Prostate Cancer - Assignment Example

Pro Cancer By Lecturer’s and Pro cancer: Pro cancer has emerged to be one of the mostfrequent and common cause of death amongst men in the current world. In U.S, this type of cancer is the most frequently diagnosed type of cancer coming after lung cancer and skin cancer respectively (FILMS FOR THE HUMANITIES FILMS MEDIA GROUP, & INFORMATION TELEVISION NETWORK, 2008). It is considered as the major cause of death amongst the U.S. men, and is therefore considered as being among the most vulnerable diseases. In 2008, the cases of prostate cancer were approximated to be 903,000 with up to 258,000 deaths worldwide, thereby making it to be the 2nd most frequently diagnosed strain of cancer amongst men (CHISHOLM, 2010). On the other hand, it was considered as the sixth leading source of male cancer deaths (ABLIN & PIANA, 2014). Despite the current findings and publications from several randomised trials, there are still a lot of discussions concerning the merits and dangers. There is still no clear consensus on the most appropriate utilisation of PSA testing amongst men with little or no history pertaining prostate cancer. All positional guidelines and statements are based on related body of evidences, although some of them seem to be more comprehensive than others, but interpretation of the evidence and implications and the interpretation of evidence for practice differ, thus leading to some sort of confusion amongst the doctors and the vulnerable men (UNITED STATES, 1996).  Studies show that, the risk of contracting prostate cancer by the American men is at 16 percent, while the risk of succumbing to death out of it is only 2.9 percent (CHISHOLM, 2010). This data simply suggests that this type of cancer tend to grow gradually, and can be put into control if early diagnosis and treatment is done before it gets clinically advanced. Currently, the most commonly used technologically advanced tests for detection of prostate cancer is referred to as the Prostate-Specific Antigen (PSA). This test has to do with the measurement of PSA blood level, that is, an enzyme formed in the prostate. Specifically, it is aserine protease that is comparable to kallikrein (ABLIN & PIANA, 2014).Its normal role is to liquefy viscous semen mainly after ejaculation, thus allowing for an easier navigation of spermatozoa across the cervix. This paper provides a clear and adequate summary and review of current position statements and guidelines from some of the major cancer organisations, urological societies, cancer organizations and many other eligible public health agencies. The points of contentions and agreements have been clearly highlighted to assist in decision-making concerning the use of the PSA tests at the early stages of prostate cancer detection (SPEAKING FROM EXPERIENCE PTY LTD. (2000). Evaluation of issues and benefits of PSA-based tests: As much as testing for PSA is of great benefit, it can also be controversial on the other hand since it may result to pointless, and even harmful effects to some of the patients. Since the introduction of this test in U.S., over a million more men have undergone diagnosis, and received prostate cancer treatments, but the estimates shows that most of them, approximately greater than 95 percent of those men received little or even no benefit at all from their actual diagnostic results (CASE, 2006). Even when an individual makes very optimistic assumptions concerning the importance of screening (i.e. that the overall reduction in cases of prostate cancer deaths as witnessed since the use of this test is as a result of discovery of the test), less than five percent of those getting an irrefutable diagnosis reaped rewards from those tests. More current studies have revealed tremendous efficacy in how screening has minimized the prostate cancer death rate. OH (2006) published that PSA screening reduced prostate cancer related deaths by 37 percent. Through employing a regulated group of men within Northern Ireland, where prostate cancer screening is infrequent, the research revealed this substantial decline in mortalities related to prostate cancer in comparison to men who underwent PSA testing as part of the ERSPC study. According to HRICAK & SCARDINO (2009), the risk that is posed by prostate cancer tends to increase with proportionate increase in PSA levels. However, there is a claim that the PSA tests and screening are not receiving more appropriate usage since there is a notion of overall usage of tests that doesn’t perform what they are purported to perform. For instance, 4 Nanogram/Millilitre was arbitrarily chosen as a determinant basis for biopsies during the clinical test whereby the United States Food and Drug Administration (FDA) organization claimed that the detection of prostate cancer in men aged 50 and above was the most approved PSA test that was available commercially. On the other hand, studies show that PSA levels not only change due to development of cancerous cells, but due to many other reasons. Two