was an Associated Press report that covered this HRT milestone: The FDA now requires that manufacturers of HRT drugs containing estrogen and progestin list warnings that the combination may increase the risk of Alzheimer's disease in older women. This is in addition to the current required warning that the drug combo increases the risk of breast cancer, stroke and heart attack. Four strikes and you're out? Not quite. The second article appeared less than one week later. It was a BBC News item reporting on comments made by one of the researchers who helped mount the 2002 Women's Health Initiative study that was shut down early. Addressing a conference in Seattle, she said that, in her opinion, HRT is still a safe therapy. She added that because of the controversy surrounding the use of the combined drugs, she's found that it's difficult to convince women that they should take HRT. The BBC article points out that over the past 10 years, about 20,000 cases of breast cancer diagnosed in the U.K. alone have been linked to HRT use. Gee... you think that might have something to do with women's reluctance to use this drug? The signals may be mixed, but as the list of known risk factors continues to expand, the decision about using synthetic HRT gets easier every day. To Your Good Health, Jenny Thompson Health Sciences Institute ************************************************************** Sources: " Screening Without Evidence of Efficacy " Malcolm Law, British Medical Journal, Vol. 328, 2/7/04, bmj.bmjjournals.com " Prostate Test 'Of Little Value' " BBC News, 2/6/04, newsvote.bbc.co.uk " Effect of Verification Bias on Screening for Prostate Cancer by Measurement of Prostate-Specific Antigen " New England Journal of Medicine, Vol. 349, No. 4, 7/24/03, ncbi.nlm.nih.gov " Prostate Test Misses Tumors, Study Finds " Gene Emery, Reuters Health, 7/23/03, preventdisease.com " Variation of Serum Prostate-Specific Antigen Levels " Journal of the American Medical Association, Vol. 289, No. 20, 5/28/03, jama.ama-assn.org " Study Recommends 2nd Test Before a Prostate Biopsy " Mary Duenwald, The New York Times, 5/28/03, nytimes.com " FDA: Hormone Therapy, Dementia Linked " Associated Press, 2/10/04, msnbc.com " HRT 'Scare' Expert Plays Down Risk " BBC News, 2/16/04, news.bbc.co.uk Copyright ©1997-2004 by www.hsibaltimore.com, L.L.C. The e-Alert may not be posted on commercial sites without written permission. Before you hit reply to send us a question or request, please visit here http://www.hsibaltimore.com/ealert/questions.html ************************************************************** If you'd like to participate in the HSI Forum, search past e-Alerts and products or you're an HSI member and would like to search past articles, visit http://www.hsibaltimore.com ************************************************************** Search - Find what you’re looking for faster. Quote Link to comment Share on other sites More sharing options...
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