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Showing posts with label Screenings. Show all posts
Showing posts with label Screenings. Show all posts

Monday, 17 February 2020

Japanese Cancer Detection using worms

Biologist harnesses power of tiny worms in project that could reshape way cancer is screened and treated




BY TOMOKO OTAKE
STAFF WRITER 
OCT 8, 2017

Call it worm power.




Takaaki Hirotsu is trying to harness the power of the nematode worm — a tiny, transparent roundworm that lives in soil or water — to detect all forms of cancer at their earliest stages.
The use of nematodes for superearly cancer detection — a project not being undertaken by anyone else at the moment — could dramatically change the way cancer is screened and treated, both in Japan and overseas.
The 45-year-old biologist stunned the world in March 2015 when, as a researcher at Kyushu University, he announced in a science journal his discovery of the nematode’s unique ability to detect the odors of cancerous cells. The research, published in Plos One, said the roundworm was found to be attracted to diluted urine samples of cancer patients and tended to quickly home in on them while moving away from the urine of healthy people.
The scent detection worked with about 95 percent accuracy, a remarkable result compared with other tumor-marker diagnostic tests using blood samples, according to the paper.
Now, 2½ years later, he runs his own venture, Hirotsu Bio Science, where he collaborates with more than 20 hospitals and cancer research institutions nationwide to conduct clinical trials for this novel cancer-screening method.
He aims to launch a diagnostic kit — N-Nose — by early 2020, with the goal of eventually making it the predominant first-stage screening tool in Japan and abroad.

Takaaki Hirotsu, CEO of Hirotsu Bio Science, is interviewed at his office in Tokyo's Akasaka district on Sept. 25. | YOSHIAKI MIURA
Hirotsu’s interest in the nematode worm, which measures about 1 mm long, spans more than two decades, dating back to the late 1990s, when he was in a master’s program in biology at the University of Tokyo, commonly known as Todai. His primary research interest at the time was the mating behavior of the nematode worm — which is either male or hermaphrodite. A hermaphrodite nematode has both male and female reproductive organs and can self-reproduce.
“The nematode worm is mostly hermaphrodite and can create its clones,” he said. “To boost its survivability in the environment, it only occasionally mates with a male. When that happens, the male nematode circles around the hermaphrodite one, which is kind of like the mating dances of fish and other animals, though not as conspicuous. I found that interesting and wanted to find out why.”
But it was a secondary, side theme given by his Todai professor that really opened up his research opportunities: scent.
Using the worm, he established that a well-known cancer protein called Ras is activated by the scent stimuli — a discovery that was published in the journal Nature in 2000. For years after that, he continued to research smells, using the nematode as a model organism.
“People’s like or dislike of the same smell changes depending on its concentration,” he said. “Indole, for example, is an aromatic substance that, when diluted, smells like jasmine. But when it’s in a concentrated form, it smells like feces. I found such things amazing, and did countless experiments on how the worm reacted to the same aromas differently as their concentration changed.”
It was only in 2013 when Hirotsu — who until then considered himself a basic research scientist — began studying whether the worm can be used to sniff out cancer. It was after a doctor who studied the use of dogs for cancer detection asked him whether it was possible.
Dogs have long been known for their ability to smell cancer, even in its early stages, though it is not known exactly why they are so good at it. One promising theory is that they can smell a mixture of gases discharged only by cancerous cells. But training such specialist dogs is an expensive undertaking, and there are currently not nearly enough canines capable of screening everyone in Japan.
“Since I was confident that I had done more tests, and was more skilled at fine-tuning them, on the worm’s reaction to smells than anybody else, I thought I would be the first one to find out whether it would work (for cancer detection),” he said.
And so he did. He says he is now convinced that nematodes are the best cancer screening tool. The worms are cheap and easy to keep, and are just as good as — if not better than — dogs in their sensitivity to smells, he said.
But why are nematodes attracted to cancerous cells? While the precise reason is unknown, they seem to hate humans in general, as they shy away from any sample type, be it urine, saliva or human tissue, he said.
One potential reason is that cancer cells produce certain odors that smell a lot like the food of nematodes, he said, adding that they feed on E. coli and other bacteria.
“It could be possible that the chemicals discharged by cancer cells smell like their food and they are carried through the bloodstream into the urine of cancer patients,” he said.
Hirotsu wants to make N-Nose the universal, first-stage screening tool for everyone submitting just a tiny urine sample. And for a reasonable price, too — less than ¥10,000. Keeping the price down is one reason he decided to set up his own venture and became its CEO in August 2016, instead of having others run the business. (He disbanded his previous venture, which he set up in late 2015 and asked someone else to head, after clashes over management policy.)
Currently, C. elegans, the nematode’s scientific name, can detect whether or not someone has cancer, but not the disease’s location. Hirotsu, though, is working on engineering nematodes that react to specific types of cancer.
“The way cancer smells is said to be different according to cancer types,” he said. “So it’s theoretically possible that, once someone is confirmed to have cancer using the wild-type C. elegans, we can find out what type, using genetically modified nematodes that react to particular cancer types.”
He said his research priority is creating a series that can single out pancreatic cancer because it is the hardest cancer to detect early on and is known for its poor prognosis.
One serious issue N-Nose could raise is that, because the worm’s ability is so exceptional, and because it can detect cancer at such an early stage, it may not be possible to confirm the results using conventional tests that are available now. This could result in a situation where someone tests positive in N-Nose but is left with no options to find out what type of cancer they have or to get it treated.
To address such concerns, Hirotsu is preparing to set up an academic group involving doctors, ethicists and psychologists to create guidelines on how to explain the test results to people.
“We need to decide beforehand what kind of explanations the doctors will give to patients, what kind of exams to take next, and what to do when the patients test negative in the follow-up exam,” he said.
But that does not discount the value of the nematode test itself, claimed Hirotsu, who also plans to roll out the diagnostic kit overseas by around 2020.
“As a nematode researcher, I want everyone’s cancer to be detected early, instead of late,” he said.
That, he believes, will change people’s perception of cancer — from the incurable to the curable.
“Right now, getting a cancer diagnosis is like a death sentence for many,” he said. “Many people cite the fear of a diagnosis as a reason to avoid screenings. But when our test becomes widely available, more people will have their cancers discovered and cured. The time will come when people will feel happy to get a cancer diagnosis. It would change the way people look at cancer. It would help enrich people’s lives.”
“Generational Change” is a series of interviews, profiling people in various fields who are taking a leading role in bringing about changes in society.