other main causes of rise in PSA levels can either be the issue of prostate enlargement (benign prostatic hypertrophy) or due to prostate infections (prostatitis). It can also intensify for about 24 hours after ejaculating and for a few days after catheterization (OH, 2006). Controversy related to screening If not well managed, prostate cancer can evolve into a lethal malady, but its developmental pace can also be reduced such that an individual can witness slight problems during his life-time (CASE, 2006). It is normally hard for a doctor to uncover how the cancer proceeds based on the currently available screening. It is not often recommended for healthy men to be subjected to PSA screening due to the fact that, potential risks tend to outweigh the expected benefits. This is pin-pointed to various evident-based research reviews that have come up to the conclusion that PSA–based screening outcomes have elicited slight or no decline at all in prostate cancer mortality rates, and is normally associated with various harms that relates to subsequent treatments and evaluations, some of which might be of no importance (HRICAK & SCARDINO, 2009). Prostate cancer screening can also be controversial in that, there is no clear and favourable consensus in terms of cost, and the cases of uncertainty that emerges due unclear long-term benefits to the affected individuals. PSA testing may end up predisposing an individual unto over-diagnosis, hence leading to unnecessary treatment (CASE, 2006). In line with this, follow-up that are always recommended for may include very painful biopsies that can lead to extreme bleeding and consequent infection (Kelman and Scardino, 2014). Generally, the tests popularity has ended up to an incredibly costly public health hazard, since among the 16 percent of men who will ever be diagnosed of prostate cancer, only 3 percent have got a chance of dying from it (Kelman and Scardino, 2014). According to VIJAYAKUMAR & CHEN (2011), PSA testing for men aged 70 years and above is totally discouraged since most people who are distinguished to have prostate cancer by use of PSA tests at this age would definitely die of causes not cancer related (VIJAYAKUMAR & CHEN, 2011). On the contrary, about 25percent of men who are diagnosed of prostate cancer during their late ages have little or no chances of survival especially if they are diagnosed with high grade strain of prostate cancer. Contrary to this, some people tend to argue against the aspect of young men undergoing PSA testing. The arguments are based on the facts that, many of them would end up having been screened only to find out one strain of cancer, and hence many of them would end up receiving treatment for an un-progressive form of cancer. In addition, such arguments tend to ignore the reality that low-risk prostate cancer only requires gradual treatment since it may be open to a more active surveillance. Cancer of the prostate is becoming very common and is extremely heterogeneous. This is because, most people take that cancers of the prostate are languid in nature and would never proceed to clinically eligible levels if left untreated and undiagnosed in the course of a mans existence. Additionally, its subset is potentially fatal, and so screening can discover some of those who are within a manageable stage. Thus, this aspect of screening for PSA is totally advocated for by some people as a clear and proper way of unearthing high-risk, and dangerous prostate cancer, putting in mind the fact that, the un-discovery of a lower-risk malady does not often need a lot of treatments unlike the high-risk maladies. Case study: The American Cancer Society (ACS) does not fully back up routine testing and screening for prostate cancer currently. This is because ACS believes that the health care experts should first of all discuss the potential limitations and benefits of prostate cancer testing with men before they begin any form of testing. The discussion should mainly include a bid for testing using prostate-specific antigen (PSA) blood test, and an annual digital rectal exam (DRE) that should kick-start at the age of 50 years. This should mainly be performed to men who are at extreme prostate cancer risks and have got at least 10 years of life expectancy (VIJAYAKUMAR & CHEN, 2011). After such a discussion, those who will finally favour taking such tests should be tested. They should actively participate in this form of decision-making by getting insights about prostate cancer, and the dire benefits and risks of its early detection and treatments. This will probably enhance the overall caution as well as timely diagnosis and treatment of prostate cancer amongst most men. Prostate cancer screening is among the most controversial topics within the aspect of urology. The US Lung, prostate, Ovarian and colorectal Cancer Screening trial demonstrated very slight variation in prostate-cancer-related deaths between men who were screened yearly rather those who were screened on rare basis. So citing such an uncertain