wpid-breast-cancer.jpgMHFG Consensus Statement on Prostate Cancer Screening for Ghanaian Men for the Early Detection of Prostate?Cancer.

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Introduction:

Black men suffer the highest prostate cancer incidence and mortality rates among men of all racial and ethnic backgrounds. According to the Prostate Cancer UK ?1 in 4 Black Men will get prostate cancer in his lifetime. This racial disparity is the largest for any major cancer and all Black men are deemed to be at high ? risk for prostate cancer. It is estimated that closed to 1000 men diagnosed with prostate cancer in Ghana and closed to 800 men die of the disease in Ghana(Obu 2014)

Recent guideline statements and recommendations regarding the use of prostate ? specific antigen (PSA) testing for the early detection of prostate cancer, and the resulting controversy, have led to confusion and a lack of clarity for the men most at risk for suffering and dying from prostate cancer.

Despite high-level evidence for the use of PSA testing as an aid to early prostate cancer detection, and also for its role as a predictor of future risk, the U.S. Preventive Services Task Force (USPSTF) has called for PSA testing to be abandoned completely. The American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) support a role for PSA testing but with somewhat conflicting recommendations. The guideline statements have endorsed the role of shared decision-making for men considering PSA testing.? However, media reports on the PSA test controversy are confusing and preventing many black men from even having a discussion with physicians about early detection, thereby negating any opportunity for shared decision-making, and in the absence of discussion most men do not have PSA testing. But the question still remains, should Ghanaian men screen for prostate cancer?

Ghanaian men are of Africa descent. Black ?men deemed to be at high ? risk for prostate cancer, including men with a family history and men exposed to agent orange , were not included?in sufficient numbers in the two main randomized clinical trials ?used as the scientific evidence to formulate the PSA test guidelines. Few men, if any, of African ancestry and obviously no African Americans were included in the European trial. ?Consequently, some guidelines do not directly or clearly address the needs of African American men. In the UK there is an informed policy on prostate cancer screening for men 50year and above called the Prostate Cancer risk management program? In the Caribbean?s-Jamaica a policy also exit for men 40years with support from the urological association.

 

 

 

 

Men? Health Foundation Ghana (MHFG)has formulated a set of consensus statements for PSA testing to address the need for providing clear guidance on PSA testing for black men and other high ? risk men. These statements rely on??The Melbourne Consensus Statement on Prostate Cancer Testing??adopted by leading prostate cancer experts from around the world at the?2013 Prostate Cancer World Congress?in Melbourne, Australia . The three statements herein were excerpted from this statement with modifications.

The (MHFG) consensus statements are consistent with the?NCCN Prostate Cancer Early Detection guidelines and the Prostate Cancer Risk Management Program (PCRMP) practice in the UK.? The NCCN, which state:??Although age 50 has traditionally been the age for starting to consider PSA testing, researchers have recognized that high-risk groups such as African Americans and men with a family history of prostate cancer may benefit from beginning testing at an earlier age.?

There is no organized screening programme for prostate cancer but an informed choice programme, Prostate Cancer Risk Management, has been introduced. If you are worried about a specific problem, or otherwise worried about the risks of cancer, then you should talk to your GP.

Aim of Prostate Cancer Risk Management

The aim of Prostate Cancer Risk Management is to ensure that men who are concerned about the risk of prostate cancer receive clear and balanced information about the advantages and disadvantages of the PSA test and treatment for prostate cancer. This will help men to decide whether they want to have the test.

Information packs have been sent to General Practitioners to assist them in the counseling of men who enquire about testing. The pack will help the primary care team to provide men with information on the benefits and limitations of the PSA test. It comprises a reference booklet and summary sheet for the primary care team and a book of tear off patient information sheets. Prostate CancerStats are also included.

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Absent scientific evidence from randomized clinical trials, guidance on PSA testing for high ? risk men must be provided through expert opinion.?Studies have shown that black men as a group are diagnosed with life threatening prostate cancer at an earlier age and with a more advanced stage of the disease. It is believed that these factors contribute to a death rate that is 2.45 times higher than for white men. Expert opinion has historically held that black men should begin PSA testing at an earlier age, and the two main randomized clinical trials provided no scientific evidence that disproves this opinion.

 

MHFG is made up of medical specialists and Naturopathic Practitioners with extensive experience diagnosing and treating prostate cancer patients.?For many, this experience spans the period before the PSA test was adopted, which provides them with a perspective on how black men presented with prostate cancer before the era of wide-spread PSA testing and more than two decades later today.

