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Behind the Headlines-08

Us TOO FLORENCE - BEHIND THE HEADLINES-8
BY BOB HORNEY - PROSTATE CANCER SURVIVOR - Us TOO CHAPTER LEADER
(Published April 09, 2014, The Siuslaw News)

In March, we saw why the National Cancer Institute (NCI) Prostate, Lung, Colorectal and Ovarian (PLCO) Trial was (DOA) Dead on Arrival. It was not a PSA screening vs. no PSA screening trial, but rather a "provided" PSA screening as part of the trial vs. a "usual care - get your own if you want" PSA screening.
According to PLCO entry criteria, multiple prior PSA tests were part of the trial's protocol from November 1993 to April 1995. The trial age range during that period was 60 to 74. From April 1995 to the end of recruitment in 2001, trial protocol was changed to accept only 1 PSA test during the previous 3 years and the eligible age at entry was reduced to 55 years of age.
As it turned out, the screening (with PSA/DRE tests) was 80-85% in both groups - much too close for any statistical value and, therefore, unable to answer the question, "Can screening with PSA and DRE reduce prostate cancer mortality?" One can reasonably question how the NCI could justify spending millions of dollars on such a poorly designed trial.
Allowing participants in both groups to enter the trial with prior PSA tests and to continue receiving PSA tests during the trial doomed it from the start. An editorial by Fritz H. Schroder and Monique J. Roobol in European Urology 58 (2010) stated it plain and simple that "the PLCO trial did not comply with minimum standards for a trial (e.g. having sufficient power to demonstrate an effect)."
However, all is not lost! It is true that the PLCO, as designed by the NCI, will never prove that screening can reduce prostate cancer mortality, but...
Oliver Sartor, M.D., Tulane University School of Medicine provides us with the following important information that has clearly been kept "Behind the headlines." When the NCI authors analyzed data for those with and without PSA testing, "The cumulative death rate from prostate cancer at 10 years in the two groups combined was 25% lower in those who had undergone two or more PSA tests at baseline than in those who had not been tested." There is no surprise in that statistic. Men who have had two or more PSA tests with no abnormal results are much less likely to have abnormal results in the future. As to these prescreened men, Patrick Walsh, M.D., Johns Hopkins adds, "Consequently, these men were not only less likely to have cancer, but also less likely to have life threatening disease."
Patrick Walsh points out an even greater piece of positive data. In a later reanalysis of the data focusing on men who were healthy - those being the men who are most likely to receive the greatest benefit from treatment - the PLCO researchers found that there was a 44 percent reduction in deaths from prostate cancer at ten years. Based on these findings, the authors estimated that only FIVE healthy men would have to be treated to save one life.
Why has this information not seen the light of day - in big, bold letters? We know that healthy men - especially "young" healthy men - have the most to gain from PSA screening. They have 30-40 years of life ahead of them and can easily, in most cases, undergo aggressive treatment with few lingering side effects. Plus, we know PSA screening can detect potential problems while the men are healthy and feeling great, 8-10 years before symptoms arise.
The information shared above by Drs. Sartor and Walsh, support the Us TOO Florence recommendation that men receive a baseline PSA test along with a digital rectal exam (DRE) at age 40 (also Dr. Walsh's recommendation). That set of data, in the hands of an experienced urologist, can prevent future misfortune at the hands of that walnut-sized prostate gland.

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