By Dr. Raphael Nyarkotey Obu:ND(TAP00396)
The PSA era is not over and what is Ghana current Position on Prostate Cancer Screening?
The PSA test era is not over and so you are worried about prostate cancer and you are a man of African descent and probably you have heard the controversy on prostate cancer screening. Prostate Cancer screening is not straightforward and the PSA test is not a test for prostate cancer but it is a test for prostate cancer risk but it is still the best test for prostate cancer screening if you want to screen for prostate cancer especially if you are black man. Prostate cancer screening is one of the most controversial topics in urology today with some organizations calling for a total abolishment of the PSA test for prostate cancer screening whilst some organizations are also in support of the test for prostate cancer especially if you are a black man. Let me state categorically clear that most research on prostate cancer is based on how the disease behaves in white men and not black men and yet it is black men who are more prone to prostate cancer and have high mortality rates so what should black men and their doctors do especially men of West African descent? This debate was one of the assignment for the first ever Master?s Program in Prostate Cancer at the Faculty of Health and Well-being , Sheffield Hallam University , UK where I presented how the PSA test is administered in Ghana with no clear policy and how men access the PSA test.
I also presented on how I developed the concept of using the mobile ultrasound as part of the screening process using the local churches, corporate institution and the communities to assess men prostate volume alongside the PSA test. In my practice at that time was a clinical sonographer diagnosing men with prostate disorders. In the cause of my practice I realized that there are instances where ultrasound of the prostate result show normal and the PSA test appears very high. In one instance I came across a man with normal prostate volume with a PSA of 100ng/ml and eventually he went for a biopsy and it was confirmed clinical prostate cancer. So I told the man if he had relied on the ultrasound report alone he probably will have an advanced prostate cancer in the near future now this patient is doing very fine after conventional treatment and using complementary therapies to support the patient.
In another scenario a patient who?s GP did a DRE, ?She told me my prostate felt fine and was normal, but she did a PSA test anyway. She said they were often over high and gave false positives, But she decided to do one. Subsequently my Consultant said my prostate felt normal but as my PSA was 200 then they would do a biopsy.
I have now been diagnosed with prostate cancer, but so easily could have slipped through the net but for the PSA test. So you see that DRE could also miss prostate cancer.
In Ghana most of the laboratories result cannot be rely on so I urged you men to always have a second option from a different source for instance a patient diagnosed with Prostate cancer who decided to observe the cancer for a while before any radical treatment after a while he did the PSA test and it was 19.0ng/ml and he came to me with the report and I ask him to repeat in a different good lab I know. The report came out with a PSA of 70.8ng/ml just three days of the previous test and he was astonished and I told him so you see the difference. I advise him to start radical treatment which he did and now doing very fine after I provided all the necessary treatment information. The highest PSA I came across in my practice is 3756ng/ml of a patient diagnosed with prostate cancer in 2012 and was roaming in the Herbal Hospitals for two years because of media advertisement of treatment cure. At the time of the diagnosis his PSA was 50.0gn/ml and after two years his PSA is now 3756ng/ml so you see but now after hormonal treatment he is doing fine. If you ask whether men should do the PSA test I will say yes for Black men. I think all men should have them because ludicrous advice against prostate cancer screening could cause needless death. The whole debate is simple, is based on that some doctors insist that testing for a protein called prostate-specific antigen (PSA) helps detect prostate cancer early, making it far less lethal. Others contend that PSA screening has prompted a barrage of needless treatment.
MrAblin, of the University of Arizona, claims to have been the first to identify PSA, though this is controversial. However, what matters is not who discovered it, but whether the protein provides any useful information. In some men with cancer, PSA levels may be elevated. But a high PSA does not necessarily mean that a man has cancer, nor does a low PSA mean he should be carefree period!Aggressive treatment can cause incontinence and impotence, which often lead people to seek yet further treatment, from penile implants to urinary cuffs.
