READER RESPONSE: Re: Open an entire can of worms with one test, Medical Matters, Healthplus, April 28th
Dear Sir,
Prostate cancer is often termed “an old man’s disease”, and while Dr Houston’s article seemed to be based on this premise, there are, unfortunately, a significant minority of us who are a hell of a lot younger and who, unfortunately, have developed prostate cancer (PC), many asymptomatically and many with an aggressive strain.
In such circumstances, testing of young asymptomatic men is, coupled with DRE, currently the only effective “go-no go” gauge for PC.
If one does not actively seek out the minority of men with aggressive PC, allowing them to possibly develop distant metastases, then an opportunity has been missed.
Dr Houston referred to Drummond et al. I was very concerned with some of the findings of this (study), particularly in relation to GP knowledge. Having spoken to many PC survivors, ranging from those on “watchful waiting”, to radiation, surgery and ADT, I am shocked at the findings in this area.
It beggars belief beyond incredulity that most survivors are well informed and more knowledgeable than the survey respondents appear to be.
The questionnaire itself is strange; C6 D “Ask, prior to testing, whether the patient has ejaculated in the preceding week.”
Where did this come from? I have never come across anything other than recommending abstinence for 48 hours prior to the test. I can’t help but feel that this study was not as well designed as it might have been.
I disagree with several of the observations Dr Houston makes in the article. I feel that the article lacked balance and that, in several instances, Dr Houston did not quote the article but changed a few words that, in effect, changed the tone of the report, thus supporting his argument.
For example; “the time from the development of the cancer to a person’s death does not change”, as opposed to “the actual time from the development of cancer to death may not change”. There is a fundamental difference between these two statements which changes the observation in the report to appear as a fact, where no such factual evidence exists.
Dr Houston’s penultimate paragraph states that population screening cannot be justified. The report says nothing of the sort. It does say that “trials are under way to determine the effectiveness of PSA testing as a population screening programme”.
Dr Houston continues to state that international studies support his statement. Many recent studies have questioned the efficacy of screening as death rates do not yet appear to be falling, however I have not seen any suggestions that screening cannot be justified. Furthermore, Dr Houston states that his hypothesis is in line with the 2006 National Cancer Forumreport. In fact this report says that "population-based prostate screening should not be introduced at present" (my emphasis).
I am most surprised that Dr Houston did not provide balance by way of outlining the risk factors and symptoms of PC, as in the discussion section of Chapter 17, Cancer in Ireland 1994-2004. Perhaps you will consider doing this with equal gusto in a future edition?
Yours sincerely,
John Quigley,
Cluain Mhuire,
Trabeg Lawn,
South Douglas Road, Cork.