Key events in Hirotsu’s life

1972 Born in Suo-Oshima, Yamaguchi Prefecture
1995 Graduates from the University of Tokyo, faculty of biology
1997 Completes a master’s degree program with a focus on biochemistry at the university
1997 Joins Suntory Inc.
1998 Leaves Suntory, starts a Ph.D. program at the University of Tokyo
2000 Publishes a paper on cancer protein Ras
2001 Receives a Ph.D. in science from the university
2004 Becomes a postdoctoral research fellow at Kyoto University
2005 Joins Kyushu University as an assistant professor
2016 Establishes Hirotsu Bio Science Inc. and becomes CEO



Venture behind worm cancer-screening method raises ¥30 million from Shinkin Capital




NATIONAL / SCIENCE & HEALTH

OCT 26, 2017

BY TOMOKO OTAKE
STAFF WRITER




Hirotsu Bio Science, a medical venture developing a cancer screening tool using nematodes, has secured ¥30 million in funding from Shinkin Capital Co. to accelerate growth in overseas markets, the firm announced Thursday.
The Tokyo-based venture run by Takaaki Hirotsu, formerly a biology researcher at Kyushu University, is creating a method to detect early-stage cancers with nematodes, which he discovered are attracted to the diluted urine of cancer patients.
The firm plans to introduce the urine test kit, named N-Nose, by January 2020. It is currently conducting clinical trials involving patients with about 10 different cancers at over 20 hospitals and cancer research institutes across Japan.
At a news conference held Thursday in Tokyo with Shinkin Capital, a subsidiary of the Shinkin Central Bank, Hirotsu said a roll-out of the product abroad will occur around the same time as the Japan launch.
Earlier this month, Hirotsu’s firm reached a joint research agreement with Queensland University of Technology in Australia, and is scheduled to start clinical trials there starting this winter. With results of the research in Australia, it hopes to market the screening kit in the U.S. and Europe.
“N-Nose is painless, quick and cheap. And it can detect cancers in super-early stages,” Shinkin Capital President Kazuo Yamaguchi said. “We find it to be a socially valuable investment.”

https://www.japantimes.co.jp/news/2017/10/26/national/science-health/venture-behind-worm-cancer-screening-method-raises-30-billion-shinkin-capital/




Patents by Inventor Takaaki HIROTSU
Takaaki HIROTSU has filed for patents to protect the following inventions. This listing includes patent applications that are pending as well as patents that have already been granted by the United States Patent and Trademark Office (USPTO).

