Daily Archives: May 11, 2017

PSA Screening

Prostate cancer and screening

PSA tests. The jury was out. Top specialists like Tony Costello at RMH actively push for early detection for early treatment. Other  groups like the USANZ preferred that screening not be done as the rewards of detection and the downside of the treatment outweigh, they felt,  any active management. How times change. Now the guidelines are to

  1. Offer evidence-based decisional support to men considering whether or not to have a PSA test, including the opportunity to discuss the benefits and harms of PSA testing before making the decision.
  2. For men at average risk of prostate cancer who have been informed of the benefits and harms of testing and who decide to undergo regular testing for prostate cancer, offer PSA testing every 2 years from age 50 to age 69, and offer further investigation if total PSA is greater than 3.0 ng/mL.

Compare and contrast the attitude here to that for women. Several factors weigh in the men are older, The cancer is internal rather than external so harder to get at. The operation has functional rather than cosmetic consequences..

I am an interventionist, I believe that the test itself is easy to do, compared to a mammogram and the results are easier to interpret. The follow up for a positive result is just as traumatic with the biopsy and examination being more difficult. I find it hard to square the idea of watching known cancer if presumed low risk and would prefer the idea of some treatment earlier rather than later.  Of great interest are 3 concepts. One that with a low PSA < 1.0 at 40 and at 60 YO ones risk of cancer is almost negligible [less tests one good outcome. Secondly that if the blood test is going up but there is no lump felt an MRI of the prostate can be done to give complete visualization of it and guide management better.

Choice of procedure Robotic surgery or radiation or both. With apologies to the surgeon who has done all the work Radiation would be a preferred option, just. The upside is that any local spread should get knocked off. secondly the side effects are broadly similar. Prostate cancer is particularly prevalent in the Shepparton area and perhaps a study should be done by our local hospital on the actual incidence.

Vaccination

Vaccination mentioned only to be discarded. A very contentious subject.

Vaccination is good for most people. and for the population as a whole.
It should be encouraged. Without the help of vaccinations many of us would not be here today. Vaccination is exposing the body to a less harmful form of a disease to let the body develop its immune response to the more serious disease when it comes along. The vaccine is a temporary measure and the body does all the work.
There are side effects to vaccination just as there are to all medical and alternative medical treatments.

A new problem is that we have overcome the most serious past illnesses but new vaccines are constantly being developed. There are now 15 different childhood vaccines. We have reached a grey area between protecting everybody from everything at great cost or accepting that we cannot and should not do so.
Anyone wanting to see the effects of non vaccination should visit an older graveyard and look at the number of young people with diphtheria as the cause.

Influenza is an interesting vaccine, Two A and B variations. A is the most prevalent and most current infections are variations of the swine flu from 2009. The older Hong Kong Flu is still mildly active and included. The controversy here is whether all children of all ages should have the flu shot.  Current guidelines is only for children at extra risk. The death rate from meningococcal disease is the same as that for the flu. Which double standard would you like to choose?

A shingles vaccine for older people is out to reduce the risk of shingles. It has a 3 year effectiveness and a 50%  reduction in risk. I think the benefit is very low for this  injection and it smacks  of  salesmanship.

Hep A recommended for all and Hep B if going to Asia or needing blood transfusions.

There is a common practice of subjecting terrified little people to an expensive unneeded vaccination for whooping cough. Yes I am talking about grandparents who are about to have a grandchild. It is a rite of passage that we all have to endure even though the stuff does not work very well. In the remote chance of the grandchild developing whooping cough you will be exonerated. Plus it comes combined with tetanus toxoid and diphteria toxoid so at least you get your 50 year old booster of tetanus toxoid.