New UK Study

[pca2004]

Interesting/amusing/important(?)

UK study below[1]

"We examined {all-cause mortality/overall survival} and {PrCa-specific survival} in 16,340 men by degree and number of relatives with prostate and genetically related cancers (breast, ovarian, and colorectal)."

Unexpectedly, "A stronger FH {family history} was inversely associated with the risk of all-cause and PrCa-specific mortality." Appears that awareness of risk can override an anticipated increase in mortality.  Behavioural changes seemingly affect survival in those at high risk.  

As we know, the risk of PCa is quite significant if one lives long enough.  Perhaps young men should be told that the lifetime risk is akin to having a family history. They should be encouraged to adopt the behaviours of those with familial PCa, including PSA screening.

The originators of the PSA test felt that it was useful for monitoring men with diagnosed PCa, but not as a screening tool. However, the U.S. PSA era quickly became a mass screening phenomenon.  Many countries did not buy into that, although the U.K. system did allow men to request the test.

... "studies suggest that around 6% of men undergo prostate-specific antigen (PSA) testing each year in UK" (2017) [3]

whereas, "In 2018, 39.0% of men aged 55-69 years had a PSA test within the past year." - in the US [4]

In the aftermath of the U.S. Preventive Services Task Force [USPSTF] recommendations, the US has moved away from screening.  There has been a reduction in overtreatment, but an increase in men diagnosed with advanced PCa.  As a cynic, I believe that this was a trade-off intended by the USPSTF.

One of the beliefs of the USPSTF members was that screening did not improve survival:

"The U.S. trial did not demonstrate any prostate cancer mortality reduction. The European trial found a reduction in prostate cancer deaths of approximately one death per 1,000 men screened in a subgroup of men 55 to 69 years of age. This result was heavily influenced by the results of two countries; five of the seven countries reporting results did not have a statistically significant reduction. All-cause mortality in the European trial was nearly identical in the screened and nonscreened groups." [2]

There is no need to rehash the controversy regarding those studies.  The above is simply background to the recommendation.

But, IMO, the new UK study shows that screening does affect survival.

... we "found that the stronger their family history, the better they did in terms of overall survival. We looked at the type and timing of patients' diagnoses compared with those of their relatives and found that this effect is likely to be explained by awareness, which indicates the importance of screening and awareness programmes."  

-Patrick

[1]  pubmed.ncbi.nlm.nih.gov/365...

[2]  aafp.org/pubs/afp/issues/20...

[3]  ncbi.nlm.nih.gov/pmc/articl...

[4]  progressreport.cancer.gov/d...

[cujoe]

Patrick - Seems your ability to post has been restored. Welcome back once again.

At the moment, I don't have time to dig into this paper but it is one that has relevance to me and my extended family - as cancer has been the cause of death for both parents and two of my 4 siblings. In addition, each surviving sister has had or is currently being treated for cancer.

Curiously, except for my two sisters (breast cancer), the rest have been different cancers. It is also not clear that in my family's case, the awareness of familial cancer risk has had much impact, since two nephew (via 2 sisters) both had prostatectomies in their mid-40s! It is also curious that so far genetic testing has not come up with any germline (or, in my case via the STRATA CT, germline or somatic) gene defects.

Thanks for posting! This is especially useful information to me and I will send it along to my family to help motivate them to get screened early & often and get their diet/lifestyles under control to reduce their risks. Who knows this post might even save a life somewhere/someday.

Stay Well - Ciao - K9 terror

[Graham49]

In my case, my grandather on my mothers side died of prostate cancer but I did not find out about this until I had PCa. I don't know what caused the death of my mothers brothers. I had no awareness of PCa until I started getting peeing problems.

[NPfisherman]

Is the medical community failing PCa patients in various parts of the world?? Indeed, it is... The sad state of affairs is that a rather inexpensive test could save thousands of lives and a lot of suffering, but is not ordered. Too many show up on forums that did not get a PSA until too late...

Fish

[MateoBeach]

USPSTF model did not include, nor allow for, advances in treatment to provide less harm and better treatment options going forward. They wanted to discourage mass screening, probably for societal costs IMO.

Instead, men, their families and their physicians chose screenings with PSA in large numbers anyway. Resulting in very many cases of PC diagnosed earlier instead of being missed and ignored. This population, demanding the best in treatment options for all stages has led to an explosion is research and all of the recent and ongoing advances we are continuing to see. It’s a revolution. Paul

[NPfisherman in reply to MateoBeach]

Pablo,

Indeed, each year when I modify my annual post " Being Thankful" , I have to increase the number of trials... The problem is that many drugs get past Phase IIb and then are stalled as Big Pharma tries to nickle and dime small biotechs that do not have Phase III monies...something must change...

DD