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MHFG Consensus Statements for Prostate cancer screening in Ghana

?Consensus Statement 1😕Baseline PSA testing for Ghanaian men and other men deemed to be at ??high ? risk for prostate cancer is suggested beginning at age 40 or even early for predicting their future risk of prostate cancer. Although these men were not included in sufficient numbers in the two main randomized trials, there is strong evidence that this high-risk?group of men may benefit from the use of PSA testing as a baseline to aid risk stratification for developing prostate cancer, including life-threatening disease. Studies have shown the value of PSA testing in this cohort for predicting the increased likelihood of developing metastatic and lethal prostate cancer 25 years later for men whose baseline PSA is in the highest percentiles above the median. Those men with a PSA below the median could be spared regular PSA testing as their future risk of developing prostate cancer is comparatively low; however, future testing should not be ignored for these men, but rather a schedule of PSA testing should be discussed and developed with each man?s physician. Those men with a PSA above the median for their age group are at considerably higher risk and need closer surveillance and regular testing. The median PSA for men aged 40?49 ranges from 0.5?0.7 ng/ml, with the 75th?percentile ranging from 0.7?0.9 ng/ml.?The higher an individual?s PSA is above the median, the greater the risk of later developing life-threatening disease. For example, men in the highest tenth percentile account for approximately half of prostate cancer deaths. A baseline PSA in the 40s has value for risk stratification and this option should be discussed with men in this age group as part of a shared decision-making process. PSA testing should be a consideration for men with a life expectancy of more than ten (10) years.

Those men determined to be at high risk for developing future prostate cancer because of their PSA level should be encouraged to embark on a wellness prevention program involving diet, exercise and weight control. This is also an opportunity to discuss the importance of an overall wellness prevention program for all the men undergoing a baseline PSA test.

Consensus Statement 2: PSA testing should not be considered on its own, but rather as part of a multivariable approach to early prostate cancer detection.?PSA is an imperfect predictor of current risk and additional variables such as digital rectal examination, prostate volume, family history, ethnicity, risk prediction models, and new tools, can help to better risk stratify men.Further developments in the area of biomarkers, as well as improvements in imaging will continue to improve risk stratification, with potential for reduction in over-diagnosis and over-treatment of lower risk disease. Routine genetic testing may be available in the future to aid in assessing prostate cancer risk for those men with a family history of the disease. MHFG We are leading change in Ghana and we believe men deserve better treatment.

Consensus Statement 3:?A prostate cancer diagnosis must be uncoupled from prostate cancer intervention. Although early detection is essential to diagnose high-risk cases within the window of curability, it is clear that many men with low-risk prostate cancer do not need immediate aggressive treatment. With an incidence rate 1.6 times higher than other men, black men, as a group, are at an increased risk for over-treatment and potentially suffering unnecessary harms from such treatments. Men should be counseled about their treatment options and caution should be exercised to prevent over-treatment. Active surveillance protocols have been developed and have been shown to be a reasonable and safe option for many men with low-volume, low-risk prostate cancer. However, there is published evidence that black men are more likely to fail active surveillance protocols than men of other ethnicities. While it is accepted that active surveillance does not address the issue of over-diagnosis, it does provide a vehicle to avoid excessive intervention. Active surveillance strategies need standardization and validation to reassure patients, especially black men and clinicians that this is a safe strategy. The NCCN Prostate Cancer Treatment Guidelines have offered excellent guidance in this area, and an ever-expanding medical literature and informative clinical trials assure continued refinement and confidence in this strategy. In addition there are new prognostic tests currently available and others in various stages of scientific and clinical validation to help determine if the cancer is life threatening.

Conclusion:

An important goal when considering early detection of prostate cancer today is to maintain the gains that have been made in reducing metastases and cancer-specific survival over the past twenty plus years since the introduction of PSA testing, while minimizing the harms associated with over-diagnosis and over-treatment.? Outright abandonment of PSA testing by large numbers of black men due to confusion and lack of clarity would lead to a significant increase in the proportion of these men who present with advanced prostate cancer. It is critical not to surrender the gains that have reduced the black men death rate from prostate cancer by more than 40%. This would be a devastating setback for the men who are suffering from the disease at epidemic proportions. The objective of MHFG?s Consensus statement is to provide clearer guidance for these men to reduce the mortality rate in Ghana.