  • Publication number: 20190369084
    Abstract: The present invention provides a method for evaluating the taxic behavior of nematodes in response to an odor substance based on olfactory sense, and a dish and a behavior evaluation system to be used for the evaluation method. [Solution] Provided is a method for evaluating the taxic behavior of nematodes in response to odor of a test sample, the method including: a) providing a dish in which the test sample is arranged on the bottom surface, and nematodes are arranged in a region or a site of the bottom surface 1 cm to 3 cm away from the test sample; b) observing the arrangement of the nematodes on the bottom surface at 3 to 15 minutes after the later one of the test sample or the nematodes is arranged; and c) evaluating whether the nematodes show attraction behavior or avoidance behavior in response to the test sample, from the arrangement of the nematodes observed, and a dish or a taxic behavior evaluation system suitable for the method.
    Type: Application
    Filed: September 11, 2017
    Publication date: December 5, 2019
    Applicant: HIROTSU BIO SCIENCE INC.
    Inventors: Takaaki HIROTSU, Takayuki UOZUMI, Satoru KAIFUCHI
  • Publication number: 20170016906
    Abstract: A cancer detection method characterised in that a nematode is bred in the presence of bio-related material originating from a test subject, or a processed product of same, and cancer is detected using the chemotaxis due to the sense of smell of the nematode as an indicator.
    Type: Application
    Filed: December 10, 2014
    Publication date: January 19, 2017
    Applicant: KYUSHU UNIVERSITY, NATIONAL UNIVERSITY CORPORATION
    Inventors: Takaaki HIROTSU, Hideto SONODA

ALSO:   Just a drop of urine, worms for highly effective cancer screening

Tuesday, 12 April 2016

PillCam screening for colon cancer

Less invasive methods may provide options for colorectal cancer screening
New methods of screening for colon cancer may provide more pleasant alternatives to the colonoscopy for some patients.

By MICHELLE CASTILLO CBS NEWS February 3, 2014,


During a colonoscopy, doctors look for precancerous polyps that may exist in the colon. This usually involves placing a tool called an endoscope with a camera on one end inside the patient through the rectum to look at the entire large intestine and part of the small intestine. Doctors can also remove any growths they see at this time.
A September study found that routine colonoscopies reduced the risk of colorectal cancer by as much as 40 percent. But the procedure often requires sedation and can be uncomfortable. 
Now researchers at the Kaiser Permanente Center for Health Research say a review of past studies shows that 80 percent of colon cancer cases can be detected with a simple at-home test. The fecal immunochemical test, also known as FIT, involves the patient taking a fecal sample, which is then sent to a lab and examined for the level of blood inside it. 
“The reasoning is that early colorectal cancers bleed. The test is meant to pick up on that bleeding, and if positive, a colonoscopy is then warranted,” Dr. Elizabeth Liles, of the Kaiser Permanente Center for Health Research, told CBS News.
Also on Monday, the Food and Drug Administration approved the use of thePillCam Colon for people who were not able to complete a standard colonoscopy. The pill-sized camera takes photos of the patient’s insides over the course of 10 hours. It measures a little over 1.25 inches long by less than 0.5 inches wide, and is simply swallowed to start the process.

After the patient swallows the tiny camera, they wear a corresponding device around their waist. The device transmits the photos of the intestines to a computer, where a physician can take a closer look at what is going on inside the patient. 

