Fwd: THE MOSS REPORTS Newsletter (08/10/03)

[Guest guest]

Mon, 11 Aug 2003 15:21:35 -0400 (EDT)

 

 

THE MOSS REPORTS Newsletter (08/10/03)

 

----------------------

Ralph W. Moss, Ph.D. Weekly CancerDecisions.com

Newsletter #94 08/10/03

----------------------

 

 

 

PSA USE SHARPLY QUESTIONED

 

 

 

Another pillar of the cancer establishment is

tottering. The widely used Prostate Specific Antigen

(PSA) blood test, designed to detect prostate cancer

while it is still in its early stages, has been found

to miss 82 percent of tumors in men under 60, and 65

percent of cancers in older men, according to a recent

study published in the New England Journal of Medicine.

 

 

At the present time a reading under 4.0 is considered

the sign of a healthy prostate. But scientists at

Harvard Medical School and elsewhere have responded to

these findings by suggesting that the cut-off point for

a " healthy " PSA score should be lowered to 2.6. Indeed,

the Prostate Cancer Coalition already advocates

checking men with lower PSA levels. If this new

yardstick were generally adopted, it would mean that

thousands more men every year would be told to have

surgical biopsies to see if they really have prostate

cancer. Many more men who do not have prostate cancer

would undergo these biopsies just to make sure.

 

 

The PSA test was approved by the FDA in 1986 and was

purported to have an 80 percent rate of accuracy in

detecting prostate cancer in its early phase. However,

studies have repeatedly shown that the PSA test is

decidedly unreliable. In up to 82 percent of cases of

men under 60 years of age who actually do have prostate

cancer, the PSA test gives a normal reading (4.0 or

below). Conversely, in 12 percent of men who do not

actually have prostate cancer, the PSA test will give a

suspicious reading of 4.1 or above. Other conditions,

such as prostatitis (inflammation of the prostate

gland) can lead to false positive readings.

 

 

If the " healthy " score were lowered to 2.6, scientists

say, then the percentage of men without cancer who

would be subjected to an unnecessary biopsy would rise

from 2 percent to 6 percent.

 

 

The widespread use of PSA screening has created a boom

in biopsies, according to the January 2002 issue of the

journal Urology. Lowering the normal score by several

points will generate even more office traffic for

urologists. But will it really save the lives of those

who submit to it? In an editorial in the same issue of

the New England Journal of Medicine, Drs. Fritz

Schroder and Ries Kranse of the Erasmus Medical Center

in Rotterdam, Netherlands, say no. They point out that

there is no conclusive evidence showing that the PSA

screening test actually reduces the risk of death from

prostate cancer, without reducing many men's quality of

life.

 

 

There is no doubt that we need a way to detect

aggressive prostate cancer. Prostate cancer kills about

29,000 American men each year and is the second most

common cancer killer of US men, after lung cancer.

However, there are so many problems with the PSA that

it can really no longer be considered a reliable means

of finding early but life-threatening cancer. To

complicate matters even further, many experts point out

that prostate cancer is usually a slow-growing disease

and in fact, in older men, often does not require any

treatment at all, except " watchful waiting. "

 

 

The very name " Prostate Specific Antigen " implies that

this marker is found only in prostate tissue.

However, in 1995 scientists at Fox Chase Cancer Center,

Philadelphia, showed that genetic material (RNA)

contained in PSA was also present in several

non-prostate cell lines, including ovarian cancer, lung

cancer, myeloid leukemia, as well as occasionally in

normal blood. Oddly, Canadian scientists have also

found this " prostate-specific " marker expressed by

female breast cancers (Zarghami 1996). So the idea that

PSA is specific to prostate cancer is inaccurate, to

say the least.

 

 

I am not saying that PSA tests are worthless. In fact,

they are still very important in diagnosing the

progress of the disease, once established. But PSA is

what scientists call a " dynamic measure. " What is

really important is how it changes over time. A rising

PSA, for example, is a valuable indicator that the

cancer is progressing. And a PSA above zero in a man

whose prostate has been removed is usually an

indication of recurrent disease. But as an absolute

measure it is of doubtful value, and may now lead to a

tremendous extension of surgical biopsies. This is a

questionable development.

 

 

In a prostate biopsy, a visualizing device, called a

transrectal ultrasound (TRUS), is inserted into the

rectum, and a tiny needle is threaded through the

rectal wall and into the prostate. Most doctors take

six samples, but others take as many as 45 samples of

the prostate in a needle-in-the-haystack search for

cancer. The more elaborate biopsy requires anesthesia.