Deaths from prostate cancer dropped by 45% between 1993 and 2010, signifying that the test may have helped. But opponents of PSA testing, once regarded as heretics, have gained credibility recently, as a result of two big new studies. An American trial reported that PSA screening brought a tiny increase in mortality, relative to a control group. A large European trial reported moderate benefit only in those aged 55-69; screening saved about one man for every 1,000 men tested. These studies helped convince a government panel in America to recommend in 2012 that no man be screened for his PSA levels.
The recommendation sparked a furore. The American Urological Association (AUA) declared itself to be ?outraged?. Critics such as DrCatalona said the trials were flawed. Now different doctors, faced with the same data, are drawing dramatically different conclusions. The result is a m?lange of practices both within America and outside it.
Last year doctors and academics at the Prostate Cancer World Congress recommended screening for those aged 50-69; a baseline test for men in their 40s was declared ?useful?. The AUA urges ?shared decision making? about screening for men aged 55-69 and ?individualized? decisions for younger men with a higher risk of cancer. Andrew Vickers of Memorial Sloan Kettering, a top cancer center in New York, says that screening has historically been done ?very stupidly? in America, but insists that the PSA test is valuable. Sloan Kettering urges that men aged 45-70 be tested, then consider a biopsy if their level is 3ng/ml or more.
More organization recognized informed decision for men considering prostate cancer screening. The UK has the Prostate cancer risk management program; very powerful information for both GP and men worried about prostate cancer and is even free under the NHS. The Canadian guidelines called for abolishment of the PSA test for prostate cancer screening for men but most of the recommendation black men were not involved and even if they were part of it represent a minor for instance the US Task force used only 4% of black men. Now, The Prostate Cancer Foundation of Australia and Cancer Council Australia have released new draft guidelines for health professionals on PSA testing. They?re now open for consultation, so may still change before they?re decided.
We know that the PSA test isn?t perfect and that prostate cancer diagnosis is nowhere near where it should be. These draft guidelines don?t change that. And they don?t recommend nationwide screening. But they do give doctors in Australia the kind of clarity around best practice for PSA testing (in men with no symptoms of prostate cancer). And that is something i want doctors and men in the Ghana to have.
So what is it that doctors Down Under should soon be clear on?
Australian doctors have now been given clear guidance on repeated PSA tests ? which Ghana don?t have. The draft Australian guidelines recommend that men between 50 and 69 years old, who are interested in regular testing for prostate cancer, and have talked through the pros and cons of this with their doctor, should be offered repeat PSA tests every two years.
The guidelines also give doctors a best course of action for looking after men at higher than average risk of prostate cancer (Black men and men with a family history of prostate cancer). If men in this category want to be tested for prostate cancer, they can start having PSA tests from age 45.
What the guidelines have to say about digital rectal examinations (DRE) is also interesting. They say that DRE shouldn?t be a routine part of first-line testing for prostate cancer by GPs if men have no symptoms. It?s still recommended, but only to be carried out by specialist clinicians for men who are referred for biopsy. This is different in other part of the world like the UK, where the guidance for GPs assumes they will also carry out a DRE, but isn?t very clear on best practice.
The Prostate Cancer Foundation of Australia and Cancer Council Australia have also come to a point on the highly controversial question of using a man?s first PSA test for comparison in these guidelines. They say that although men should be able to have repeat PSA tests, the first test should not be used as a comparison (or baseline) to see how much PSA levels have changed over time.
This has been a penetrating point for prostate cancer policy makers around the world lately. The Prostate Cancer UK in early 2015, with the help of health professionals and other experts, will develop a clinical consensus on that very question.
I think it is time for the authorities in Ghana to start a feasibility study on all prostate cancer guidelines and the Australian recommendations and implement it in Ghana. The NHIS should alsoinvolve a free prostate cancer screening for men in Ghana from 40years and above.
I think the Australian guidelines it?s great and these new draft guidelines show it?s possible take some of the uncertainty out of PSA testing for both men and doctors. If the final guidelines stay looking as the draft does now, men in Australia will soon know exactly what to expect when they go to their doctor to ask for a PSA test. Men in the Ghana and West Africa deserve the same certainty.
The UK National Screening Committee is planning to update the Prostate Cancer Risk Management Programme (PCRMP), which tells UK GPs what to do when a man asks for a PSA test. In Ghana it is time to equip men and GPs to make an informed choice about whether to have a PSA test and, if so, how often like Australian.