According to the pill’s manufacturers, clinical trials showed that the pill was able to correctly detect non-cancerous growths called adenomas that were at least 6 millimeters, 88 percent of the time. It was able to determine growths were not adenomas 82 percent of the time.
But, compared with optical colonoscopies, the PillCam only came up with the same positive adenomas and polyps findings 69 percent of the time when the growths in questions were at least 6 millimeters. The two methods had the same negative findings in 81 percent of the time. 
There are some risks of taking the pill camera, including the device getting stuck inside the body, choking on it when trying to ingest it or skin irritation. People also have to avoid high electromagnetic fields, such as MRI machines, when the device is inside them. More complex medical procedures may be necessary if any of these complications occur. In addition, the PillCam cannot perform a biopsy or remove abnormal polyps. 
Although the traditional method of colonoscopy still provides clearer, more accurate results, this method might be good for people whose colonoscopy procedures were incomplete. 
"Even though colonoscopy is an excellent screening tool for colon cancer, it is not perfect," Dr. Jon LaPook, chief medical corespondent for CBS News, said.  "One drawback is that sometimes it is technically too hard to advance the instrument through the entire colon. This can be for a variety of reasons, such as the colon being too winding and angulated.  In these cases, the Pillcam offers another way of visualizing the lining of the colon."
About 750,000 patients each year experience an incomplete colonoscopy, according to the manufacturers.
“Among the limited alternatives available after incomplete colonoscopy, PillCam COLON gives us a minimally invasive, radiation-free option that provides endoscopic images of the same basic type that have made colonoscopy so useful," Dr. Douglas Rex, distinguished professor of medicine at Indiana University School of Medicine and the director of endoscopy at the Indiana University Hospital, said in a press release.
The PillCam costs about $500, whereas a colonoscopy procedure is about $4,000, according to the Associated Press. 
The pill had been approved in about 80 different markets before today’s FDA approval. With the U.S. allowing the devices, the manufacturer Given Imaging Ltd. said about 3 million people are expected to use the PillCam annually. 
About 102,480 people were diagnosed with colon cancer and 40,340 were diagnosed with rectal cancer last year, according to government estimates. Almost 51,000 people died from those cancers last year. According to the American Cancer Society, colorectal cancers are the third leading cause of cancer-related death in the U.S.
The Centers for Disease Control and Prevention recommends that people get a routine colonoscopy when they turn 50 and continue to get one every 10 years after that. Those with a history of colorectal polyps or other bowel problems may need screenings starting at an earlier age. Talk to your doctor about whether or not scheduling a colonoscopy is right for you. 
http://www.cbsnews.com/news/less-invasive-methods-may-provide-options-for-colorectal-cancer-screening/

This post is on Healthwise

See also:

http://healthticket.blogspot.my/2014/02/fda-approves-pill-camera-to-screen-colon.html

Saturday, 26 March 2016

You need to do this colon cancer test before it’s too late

Just a few weeks after she turned 17, Danielle Burgess was diagnosed with colon cancer.
Burgess had been noticing blood in her stool for several years, but she shrugged it off after consulting “Dr Google” and self-diagnosing haemorrhoids.



You need to do this colon cancer test before it’s too late
Colorectal cancer, a malignancy that occurs in the colon or rectum, is a leading cause of cancer deaths. Photo: TNS
By the time she went to the doctor to have a colonoscopy, she was diagnosed with Stage 3 colon cancer.
“It wasn’t great, but they gave me a lot of treatment options,” said Burgess of Kansas City, Montana, US.
Six months later, she was cancer-free. Doctors continued to monitor her colon (large intestine) every three years.
In 2009, when she was 25, a growth on her colon once again tested positive for cancer.
“Luckily, they caught it early,” said Burgess, now 32.
Colorectal cancer, a malignancy that occurs in the colon or rectum, is a leading cause of cancer deaths. This year, it’s expected to claim the lives of nearly 50,000 people in the US.
It’s also largely preventable.
Screening tests can detect and remove abnormalities before they have a chance to turn cancerous – or spot problems in the early stages, when the disease is more responsive to treatment.
The American Cancer Society and other groups say that screening for most men and women should begin at age 50.
Even so, many choose to ignore this advice. Roughly one-third of the country’s eligible adults haven’t been screened for colorectal cancer as recommended by the US Preventive Services Task Force, according to the US Centers for Disease Control and Prevention (CDC).
The CDC estimates that if everyone age 50 and up had regular testing, at least 60% of deaths from this cancer could be avoided.
“In nearly every case, colon cancer begins with a small growth called a polyp, which over time turns into a large polyp, and eventually turns into cancer,” said Dr David Greenwald, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital in New York.
“This process takes many years to occur; if polyps are removed when they are small, or even when they are big, but before they turn into cancer, colon cancer is prevented.”
If found in its earliest stages and if the cancer hasn’t spread, the survival rate beyond five years is 90%, said Durado Brooks, managing director of cancer control intervention for the American Cancer Society. If it has already spread, the survival rate drops to 12% beyond five years.
“Our treatments are much, much more effective at the early stage,” Brooks said.
There are numerous ways to screen for colorectal cancer, and several organisations have issued their own guidelines.
The US Preventive Services Task Force recommends screening using high-sensitivity faecal occult blood testing (FOBT), sigmoidoscopy or colonoscopy beginning at age 50 and continuing until age 75, at which point the decision to continue screening should be made on an individual basis depending on the person’s overall health and screening history.
The tests the task force recommends:
High-sensitivity FOBT or faecal immunochemical test (FIT) to detect blood in the stool, a possible sign of cancer. People get a kit and collect small samples of stool that are sent to a lab. This test should be done annually.
Flexible sigmoidoscopy, where doctors use a thin, flexible, lighted tube called a sigmoidoscope to examine the interior walls of the rectum and the lower third of the colon. Should be done every five years in conjunction with FOBT/FIT every three years.
• Colonoscopy, similar to a sigmoidoscopy, but uses a longer colonoscope tube to look at the inside walls of the rectum and the entire colon. Should be done every 10 years. During the procedure, tissue samples may be collected for further testing or polyps may be removed.
Colonoscopies are often performed as a follow-up if abnormalities are picked up by other screening methods.
Doctors say they’ve heard a plethora of excuses from patients who’ve put off screening.
“Some excuses for not undergoing screening, include a fear of being diagnosed with cancer,” said Dr Andrew Chan, associate professor of medicine at Harvard Medical School and gastroenterologist at Massachusetts General Hospital.
“Other patients do not want to undergo endoscopic screening tests because they are afraid of pain or discomfort. For these patients, I explain that the vast majority of patients do not experience discomfort since they are given sedatives and pain medicines during the procedures.”
 


