Why IMU is a multi multi bagger, page-23327

Nothing to do with IIMU - or cancer trials. However, it is an interesting commentary on cancer thinking - ad doctors catching the disease in earlier stages.

I had prostate cancer. Outdated advice is letting down men (thenewdaily.com.au)

I had prostate cancer. Outdated advice is lettingdown men

MurrayGriffin
May 08, 2024, updated May 08, 2024

I was lucky. If my doctor had listened to his professional organisationI could have been facing death within the next few years, or at the very leasta range of debilitating and complex treatments.

Instead, he arranged a simple blood test at my request withoutsuggesting it was probably unnecessary.

Soon after, I had urgent prostate cancer surgery, and can now expect tolive for many more years in good health.

I’m telling my story because the attitude of the Royal AustralianCollege of General Practitioners towards these blood tests is outdated andmisguided.

I have no doubt it is causing many older men to needlessly suffer, andsome men to needlessly die.

‘No obligation’

Cancer affects many women and men.

In men, prostate cancer is the most common cancer – apart from commonskin cancers – and the current approach to screening for it is deeply flawed.

A large part of the problem lies with the Royal College of GPs which,bizarrely, recommends against the blood test for symptom-free men (although itsopposition is more muted when – as in my case – a blood relative has hadprostate cancer).

That’s right. Prostate cancer is very common in men who are in theirlate 40s or older, it can be present without men knowing it (as in my case),and there is a simple blood test that can indicate its presence.

But the college says ‘‘GPs have no obligation’’ to offer that blood testto symptom-free men, and suggests that in most cases they should advise that itis unnecessary.

The college’s reasoning is that a number of things can cause a bloodtest result showing elevated PSA (the marker which can indicate cancer needingtreatment).

As a result, it says the test is likely to cause too many men to seekout unnecessary, invasive biopsies and treatment.

Follow-up testing

The problem with the college’s reasoning is two-fold.

Firstly, it doesn’t take into account new, non-invasive follow-uptesting procedures.

Secondly, it doesn’t take into account the fact that most men aren’tstupid.

First things first. It’s true that PSA levels can be temporarilyelevated for benign reasons – for example, if you’ve had sex or even ridden abike within a few days of the test.

But if a PSA test (or a couple of tests in succession) shows elevatedPSA levels then there is another, more precise and non-invasive test that canreadily be used to identify whether there is anything to worry about.

An MRI scan is a medical imaging procedure that uses a magnetic fieldand radio waves to take pictures inside the body, and it can quickly identifywhether there are cancerous areas of a type and extent that warrant a biopsy.

MRIs, of course, are not a particularly new form of imaging. But thecollege’s attitude to PSA blood tests seems to ignore the role the technologynow plays in safely and quickly weeding out high PSA results that are of noconcern.

Secondly, the college’s reasoning assumes men can’t understand the mostbasic nuances of cancer, such as whether they have a form that is extremelyslow-growing and likely to never be harmful.

Many prostate cancers fall into that category.

Men with this form of prostate cancer shouldn’t do anything except havefurther regular blood tests, and maybe an occasional MRI – a strategy known inhealth circles as ‘‘active surveillance’’.

It’s true that there are a lot of things that are hard to communicateabout cancer. But the concept of ‘‘active surveillance’’ isn’t one of them. Foranyone to suggest otherwise is ridiculous.

Guidance overhaul

No doubt the College of GPs will say its advice aligns with 2015recommendations from the Prostate Cancer Foundation of Australia and the CancerCouncil – advice that has, in turn, been approved by the National Health andMedical Research Council.

These organisations do excellent work – I experienced first hand thewise advice of the foundation as I was considering treatment options, and amvery grateful for it.

However, the 2015 guidance on PSA testing is now outdated, and thestudies that are often cited were conducted in the pre-MRI era, as experts havepointed out.

The guidance needs to be overhauled, and in the meantime the College ofGPs should immediately drop its resistance to PSA testing of symptom-free men.

Take the step

In the interim, it is men’s wives, husbands, partners, relatives andfriends who need to urge them to regularly take this simple, and potentiallylife-saving step.

There’s no use pretending that prostate cancer treatment doesn’t involvedifficulties. It results in a new normal, which isn’t as good as the oldnormal.

In some cases, there can be challenging additional treatment sideeffects, although these don’t always last for a long time.

For that reason, men who find they need treatment should ask lots ofquestions when deciding on their treatment strategy.

And, despite what some medical bodies say, there is an importantprecursor question that all middle-aged men need to ask their GP: ‘Can I have aPSA test?’