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Too much prostate cancer testing?
Are men being over-tested and over-treated for prostate
cancer? This was the topic presented by Club member David Garmaise at the
Sunday, June 30 meeting of the Pattaya City Expats Club. He pointed out that
in May 2012, following several studies on the use of the PSA test for
prostate cancer screening; one U.S. agency stated: “The U.S. Preventive
Services Task Force recommends against PSA-based screening for prostate
cancer.”
David said that the position of the Task Force is and remains controversial.
Further, the purpose of his presentation was to explore the reasons for the
position they took. David explained that although he is a prostate cancer
survivor, he is not a medical doctor; and that any opinions he provided were
not medical opinions and the issues of over-testing and over-treating had to
be looked at together.
Speaker for June 30th was
board member David Garmaise. The topic was the controversial subject of
prostate cancer, and an attempt to unravel the often conflicting information
about it, from the perspective of a patient. A number of other members
shared in some detail their experiences, and a prostate cancer interest
group was formed to share further information on the topic.
David presented some general facts about prostate cancer,
including PSA results as well as the Gleason score provided as a result of
biopsy that may indicate an aggressive form of the cancer; PSA level of 10
or greater or Gleason score of 8 or more. Although the Gleason score is
considered to be a more reliable indicator of the cancer’s aggressiveness
than the PSA test, it also has limitations as a reliable indicator.
Additionally, he noted that studies show the lifetime risk of dying from
prostate cancer is estimated to be 2.8%.
David explained that the most commonly used treatments for prostate cancer
are surgery to remove the prostate and radiation. Some people choose active
surveillance, also referred to as “observation” or “watch and wait.”
Further, those who argue that we are over-treating prostate cancer will
point to the analysis of the results of several studies. For example, the
Task Force said that 90% of the men diagnosed with prostate cancer choose to
have surgery or radiation; and that two-thirds of these men have low grade
cancer that probably does not need to be treated.
Open Forum MC Roy Albiston
invites members & guests to asks the many questions about life & living in
the land of smiles, such as how to get a drivers licence or get a car
registered, or ‘can falangs own land?’ The club website is also an excellent
source of information, and can be found at www.pattayacityexpatsclub.com.
One can also sign for the newsletter on the site, so you will be informed on
Thursday or Friday what the topic will be for the following Sunday, and also
of upcoming events in Pattaya.
David presented data from the PIVOT study in the U.S.
which enrolled 732 patients, half of whom had decided to have surgery; the
other half chose active surveillance. After observing the patients for 10
years, the researchers discovered that there was very little difference in
outcomes.
Master of Ceremonies Richard
Silverberg opens the June 30th meeting of the Pattaya City Expats Club by
inviting visitors and guests to introduce themselves, prior to calling on
the speaker. Jerry Dean assists with the AV presentation.
They predicted that 1.6% of men who choose surgery will die from
prostate cancer in 20 years, compared with 2.8% of men who choose
observation; and that the average life extension for men who choose surgery
will be just 1.8 months.
Those who say that we are over-treating also point to data on the risk of
adverse events from surgery. For example, the Task Force said that for each
1,000 men who choose surgery: five die within one month of surgery; 10 to 70
have serious complications; and 200 to 300 have long-term adverse effects.
One researcher from the PIVOT study concluded: “There is probably a benefit
[from surgery] for 1 or 2 patients out of 100, and these men derive a lot of
benefit, and there is probably no benefit for anyone else.”
So, are we over-treating? David felt that it depends how you look at it. At
the society level, if you have to treat 100 people to save one or two lives,
and if the complications from surgery can be significant, he said it does
look like we are over-treating. However, at the individual level, the
natural response of most men who have been diagnosed with prostate cancer
and who look at this data is to say: “Maybe I’m that one person in 100 that
needs to be treated!”
Are we over-testing? David said that three main arguments are advanced in
support of this thesis: (1) the PSA test often produces false positives,
which can have negative psychological effects and which usually leads to
more (unnecessary) testing; (2) a high PSA level usually leads to a biopsy,
and the biopsy itself can cause complications (for example, the risk of
infection is at least 2%); and a diagnosis of cancer usually leads to
over-treatment for most men.
The Task Force concluded: “Existing studies adequately demonstrate that the
reduction in prostate cancer mortality from PSA testing after 10 to 14 years
is, at most, very small, even for men aged 55 - 69.” Researchers from a
European study concluded: “For every life saved, 1,410 people had to have a
PSA test and 48 people were put through unnecessary treatment.” So, are we
over-testing? David said that, again, it depends on how you look at it. As a
society, if we test over 1,400 people and treat 48 to save one life, it
looks like we are over-testing. However, David believes that the decision of
whether not to take the PSA test has to be an individual one. David added
that he found the argument that testing automatically leads to
over-treatment to be patronising. His opinion was that the researchers are
saying that patients who are diagnosed with prostate cancer cannot be
trusted to make intelligent decisions about treatment.
David said he found two major flaws in the arguments for not testing. First,
if you don’t do the PSA test, you don’t know there might be a problem.
Second, if you don’t do the biopsy, you have no idea how aggressive your
cancer might be.