The American Cancer Society’s recommendations include additional screening options, such as an X-ray of the colon and rectum called a double-contrast barium enema, and a CT colonography (virtual colonoscopy), where X-rays and computers create images of the entire colon.
Both require that the colon is completely empty before testing, so patients need to do a colon-cleansing prep, same as they would with a standard colonoscopy.
The society also recommends a stool DNA test every three years that entails sending a bowel movement to a lab to be checked for cancer cells.
“They (stool tests) may not be as sensitive as colonoscopy, and some patients also worry about having to manipulate faecal matter,” Dr Chan said. “However, any screening is better than no screening exam.”
While most adults can wait until 50 to start routine screening, tests should begin earlier and be done more frequently for those at higher risk, such as people with inflammatory bowel disease or a strong family history of colorectal cancer or polyps.
People also need to be vigilant about symptoms – no matter what their age.
Just before Susan Cohan’s 40th birthday in 2002, she experienced stomach pain and rectal bleeding. She saw several doctors who prescribed laxatives rather than referring her to a gastroenterologist.
Cohan ended up in the emergency room in incredible pain. She was diagnosed with advanced stage colon cancer and told she had a couple of months to live, said her father, David Cohan, president of the Baltimore-based Susan Cohan Colon Cancer Foundation.
“Susan died two years later after a heroic battle,” her father said. “We urge anyone, regardless of age, with symptoms such as abdominal pain, bleeding or continuous constipation to get screened for colon cancer.” – Chicago Tribune/Tribune News Service
http://www.star2.com/health/wellness/2016/03/23/you-need-to-do-this-colon-cancer-test-before-its-too-late/

Saturday, 12 December 2015

How to know if you need regular prostate screening

There's a debate going on within conventional medicine. It concerns regular prostate testing for men under the age of 55.

December 8, 2015



There's a debate going on within conventional medicine. It concerns regular prostate testing for men under the age of 55. One side says the testing "may not have any benefit" for those under 55. The other side says, "Nearly half of all deaths from prostate cancer can be predicted before age 50." So which side is correct? And what should you do to keep your prostate healthy?

Both sides of this debate have valid arguments. But, as you'll see, their conclusions are basically two sides of the same coin. Here's what I mean.

The side that says there may not be much benefit to screening has substantial evidence on its side. One study, for instance, looked at outcomes from 6,822 men in the Rotterdam arm of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The researchers followed these participants from the their late 50s (55-59) until they reached 75. At the start of the study, screening indicated that 189 men had prostate cancer. At the end of the study, 19 of the 189 had died of prostate cancer or developed metastases. Another 21 men were showing biochemical signs of prostate cancer. Of the 6,822 participants, the researchers said these 40 men were the only ones that may have benefitted from early screening. That's a rate of only .6%.

