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Posted by on in Prostate
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Movember and The Secret Stalker of the Prostate

You will no doubt be aware of the current conversation about prostate cancer screening, the PSA, and men's health in general.

I am gratified to hear the support for prostate screening particularly among the GP population. But the GP population seems to be a voice in the wilderness when it comes to this topic. The current policy position of the RACGP is that they "do not in principal support prostate screening."
See recent RACGP policy release.

The PSA has lots of problems but it's all we have. I dearly wish there was something better than the PSA as a screening test.

You get the impression that men's gender health has been forgotten. Men's health certainly plays second or even third fiddle to its competitors. Women's health has been done over and over ... read here cervical screening, and breast screening. Likewise child health ... read ante-natal management, quality child care in general, paid parental leave to bond with newborns, childhood immunisation program for starters, and Government funding for child care. There is hardly a week, or a day goes by that we don't hear about government funding for quality child care, early childhood education, and development.

But men's health has been forgotten in the meantime. Funding for men's health is virtually zero.

Yet, funding needs to be directed not only to a screening program, but also to research to find a better bio-marker for early accurate detection of prostate cancer. It is thought that there are 2 forms of prostate screening, one that is slow growing and non-aggressive, and one that is very aggressive, and rapidly fatal even with the best of treatment.

Not only should a bio-marker be able to detect early prostate cancer, but it needs to be able to distinguish between these two forma of prostate cancer.

In the interim, we're back to the topic of prostate screening.

There seems to be 2 schools of thought about prostate screening, those who are I favour of a screening program, and those who do not believe that there should be a screening program.

Prostate cancer and bowel cancer are the two highest causes of death in men in the whole of the western world. The pros and cons of having a prostate cancer screening program are worth considering.

Against a Screening Program
  • the cost of screening program
  • men generally don't adhere to this health recommendation
  • not all prostate cancers should be treated
  • unwanted side effects from surgery
  • PSA is non-specific
  • PSA cannot determine if a slightly elevated level is cancer or whether it is BPH
  • PSA is not specific to the prostate
  • PSA is not even gender specific, can be found in breast milk, obviously in females
  • PSA doubling time, may not be sufficient time to detect a prostate cancer in time before it has spread beyond the prostate

For a Screening Program
  • men are worth spending the $$$ for a screening program
  • may be lifesaving
  • in future, men will be living longer, as will all of us
  • early intervention saves lives
  • early intervention prevents morbidity
  • early intervention lowers mortality
  • early intervention is less traumatic
  • financial benefit to families, the community, and the country
  • financial savings to same

Dr. Judith O'Malley-Ford - Morris Publishing Australia

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Guest Wednesday, 23 January 2019


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