ratio between the potential effect and potential benefits, the US Preventive Services Task Force recommended in opposition to serum PSA tests. (KIRBY, CHRISTMAS et.al. 2001).Although this proportion is yet to be elucidated, early tumour detection and PSA testing seems undoubtedly of benefit to some individuals. Instead of coping up with the concept of a one size fits all methodology, medical experts are likely to implement personal risk assessments so as to reduce the danger of negative results, that includes; anxiety, biopsies, un-necessary testing, over diagnosis, and even overtreatment. The PSA tests have to be intermixed with other predictive elements or be utilised in a much more reasonable way for identification of men at higher risk of life-threatening or symptomatic cancer, without the act of over-diagnosing an indolent disease. So, a risk-adaptation approach is required, whereby PSA testing will be tailored to personal risk (POSTMA, 2006). Developmental PSA-based tests: Gene Based Biomarkers A variety of gene-based biomarkers have been widely associated with prostate cancer. Most of these tests have got the potential of improving the precision of diagnosis, risk prediction, prognosis or staging of prostate cancer. So, in reaction to the need for much better biomarkers meant for diagnosis, prognosis and risk assessment, a variety of investigative study is ongoing (POSTMA, 2006).The outcomes of this work have been readily translated or are still in the course of being translated into commercially available tests, that includes; Single nucleotide polymorphisms (SNPs), Prostate cancer antigen 3 (PCA3), Transmembrane serine protease (TMPRSS), Multiple gene tests (gene panels) and even Gene hyper methylation (BRADLEY, PALOMAKI et. al., 2013). While studies utilizing these tests tend to give insights on much helpful information towards understanding the biological mechanisms of prostate cancer, and might even eventually assist in designing treatments; the fact remains that, all the above highlighted tests are still in their developmental phase. Recommendation: Some of the recommended guidelines includes the facts that, physicians should not offer PSA testing anyhow unless they are willing to participate in joint decision-making process, whereby they have to fully discuss with the patients all the benefits and harms attached to the tests. The level of harm can be minimised by ensuring that there is a much longer screening interval, heightened PSA biopsy threshold, increase in AS/WW and even use of a clear periodic DRE (JOHNSON, SANDMIRE& KLEIN, 2004). In conclusion, men should ensure that they get proper PSA test in their 40’s so as to develop their baseline. In line with this, men at higher risks of prostate cancer should engage in adequate talks with their usual care providers before age 40 concerning prostate cancer menaces. Finally, the individuals who are at their 70’s and above should be left to make their own personal choices whether to continue or to end PSA testing (POSTMA, 2006). Reference list: ABLIN, R. J., & PIANA, R. (2014). The great prostate hoax: how big medicine hijacked the PSA test and caused a public health disaster. BRADLEY, L. A., PALOMAKI, G., GUTMAN, S., SAMSON, D. J., & ARONSON, N. (2013). PCAS3 testing for the diagnosis and management of prostate cancer.http://www.ncbi.nlm.nih.gov/books/NBK132752/. CASE, A. S. (2006). Knowledge and prostate cancer screening in African American men: the effects of a religiocultural intervention. Thesis (Ph.D.-Psych.)--Fuller Theological Seminary, School of Psychology, 2006. CHISHOLM, M. (2010). Exploring perceptions and meanings of prostate cancer screening of unscreened men. Thesis (M.N.)--Dalhousie University, 2010. FILMS FOR THE HUMANITIES & SCIENCES (FIRM), FILMS MEDIA GROUP, & INFORMATION TELEVISION NETWORK. (2008). Types of cancer. New York, N.Y., Films Media Group. HRICAK, H., & SCARDINO, P. T. (2009). Prostate cancer. Cambridge, UK, Cambridge University Press. http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=273769 JOHNSON, D. W., SANDMIRE, D., & KLEIN, D. M. (2004). Medical tests that can save your life: 21 tests your doctor wont order--unless you know to ask. [Emmaus, Pa.?], Rodale. Kelman, J. and Scardino, P. (2014). Dr. Peter Scardinos prostate book, revised edition. New York: Avery. KIRBY, R. S., CHRISTMAS, T. J., & BRAWER, M. K. (2001).Prostate cancer. London, Mosby. OH, W. K. (2006). Prostate cancer. Philadelphia, Saunders. POSTMA, R. (2006). Population based screening for prostate cancer: prognostic findings of two subsequent screening rounds. [S.l.], [The Author].f SPEAKING FROM EXPERIENCE PTY LTD. (2000). Living with prostate cancer speaking from experience. [Melbourne], Real Time Health. UNITED STATES. (1996). Management of prostrate [sic] cancer for primary care. [Birmingham], [Dept. of Veterans Affairs]. VIJAYAKUMAR, S., & CHEN, A. (2011).Prostate cancer. New York, Demos Medical.http://site.ebrary.com/id/10476357. Appendix: 1 Ages range for offering PSA testing: Appendix: 2 Read More