The other side looked at the Malmo cohort study. This study followed 21,277 men between the ages of 27 and 52. The study ran between 1974 and 1984, when all of these men gave a blood sample. Six years later, the researchers took another blood sample of 4,922 of these men. These men were in three different groups: men close to age 40, mid-to-late 40s (45-49), and early-to-mid 50s (51-55). Here's what they found: "Within 25 to 30 years, 44% of deaths from prostate cancer occurred in those with the top 10% of PSA levels at age 45-49, a PSA of about 1.5 ng/ml or more. The risk of prostate cancer death was more than 10 times greater in this group compared to men with the lowest 25% of PSA levels."

Obviously, there is some benefit to screening. But only for some men. Both of these studies agree on one thing. They both reveal that men who are at high risk of developing prostate cancer should have screening in their 40s. So how do you know if you're at high risk? All you have to do is have your doctor check your PSA periodically. That's all for now. And here's how to evaluate your PSA score.

If your score is below 4.0, don't submit to a biopsy. If it is above 4.0, delay getting a biopsy, change your diet (mainly vegetables and other high-fiber foods) and take Advanced Prostate Formula. Then have your PSA checked again in a few months. Most prostate cancers are very slow-growing so delaying the biopsy shouldn't be a problem. If your doctor suspects you may have a faster-growing cancer, you may have to go ahead and submit to the biopsy.

If your PSA score begins to come down after changing your diet, you can continue the program above and evaluate your PSA annually (or whenever your doctor recommends). The PSA test is NOT an accurate cancer test. But it IS an accurate test for inflammation. If your score is coming down, your inflammation is coming down and your risk for cancer is decreasing.

If your score is going up, that's when you need to take notice. You need to evaluate your PSA velocity. This is a term that describes how high your PSA test increases in one year. For example, if you have a PSA test and it's 1.0 higher than it was the year before, you have a PSA velocity score of 1.0. However, if your score over five years goes up 1.0 points, then your PSA velocity is 0.2 (1.0 divided by five years). Regardless, both of these scores could mean trouble.

The ideal PSA velocity is 0.03 or less. The value may vary slightly from year to year. But you want the score as close to 0.03 as you can get. If it's 0.15 ng/ml over three consecutive years, you likely have a latent cancer. I'll show you in a future issue how to treat this cancer. For now, focus on keeping your PSA scores down. The lower the better. Remember, diet (high veggies, high fiber, and low animal fat) and taking Advanced Prostate Formula should keep your PSA scores down.

If you can do this, you likely don't need any other routine screening.

http://www.advancedbionutritionals.com/Nutrient-Insider/View-Archive/458/How-to-know-if-you-need-regular-prostate-screening.htm

This post is on Healthwise

Confused about prostate cancer screening? Mayo clinic expert helps explain the latest

Urologists recommend a personalized approach to determining whether or not a patient should consider PSA screening for prostate cancer.



Date:
June 13, 2012
Source:
Mayo Clinic
Summary:
Urologists recommend a personalized approach to determining whether or not a patient should consider PSA screening for prostate cancer.
FULL STORY

There is a lot of conflicting advice about prostate cancer screening. A recent U.S. Preventative Services Task Force recommendation against prostate-specific antigen testing, regardless of age, has added to men's confusion about how to protect themselves from a cancer that hits roughly 240,000 new patients every year and claims 28,000 lives.
Mayo Clinic urologists recommend a personalized approach to determining whether or not a patient should consider PSA screening for prostate cancer. This approach should begin at age 40 and include:
* Individual and family medical history.
* The patient's age, recognizing the age-related increase in cancer risk.
* The patient's ethnic background, noting that African-American men have the highest risk of prostate cancer.
* A discussion of the pros and cons of PSA screening.
* Other medical conditions that can affect PSA score.
Organizations that recommend PSA screening generally encourage the test between ages 40 and 75 and in men with a higher risk of prostate cancer, says Mayo urologist Jeffrey Karnes, M.D.
"It may be a simple test but it's not a simple decision," Dr. Karnes says. "A PSA test is something you should decide after discussing it with your doctor, considering your risk factors and weighing your personal preferences."
Cancer overall is the No. 2 health threat to men. June is Men's Health Month, highlighting health issues of particular concern to men and strategies for prevention and treatment.

Story Source:
The above post is reprinted from materials provided by Mayo ClinicNote: Materials may be edited for content and length.
http://www.sciencedaily.com/releases/2012/06/120613145232.htm

This post is on Healthwise

New prostate cancer screening guideline recommends not using PSA test

A new Canadian guideline recommends that the prostate-specific antigen (PSA) test should not be used to screen for prostate cancer based on evidence that shows an increased risk of harm and uncertain benefits.