David concluded by saying that not all medical associations have taken as
“extreme” a position as the US Task Force. For example, the American College
of Physicians still recommends that doctors screen men aged 50 - 69. And the
U.K. government says that men “are entitled to make an informed choice about
whether or not they should have a PSA test, based on balanced information
about its pros and cons.”
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Marriott Wine triumphs over water
Dr Iain Corness
The Argentinean wine dinner held recently in the Marriott’s delightful Sala Rim
Nam was almost the victim of Thailand’s rainy season. No sooner had the guests
taken their seats with a glass of reception wine in their hands, than the
heavens opened leaving everyone to run for cover.
Quick thinking by F&B manager Luis Zamora had the guests taken to the lobby bar,
while the Marriott staff regrouped to consider their options, while Ross Edward
Marks, the Vice President - Wine, Spirits & Beer of the Central Food Retail
Company looked on.
To keep the guests entertained while an indoor setting was prepared, the
Elephant Bar was thrown open and the diners were at liberty to select any of the
Argentinean wines to be sampled that evening. This perhaps put a dent in the
expectations, but on the other hand, certainly made for fun and laughter
The wines, which by this stage were ‘free-flow’, were the Santa Julia Extra Brut
(originally the reception wine), Santa Julia Fuzion Chenin Blanc-Chardonnay,
Santa Julia Fuzion Shiraz-Cabernet and the Santa Julia Malbec.
As soon as the indoor venue was set up, the guests (reluctantly) left the
Elephant Bar and sat down for a more formal buffet-style dinner, and this time
under cover!
The Marriott staff reacted well to the change in venue and format, and were just
so obliging in response to requests (mainly for more wine), that everyone ended
up enjoying the evening, despite it being a somewhat different style of wine
tasting.
Ross Edward Marks did say that the wines were budget priced, so it might be an
idea to go chasing!
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Srisuwit School teens dominate
at Pattaya Young PR Ambassador contest
(L to R) Rungratree Thongsai,
Narong Khummnaee, Deputy Mayor Wutisak Rermkitkarn, and Phraiwan Hongsa thank
the judging committee for their time.
Warunya Thongrod
Five talented girls from Srisuwit School will spend the next year as
Pattaya’s latest “Young PR Ambassadors.”
The “SV1 Team” of 15-year-olds - Chonlada Chanpaka, Phichaya Masom, Thanyalak
Nakthong, Pijitra Singnakthum and Pakjira Teeraponkool - impressed judges of the
7th annual youth contest with their confidence, knowledge and preparedness at
the June 28 finals at Royal Garden Plaza and took home 30,000 baht in prize
money.
The “Modern City 8 Team” from Pattaya School No. 8 took second place and 20,000
baht while Srisuwit’s SV2 Team placed third, winning 10,000 baht. In all,
Srisuwit put five teams of five youngsters in the top 10, also winning Royal
Garden’s “Rising Star” award and the Best Orator prize for student Pijitra
Singnakthum. Nattha Sangkhruamjai from Pattaya School No. 8 won the Most
Talented award.
The SV3 team from Srisuwit school
performs in the final round.
“We are delighted to win because we worked together to
brainstorm various concepts and prepared extensively to learn information about
Pattaya to use in our answers,” SV1 Team member Pijitra Singnakthum said.
Two team members had participated in previous contests, which helped them
prepare captivating presentations, such as one called “Rain and Mimosa,” in
which they contrasted the negatives of rain and the happiness of visiting
“Mimosa,” a restaurant next to Jomtien Beach’s Ambassador Hotel.
“The children excelled in their performance and their confidence was
outstanding,” said judge Rungratree Thongsai. “In this competition, the kids
must learn to manage their time, speak clearly and be confident. The winning
team prevailed in part because other teams went over their allotted three
minutes or answer on point.”
A young student from Pattaya
School No. 8 beams a beautiful smile during her team’s performance.
Organized by Pattaya tourism officials and supported by the
Pattaya City Council, about 200 students from Pattaya and Banglamung entered the
7th annual Young Ambassador contest June 4. After undergoing several weekly
rounds of training, written tests and oral presentations, the field was winnowed
to 10 teams from Pattaya schools No. 8 and No. 3, Assumption School Sriracha and
Srisuwit School.
“Youths are considered important individuals who need to have education
instilled and must be aware of the importance of confidence and the history of
Pattaya to work as public relations ambassadors to advertise Pattaya’s tourism
to the world,” said Deputy Mayor Wutisak Rermkitkarn.
The winners will now spend select days over the next year at city events and
promoting tourism.
The SV1 team from Srisuwit school
wins over the judges with their performance.
Former Young Pattaya PR
Ambassadors return to the stage to sing the ‘Hero’ song.
The final step of the Success
team from Pattaya School No. 9, dancing to the theme “Art in Paradise and
Light”.
Groovy dance moves from youths
during the question & answer round of the Young Pattaya PR Ambassador 2013
contest.
The SV1 team from Srisuwit School
accepts their winning trophy from Pattaya’s deputy spokesperson Dumrongkiat
Pinijkarn.
Winning teams pose for posterity
with judges and sponsors.
Pattaya School No. 9 supporters
cheer on their Success team.
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