Throwing out the PSA test in the black communities will be a suicidal for black men.
For instance a new Canadian study suggests some men are likely to die needlessly because of expert reports that discouraged use of a common test for prostate cancer, says a leading urologist,
adding fuel to a heated debate around mass cancer screening.
A similar debate has surrounded mammography screening for breast cancer, with some advisory bodies saying it provides too little benefit while subjecting women to invasive testing after false positives, and putting others through aggressive treatment when their cancers might have been harmless.
Yet opponents say those reports often drafted by leading physicians and scientists not directly involved in the issue at hand underestimate the ability of the screening to detect early on at least some potentially deadly cancers.
I am therefore appealing to all bodies in Ghana to consider a specific policy on Prostate Cancer screening for Ghanaian men and it should be free because Men?s Health Foundation Ghana was able to start a pilot program on this with no funding at Dodowa, Akoto-House. It is time for the Parliamentary Committee on Health Issues, The Ghana Health Service, Ministry of Health and the Non-Communicable Disease unit to wake up on this important issue.
Critics that say the PSA test should be abolish want all men to die of Prostate Cancer that can be avoided.
Source: Philipp Dahm, Molly Neuberger &DraganIlic(2013)Screening for Prostate Cancer: Shaping the debate on benefits and Harm
By Dr. Raphael Nyarkotey Obu:ND(TAP00396)
Integrative Oncologist
MSc Prostate Cancer
Sheffield Hallam University, UK
Director-Men?s Health Foundation Ghana
Tel;0541090045
e.mail:[email protected]
About the writer
Dr. Obu as your Prostate Cancer Planner
Obu is a prostate cancer specialist with over 5-years of experience.
He is passionate with staying up-to-date on cutting-edge prostate cancer research.
He is invited to speak interventions for prostate cancer.
With Dr. Obu, you will know if doing nothing (or Active Surveillance) is best for you.
If you need medical treatment, he knows all the main players and can facilitate a visit both in Ghana and abroad.
Paramount of all, he doesn?t do any of the medical treatments for prostate cancer. In other words, the recommendations are 100% objective and bias-free.
An organized health summary
A strategic action plan
Facilitated appointments with treatment experts
A customized anti-cancer lifestyle protocol
Alt. Dr. Raphael Nyarkotey Obu is a registered Naturopathic Doctor with specialty in integrative oncology , ultrasound expert, renowned Prostate Cancer expert, ambassador and Cancer Psychologist focusing 100% on Men?s prostate health. My holistic, naturopathic approach is exclusive for people combating Prostate Cancer, Prostatitis, Bladder Pain / Pelvic Pain and Male sexual dysfunction.
My research, writings and professional passion are exclusive to these conditions: Cancer of the prostate, Enlarged Prostate, Prostatitis, Male sexual dysfunction, Pain (specifically pelvic pain) and urinary incontinence. Treatments include: medicinal herbs, individualized nutrition, supplements and massage.
My research interest are black race and prostate cancer, Doppler for prostate cancer diagnosis, Naturopathy oncology and the Dangme People in Ghana.
Our clinic specializes in integrative (Western & Eastern, Conventional & Natural) treatments for Prostate Cancer and Urological conditions. We individualize the treatments to the patients? needs from least invasive to more aggressive
Reference:
Philipp Dahm, Molly Neuberger & Dragan Ilic(2013) Screening for prostate cancer: shaping the debate on …www.thecochranelibrary.com/…/Screening-for-prostate-cancer-shaping-t…
Prostate cancer: Help or harm | The Economist Available at vwww.economist.com/…/21598622-furious-debate-over-screening-prostat…Mar 8, 2014
National Post Tom Blackwell | December 11, 2014 | Last Updated: Dec 11 11:26 PM ET ?Ludicrous? advice against prostate cancer screening could cause needless deaths: study
New PSA testing guidelines published in Australia could…
prostatecanceruk.org/news/…/new-psa-testing-guidelines-published-in-au… 04 Dec 2014