*MEN?S HEALTH FOUNDATION GHANA is a non-profit patient education and advocacy organization with a focus on Ghanaian men and a member of the Global Prostate Cancer Alliance. We lead change and believe men deserve better treatment. MHFG was founded in 2013 by ALT. Dr. Raphael Nyarkotey Obu, a registered Naturopathic Doctor (TAP 00396) and prostate cancer community champion after he graduated from his masters in prostate cancer-Sheffield Hallam University UK and a member of the Prostate Cancer UK Professionals Network and author of the books ?What everyman must know before & after 40years-Prostate Health (2013)? and ?Catalyst for Change in the Dangme Land.?? He currently has ten (10) publications on prostate cancer. He was recognized as one of the successful students in prostate cancer by the alumni connects office of Sheffield Hallam University UK after his called on? Ghanaian government to introduce a specific policy on prostate cancer in Ghana and was published in Daily Guide. He is the CEO of the De Men?s Clinic & Prostate Research Lab in Dodowa-Akoto House; a naturopathic clinic addressing the needs of men diagnosed with prostate cancer and established the first free prostate cancer screening center in Ghana. 0541090045 our contact

 

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Source: Men?s Health Foundation Ghana.

References:

[1] Prostate Cancer Risk Management Programme – NHS …

www.cancerscreening.nhs.uk/prostate/

[2] Senate Resolution S. Res 529, adopted on July 26, 2012; Introduced by Sen. John Kerry (D-MA)

[3] Moyer VA, Screening for prostate cancer: U.S. Preventive Services Task Force (USPSTF) recommendation statement.?Ann Intern Med. 2012; 157:120?34.

[4] Stoneham L, ?Vietnam Vets, Agent Orange and Prostate Cancer,??http://www.dailyrx.com; 11 May 2013

[5]?The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, a?large population-based randomized trial designed and sponsored by the National Cancer Institute (NCI).?The European Randomized Study of Screening for Prostate Cancer (ERSPC)?- the world?s largest randomized prostate cancer screening study.

[6] Murphy D, ?The Melbourne Consensus Statement on Prostate Cancer Testing,??BJU International (online);?07 August, 2013

[7] AUA Guidelines on the Early Detection of Prostate Cancer May 2013

[8] NCCN guidelines Version 2.2012, Prostate Cancer Early Detection, 02 May 2012

[9] Powell I et al. ?Evidence Supports a Faster Growth Rate and/or Earlier Transformation to Clinically Significant Prostate Cancer in Black Than in White American Men and Influences Racial Progression and Mortality Disparity.??The Journal of Urology,?Vol. 183, 1792-1797, May 2010

[10] ?Lilja H, Cronin AM, Dahlin A, Manjer J, Nilsson PM, Eastham JA, et al. Prediction of significant prostate cancer diagnosed 20 to 30 years later with a single measure of prostate-specific antigen at or before age 50.?Cancer.2011; 117:1210?9.

[11] Vickers AJ, Ulmert D, Sjoberg DD, Bennette CJ, Bjork T, Gerdtsson A, et al. Strategy for detection of prostate cancer based on relation between prostate specific antigen at age 40-55 and long term risk of metastasis: case-control study.?BMJ. 2013; 346:f2023.

[12] Bul M, Zhu X, Valdagni R, Pickles T, Kakehi Y, Rannikko A, et al. Active surveillance for low-risk prostate cancer worldwide: the PRIAS study.?Eur Urol. 2013;63:597?603.

[13] ?Bangma CH, Bul M, van der Kwast TH, Pickles T, Korfage IJ, Hoeks CM, et al. Active surveillance for low-risk prostate cancer.?Crit Rev OncolHematol. 2012.

[14] Schaeffer EM, et al. African American men with very low-risk prostate cancer exhibit adverse oncologic

outcomes after radical prostatectomy: should active surveillance still be an option for them? J ClinOncol. 2013 Aug 20;31(24):2991-7. doi:10.1200/JCO.2012.47.0302. Epub 2013 Jun 17. Pub Med PMID: 23775960; Pub Med Central PMCID: PMC3739860.

[15] Moul JW. Prostate cancer: Active surveillance in African American men. Nat Rev Urol. 2013 Jun;10(6):311-2. doi: 10.1038/nrurol.2013.97. Epub 2013 May 7. Pub Med PMID: 23649288.

[16] NCCN Clinical Practice Guidelines in Oncology, Prostate Cancer; Version 4.2013, 26 July 2013

[17] National Cancer Institute, Surveillance Epidemiology and End Results;?seer.cancer.gov/faststats

19. Prostate Health Education Network (PHEN)www.prostatehealthed.org/

 

 

20. National Cancer Institute Seer Statistics Fact Sheet, 2012

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