PROSTATE CANCER SCREENING IS OUT!

THE VIEW FROM THE OFFICE

The United States Preventive Services Task Force (USPSTF)
Will Advise Against Routine Prostate Cancer Screening

     The U.S. Preventive Services Task Force has concluded that healthy men should not undergo routine prostate-specific antigen (PSA) testing, the
     The recommendation, which will be made available for public comment next week, was based on an analysis of five trials and applies to men of all ages. The Times quotes the task force's chairwoman: "Unfortunately, the evidence now shows that this test does not save men's lives ... This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime."


In 2008, the USPSTF recommended against PSA testing in men aged 75 or older, and said evidence was insufficient to recommend for or against testing in younger men.

     Read the full story in the New York Times here. 

http://www.nytimes.com/2011/10/07/health/07prostate.html?_r=1&scp=3&sq=prostate%20cancer&st=cse

      As Jerome Groupman says in his new book ("Your Medical Mind"), to make a reasonable decision on screening, you have to look at the numbers. "Prostate cancer is slow-moving; more people die with it than from it. According to one 2004 study, for every 48 prostate surgeries performed, only 1 patient benefits--the other 47 patients would have lived just as long without surgery...Moreover, the 47 who didn't need the surgery are often left with an array of unpleasant and irreversible side effects, including incontinence, impotence and loss of sexual desire. The likelihood of one of these side effects is over 50%--24 of our 47 will have at least one. This means a patient is 24 times more likely to experience the side effect than the cure...Returning to prostate surgery, consider that 6 weeks is the advised recovery period. Coincidentally, the operation will, on average, add 6 weeks to your life. (This averages across the 47 people who had no benefit from the operation and the one person who did.) To my way of thinking, the decision then becomes this: When do you want to 'spend' those 6 weeks? When you're relatively young and feeling well, or at the end of your life, when you're old and only dimly aware of your surroundings?"*

* Quotation taken from the Daniel Levitin, "Heal Thyself," New York Times Book Review, Sunday, October 9, 2011, pp28-29.

COMMENT: As I have previously reported, I do not recommend this test and do not get it for myself. The test cannot tell which men will have a problem with their prostate cancer and which will not. This is the only information we really want to know. There are new tests under development, maybe one of them will provide a better option. I have already had patients asking me about the new urine test for prostate cancer, which is still in the research phase and is not yet commercially available. Another link to information on this test can be found here.

WHEN TO GET A PNEUMONIA VACCINE

THE VIEW FROM THE OFFICE

(FIRST SNOW: OCTOBER 6TH, 2011)

WHO SHOULD GET A PNEUMONIA SHOT (PNEUMOCOCCAL VACCINE) AND WHEN? This is just a brief note to clarify this question. There are separate recommendations for children and adults.

     For children, the recommendations are to do primary immunizations at 2 months, 4 months, 6 months, and a booster immunization any time between 12 and 18 months. This immunization in children is clearly and highly effective. It has dramatically reduced the rates of meningitis, pneumonia, infected arthritis, and high fever in children without an obvious source. This vaccine and the H Flu vaccine are the primary reasons why we almost never see meningitis any more. This is the standard recommendation for healthy children.

     For older children the guideline calls for performing a primary vaccine series in any individual who has any kind of immune deficiency or chronic cardiorespiratory condition (like cystic fibrosis or congenital heart disease); for adults under the age of 65 a single dose of the vaccine is recommended for persons with a chronic cardiorespiratory or immune condition with a single booster shot 5 years after the first. 

     One example of a chronic immune condition is someone who has been in a bad accident and ruptured his/her spleen with the result that it has to be surgically removed. The spleen is a major organ of the immune system which protects against severe bacterial infections. So that anyone who has had their spleen removed for any reason should get a primary series of pneumococcal immunizations; they should also receive immunizations against the H Flu germ and the meningococcal germ. Also any individual who has a chronic cardiac or respiratory condition should receive the pneumococcal vaccine because the occurrence of pneumonia with a weakened lungs or heart could be fatal.

     For young and older adults under the age of 65 pneumococcal vaccine, in a single dose, is recommended for patients with cardiorespiratory conditions. These include: asthma, smoking, emphysema, and any form of heart disease.

     For ADULTS, the recommendation is simpler. All healthy adults should receive a pneumococcal vaccine at age 65. If you receive it at age 65 and are otherwise healthy, you only need to receive this single vaccine. You do not need a booster. For some reason that I cannot readily explain, a majority of older people in the Portola-Graeagle area believe they need routine pneumonia boosters every 5 years. This is NOT the case.

     There are two groups of adults who need pneumococcal boosters after age 65:

     (1) Any healthy adult who received their initial pneumonia shot before the age of 65 is recommended to get just one booster 5 years after the first.

     (2) Any adult who has a chronic immune system problem (examples include patients on long term systemic cortisone medications, on dialysis from chronic kidney failure, or who have received any organ transplantation, or who have cancer receiving chemotherapy, or who have HIV infection, or who have had their spleen removed) need to get a single booster 5 years after the first. The experts do not recommend repeated pneumococcal boosters for anyone.

SUMMARY:  Pneumococcal vaccine is recommended for:

     1. Healthy children at 2, 4, 6, and 12-18 months.

     2. Any older children with chronic immune or cardiorespiratory problems.

     3. For all adults under 65 who have a chronic  immune or cardiorespiratory problem.

     4. For all healthy adults at age 65.

     5. A single booster shot is recommended 5 years after the first immunization for:

         a. Healthy adults who received their pneumonia shot before the age of 65.

         b. For all adults who have a chronic cardiorespiratory or immune condition.