Recommended Medical Guidelines

Back to the 1950s with New Prostate Guidelines

Posted on March 1, 2011. Filed under: Breast Cancer, Cancer, Preventive Care, Prostate, Recommended Medical Guidelines | Tags: , , , , , , , |

A new study on prostate biopsies from The Journal of the National Cancer Institute wants to take us back 60 years. The  study not only concluded that using PSA velocity for prostate cancer detection is ineffective and leads to “unnecessary” biopsies — but it also contends that all references to it should be removed from professional guidelines.

PSA (prostate specific antigen) is one way we can monitor prostate health. PSA velocity refers to the amount of change in a PSA from year to year. When doctors see a rise in PSA, they often order a biopsy. Granted, many prostate biopsies do turn out to be negative for cancer. But right now, there is no other way to determine if prostate cancer — whether it’s aggressive or non-aggressive — exists without a tissue diagnosis through biopsy.

The best way to determine whether or not a biopsy is necessary is by measuring PSA.  Waiting for a patient to exhibit symptoms of prostate cancer or to be able to detect a nodule by digital rectal exam equates to a later diagnosis, and if the patient does have cancer, it may be more advanced.

A similar problem exists for women and mammograms. In late 2009, the United States Preventive Services Task Force recommended shifting the age to start mammograms from 40 to 50, to reduce false positives that can lead to biopsies. A huge uproar ensued, leading to the American Cancer Society, among other organizations, continuing to recommended mammograms at age 40.

What’s lost in the uproar is this stark fact: These two cancers cause the second most common cancer-related deaths in men and women, and the only way we can ever hope to drop those alarming statistics down is by screening and catching those cancers early.  PSA is not perfect (nor is mammography), but both of those tests are the best means for detecting and intercepting potential problems.

Until something better comes along, it is in the best interest of potential cancer victims to implement screenings.  Not screening will result in the loss a huge number of lives.  Is it worth the cost savings of cutting back on biopsies?

One thing we can all agree on is that survivors of most cancers owe it to only one thing — “early” detection and treatment.

I have to add that on the medical malpractice side, the most common reason for damages is delay in diagnosis and treatment.  Juries will rarely be sympathetic to medical practitioners when all they see are delays that allow treatable cancers to become untreatable.

We have  to find better ways to screen and to do so affordably. Surely in 2011, we have the means to do that.

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The Prostate Dilemma

Posted on July 13, 2009. Filed under: Affordable Health Care, Cancer, Preventive Care, Prostate, Recommended Medical Guidelines | Tags: , , , , , , |

Even the medical community can’t seem to agree about prostate screenings. In March, after a U.S. study suggested that screening for prostate cancer does not reduce death from the disease, a bigger European study suggested that screening can lower the death rate as much as 20 percent. (Both studies were reported in the New England Journal of Medicine.)

Then in April, the American Urological Association issued new guidelines lowering the age recommended for prostate-specific antigen (PSA) screening from 50 to 40 years.

Peter R. Carroll, professor of medicine and chair of the Department of Urology at the University of California, San Francisco, and chair of the AUA guidelines committee on PSA screening, said: “There is no patient for which there is no (more…)

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How Doctors Should Think

Posted on October 11, 2008. Filed under: 8 Causes of Death, Cancer, Cardiovascular, Diseases, Recommended Medical Guidelines |

Every business forecasts its performance predicated on past experience except medicine. Yet, health care could benefit from that approach because there is statistical probability for everything, including health. Most predictable is the fact that some day we all have to be dead. To be dead, there has to be a cause of death.

To predict our likely cause of death, all we have to do is resort to statistics. For instance, statistics prove that two thirds of all death is attributable to cardiovascular causes, such as heart attacks, strokes, and aneurysms. Because we all know the statistics and the primary risk factors (cholesterol, high blood pressure, smoking, obesity, and stress), doctors should be aggressive in identifying and intercepting those risk factors as early as possible. From that alone, we would reduce our chances of dying of a cardiovascular event considerably.

If we can ward off a cardiovascular problem, we can live long enough to get cancer, the second most-common cause of death. Lung cancer is the number one cause of cancer-related death, even in nonsmokers. All that is required to have this disease is that we have lungs. But the main reason it is so (more…)

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