Date:
October 27, 2014
Source:
Canadian Medical Association Journal
Summary:
A new Canadian guideline recommends that the prostate-specific antigen (PSA) test should not be used to screen for prostate cancer based on evidence that shows an increased risk of harm and uncertain benefits.

FULL STORY

A new Canadian guideline recommends that the prostate-specific antigen (PSA) test should not be used to screen for prostate cancer based on evidence that shows an increased risk of harm and uncertain benefits. The guideline is published inCMAJ (Canadian Medical Association Journal)
"Some people believe men should be screened for prostate cancer with the PSA test but the evidence indicates otherwise," states Dr. Neil Bell, member of the Canadian Task Force on Preventive Health Care and chair of the prostate cancer guideline working group. "These recommendations balance the possible benefits of PSA screening with the potential harms of false positives, overdiagnosis and treatment of prostate cancer."
For men with prostate cancer diagnosed through PSA screening, between 11.3% and 19.8% will receive a false-positive diagnosis, and 40% to 56% will be affected by overdiagnosis leading to invasive treatment. Treatment such as surgery can cause postoperative complications, such as infection (in 11% to 21% of men), urinary incontinence (in up to 17.8%), erectile dysfunction (23.4%) and other complications.
Prostate cancer is the most commonly diagnosed non-skin cancer in men and the third most common cause of death from cancer in men in Canada. However, the prognosis for most prostate cancers is good with a 10-year survival rate of 95%. Prostate cancer is generally slow to progress and usually not life-threatening.
The guideline, aimed at physicians, other health care professionals and policymakers, contains prostate cancer screening recommendations for using the PSA test with or without manual rectal examination of men in the general population. Based on the latest evidence and international best practices, the guideline updates the previous version published by the task force in 1994.
Key recommendations:
  • For men under age 55 and over age 70, the task force recommends not using the PSA test to screen for prostate cancer. This strong recommendation is based on the lack of clear evidence that screening with the PSA test reduces mortality and on the evidence of increased risk of harm.
  • For men aged 55-69 years, the task force also recommends not screening, although it recognizes that some men may place high value on the small potential reduction in the risk of death and suggests that physicians should discuss the benefits and harms with these patients.
  • These recommendations apply to men considered high risk -- black men and those with a family history of prostate cancer -- because the evidence does not indicate that the benefits and harms of screening are different for this group.
"Any use of PSA testing to screen for prostate cancer requires a thoughtful discussion between the clinician and the patient about the balance between unclear benefits and substantial harms," states Dr. James Dickinson, member of the prostate cancer guideline working group.
The guidelines are consistent with the recommendations of the US Preventive Services Task Force and the Cancer Council Australia. The United Kingdom does not have an organized screening program but recommends that men concerned about the risk of prostate cancer receive balanced information on the benefits and harms of screening.
The task force recommendations are based on systematic evidence reviews and use an international framework for assessing quality of evidence and the strength of recommendations for clinical guidelines (GRADE).
To help patients and their physicians make informed decisions, the task force has created tools to help patients and physicians in decision-making about testing. Visit http://www.canadiantaskforce.ca.
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the task force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.
"The task force's guideline is an excellent example of health care decisions being made from the perspective of evidence-based medicine," writes Dr. Murray Krahn, University Health Network and University of Toronto, Toronto, Ontario, in a related commentary. "However, it paid insufficient attention to patient values, patient preferences and costs."
"The task force's guideline provides a good summary of the data on the effectiveness of prostate cancer screening and a reasonable review of the rate at which potential harms occur," he states. However, several elements could provide more complete information for making decisions. These include a comprehensive review of patient harms, a review of modelling studies, evidence on cost as well as more on patient preference and shared decision-making, of which there is substantial literature.
Dr. Krahn suggests that recommendations for clinical practice should be based on patient preferences, social values and health care costs in addition to evidence on outcomes.
"The falling overall mortality in some countries that screen intensively [for prostate cancer], the evidence that treatment may have a very modest disease-specific mortality benefit, and the highly variable preferences for treatment outcomes suggest to me that we should not push patients out of decision-making in this area," concludes Dr. Krahn.

Story Source:
The above post is reprinted from materials provided by Canadian Medical Association JournalNote: Materials may be edited for content and length.