Everyone agrees that the procedure hurts, although many

urologists downplay the pain, claiming that the

prostate isn't especially sensitive to pain. (This will

come as a surprise to any man who has suffered through

a bout of prostatitis.) Researchers at Emory University

have suggested that the common pain reliever lidocaine

gel can significantly improve a patient's comfort.

After the biopsy there may be blood in the urine,

stools, or semen for days.

 

 

According to the University of Pittsburgh Cancer

Institute, fewer than 1 percent of all patients develop

severe bleeding or an infection of the prostate or

urinary tract following biopsy. However, the key word

here is " severe. " Another study done at the Mayo Clinic

showed that of 2,258 prostate biopsies, 17 percent were

associated with at least one complication.

 

 

The total number of complications per biopsy remained

relatively constant between 1980 and 1997. But the

age-adjusted complication rate (per 100,000 men) during

this period more than doubled, from 26 to 60. This is

because the use of prostate biopsies also more than

doubled in the same period, from 138 per 100,000 to

374 per 100,000.

 

 

" The prevalence of post-biopsy complications in the

community has increased tremendously because of the

increased use of prostate biopsies, " the Mayo authors

reported. One can predict that if the normal PSA score

is reduced from 4.0 to 2.6, as proposed, this will

contribute even more to the rising number of biopsies,

as well as increasing the incidence of complications

needing further treatment.

 

 

I don't have any simple solution to the PSA dilemma.

However, I hope that medical practitioners will take

another look at the old-fashioned but nonetheless

useful method of digital rectal examination (DRE),

which, for all its limitations, at least does not poke

holes in a sensitive organ, nor frequently cause

complications, as does needle biopsy.

 

 

What will doctors do about patients (and they number in

the thousands) who have had a relatively stable PSA

score between 2.6 and 4.0? Are they really going to

send all of those men for painful and potentially

dangerous biopsies? And will men willingly submit to

such invasive procedures? I hope not.

 

 

Once again, I lift my eyes to Heaven and exclaim,

" There's got to be a better way! "

 

 

 

COMPREHENSIVE MOSS REPORTS ON CANCER

 

 

 

We have a Moss Report on prostate cancer. Like all of

our reports, it is quite comprehensive and up-to-date.

The price of these reports is $297, but our summer sale

continues with $50 off until September 2. We also offer

phone consultations and research services to our

clients. If you are facing difficult treatment

decisions on the proper treatment of this kind of

cancer (or over 100 other types) you owe it to yourself

to find out more about this unique service. Visit our

website, www.cancerdecisions.com, or call our patient

coordinators, Diane and Anne, at 800-980-1234 (if

calling from abroad, call 814-238-3367). We will be

happy to help you.

 

 

 

 

--Ralph W. Moss, PhD

 

=======================

 

References:

 

 

Djavan B, et al. Safety and morbidity of first and

repeat transrectal ultrasound guided prostate needle

biopsies. The Journal of Urology. September 2001. 166:

856-860.

 

 

Emery, Gene. Prostate Test Misses Tumors, Study Finds.

Reuters. Wed July 23, 2003.

 

Issa, MM, et al. A randomized prospective trial of

intrarectal lidocaine for pain control during

transrectal prostate biopsy: the Emory University

experience. Journal of Urology 2000: August; 164 (2):405.

 

Roberts RO, Bergstralh EJ, Besse JA, Lieber MM,

Jacobsen SJ. Trends and risk factors for prostate

biopsy complications in the pre-PSA and PSA eras, 1980

to 1997. Urology. 2002 Jan;59(1):79-84.

 

 

Smith MR, Biggar S, Hussain M. Prostate-specific

antigen messenger RNA is expressed in non-prostate cells:

implications for detection of micrometastases. Cancer Res.

1995 Jun 15;55(12):2640-4.

 

 

Zarghami N, Diamandis EP. Detection of prostate-specific

antigen mRNA and protein in breast tumors. Clin Chem. 1996

Mar;42(3):361-6.

 

---------------

 

IMPORTANT DISCLAIMER

 

 

The news and other items in this newsletter are

intended for informational purposes only. Nothing in

this newsletter is intended to be a substitute for

professional medical advice.

 

--------------

 

 

To SUBSCRIBE TO OUR FREE NEWSLETTER: Please go to

http://www.cancerdecisions.com/subscr.html

and follow the instructions to be automatically

added to this list. Thank you.