A BETTER PROSTATE CANCER TEST?

FEATURED TODAY IN THE WALL STREET JOURNAL - HEALTH

by @melindabeckWSJ   READ FULL ARTICLE HERE

A BETTER PROSTATE CANCER TEST?
Distinguishing aggressive disease from slow-growing tumors means more patients can forgo treatment.  
Several new prostate-cancer tests aim to reduce needless biopsies and unnecessary treatments by sorting out harmless from aggressive tumors. 30 MILLION U.S. men will have a PSA test. 6 MILLION of them will be found to have elevated PSA levels.  1 MILLION of them will undergo a prostate biopsy.  180,000 men who have biopsies will be diagnosed with prostate cancer. Another 180,000 men will have prostate cancer the biopsy missed.100,000 men with prostate cancer will have low-risk tumors that are unlikely to spread or cause symptoms.  60,000 men with low-risk cancers will undergo surgery or radiation anyway, probably unnecessarily.


mpMRI vs BIOPSY
Mark Scholz, a prostate oncology specialist in Marina del Rey, Calif., maintains that an mpMRI can yield much of the same information as a biopsy and far less invasively. Low-risk prostate cancers barely register, he says, adding, “When patients find out they have a choice between 12 harpoon sticks to the prostate through the rectum or an MRI, they are on board big time.” 

Joel Copeland, 62 years old, has been monitoring his PSA closely for a decade; his two brothers were diagnosed with prostate cancer. He opted for an MRI instead of a biopsy when his PSA bounced up in 2013. “I don’t like needles, but that’s not the point,” Mr. Copeland says. “The point is, biopsies can cause infection and miss cancers.”

SEE Prostate Vanguard Mailing List about Active Surveillance + Prostate Imaging

High Cost of Pharmaceutical Agents

MARK SCHOLZ, MD

In the last five years the prostate cancer world has been blessed with some incredible pharmacetucal breakthroughs--Zytiga, Xofigo, Xtandi, Provenge and Jevtana, just to name a few.  All these new medications are proven to prolong life and improve quality of life.  In my day to day life practicing as a prostate oncologist, I have seen with my own eyes how these new medications have transformed "hopeless" situations into genuine cancer remissions.

The extremely high cost of these new pharmaceutical agents, however, is a hot topic that I have addressed in prevous blogs. A recent editorial  from the Wall Street Journal addresses this issue with uncommon wisdom and aptly points out how potentially dangerous seemingly well-intentioned efforts to control costs can end up snuffing out the new drug development process.

Please click on the link HERE to read this short and extremely well-written editorial: http://goo.gl/F7pG8w

 

The Illness Business

BY RALPH BLUM

With privileges come responsibilities. That’s the way it has always been. One of the great privileges in my life has been the availability of Medicare. And the responsibility? To be watchful, careful that I do not take undue advantage of that privilege. For example? Not undergoing a costly procedure that was not absolutely necessary just because I don’t have to pay for it.

I remember in my pre-teen years a series of silly scatological jokes, including book titles like The Yellow Stream by I. P. Daily. Well, recently, I saw an accusing article by Terry J. Allen published in In These Times, and entitled “Urology’s Golden Revenue Stream.” Made me smile. But it also started me thinking about the extent to which some doctors in the prostate cancer field might be favoring profit over good patient outcomes.

I need to point out here that Mark is not and has never been one of those doctors. Care and concern for the positive outcome as well as the quality of life of his patients has always been his priority. And the over-treatment that is driving up healthcare costs as well as exposing men with prostate cancer to unnecessary surgeries and radiation therapy was the main theme of our book—Invasion of the Prostate Snatchers.

So I was alarmed to learn that rather than accessing centralized equipment and sharing costs, physicians are concentrating on their own profits by buying super-expensive in-practice technologies that pay off only if regularly used. As a result, over-treatment is driving up health care costs as well as exposing patients to unnecessary treatments.

The Wall Street Journal recently exposed one example of the public cost of this pattern. About one third of all Medicare beneficiaries diagnosed with prostate cancer now get IMRT—the targeted radiation therapy for which doctors can charge Medicare as much as $40,000 per patient. According to the Journal, some urology practices are paying more than $3 million for “turnkey” IMRT setups, and the sharp rise in IMRT use is partly driven by financial incentives. And given that the necessity for aggressive treatment for many prostate cancer patients, especially the elderly, is controversial to say the least (as far back as 2006 a study in the Journal of the National Cancer Institute found 45 percent of men receiving IMRT were “over-treated”), this seems to me to be an abuse of Medicare as well as abuser of all those men who risked the inevitable unpleasant side-effects of unnecessary treatment.

So, continuing in the spirit of Mark’s and my book, Invasion of the Prostate Snatchers, it also occurs to me that an increased sensitivity to the out-of-control cost of medical care might be an added incentive to newly diagnosed men to avoid the over-treatment so pervasive in the prostate cancer world today.