Journal References:
  1. M. Krahn. Prostate cancer screening: going beyond the clinical evidenceCanadian Medical Association Journal, 2014; 186 (16): 1201 DOI: 10.1503/cmaj.141252
  2. N. Bell, S. C. Gorber, A. Shane, M. Joffres, H. Singh, J. Dickinson, E. Shaw, L. Dunfield, M. Tonelli. Recommendations on screening for prostate cancer with the prostate-specific antigen testCanadian Medical Association Journal, 2014; 186 (16): 1225 DOI:10.1503/cmaj.140703

http://www.sciencedaily.com/releases/2014/10/141027144722.htm

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New prostate cancer screening guidance statement

Men between the ages of 50 and 69 should discuss the limited benefits and substantial harms of the prostate-specific antigen test with their doctor before undergoing screening for prostate cancer, according to new recommendations issued today by the American College of Physicians.




Date:
April 8, 2013
Source:
American College of Physicians
Summary:
Men between the ages of 50 and 69 should discuss the limited benefits and substantial harms of the prostate-specific antigen test with their doctor before undergoing screening for prostate cancer, according to new recommendations issued today by the American College of Physicians.

FULL STORY

Men between the ages of 50 and 69 should discuss the limited benefits and substantial harms of the prostate-specific antigen (PSA) test with their doctor before undergoing screening for prostate cancer, according to new recommendations issued today by the American College of Physicians (ACP).
"Screening for Prostate Cancer: A Guidance Statement from the American College of Physicians" appears in the April 9 issue of Annals of Internal Medicine, published by ACP.
"Before PSA testing, doctors and patients should discuss the potential benefits and harms of screening and the patient's individual risk of prostate cancer, general health, and preferences for testing and evaluation," said David L. Bronson, MD, FACP, president, ACP. "Only men between the ages of 50 and 69 who express a clear preference for screening should have the PSA test. For most of these men, the harms will outweigh the benefits."
The guidance statement includes talking points for physicians to help them explain the benefits and harms of prostate cancer screening and treatment.
"A small number of prostate cancers are serious and can cause death," said Amir Qaseem, MD, PhD, MHA, FACP, Director, Clinical Policy, ACP. "However, the vast majority of prostate cancers are slow-growing and do not cause death. It is important to balance the small benefits from screening with harms such as the possibility of incontinence, erectile dysfunction, and other side effects that result from certain forms of aggressive treatment."
There are substantial harms associated with prostate cancer screening and treatment, including:
  • Problems interpreting test results. The PSA test result may be high because of an enlarged prostate but not because of cancer. Or, it may be low even though cancer is present.
  • If a prostate biopsy is needed, it is not free from risk. The biopsy involves multiple needles being inserted into the prostate under local anesthesia, and there is a small risk of infection or significant bleeding as well as risk of hospitalization.
  • If cancer is diagnosed, it will often be treated with surgery or radiation, which carry risks, including a small risk of death with surgery, loss of sexual function (approximately 37 percent higher risk), and loss of control of urination (approximately 11 percent higher risk) compared to no surgery.
ACP recommends against PSA testing in average-risk men younger than 50, in men older than 69, or in men who have a life expectancy of less than 10 to 15 years because the harms of prostate cancer screening outweigh the benefits. For men younger than 50, the harms such as erectile dysfunction and urinary incontinence may carry even more weight relative to any potential benefit.
"Studies are ongoing, so we can expect to learn more about the benefits and harms of screening, and recommendations may change over time," said Dr. Bronson. "Men can also change their minds at any time by asking for screening that they have previously declined or discontinuing screening that they have previously requested."
ACP developed the guidance statement by assessing current prostate cancer screening guidelines developed by other organizations. ACP believes that it is more valuable to provide clinicians with a rigorous review of available guidelines rather than develop a new guideline on the same topic, when multiple guidelines are available on a topic, or when existing guidelines conflict.

Story Source:
The above post is reprinted from materials provided by American College of PhysiciansNote: Materials may be edited for content and length.

Journal Reference:
  1. Amir Qaseem, Michael J. Barry, Thomas D. Denberg, Douglas K. Owens, Paul Shekelle. Screening for Prostate Cancer: A Guidance Statement From the Clinical Guidelines Committee of the American College of PhysiciansAnnals of Internal Medicine, 2013 [link]

http://www.sciencedaily.com/releases/2013/04/130408184457.htm

This post is on Healthwise