The eye of the beholder.

Since I have previously written blogs on both the vaccine and the issue of screening (several blogs actually), I will simply pass these on with minimal commentary that follows. In the screening controversy, Europe updated their data showing that screening reduces death from prostate cancer but not overall mortality. My view is that 1) men with some high risk factor (African American, affected first-degree relative, BRCA-2 mutation family, etc) should be screened 2) others should be careful what they are asking for. And my corollary is that there are no screened/treated men who don’t feel either that screening saved their life or WOULD HAVE saved their life if it had been done earlier. But as a public health issue, since the vast majority of men will develop prostate cancer, current screening falls far short of the test we are looking for, and finding “more sensitive” tests is certainly not the answer. We need more SPECIFIC tests for the lethal phenotype.

As for the vaccine, there is a nice review of an alternative interpretation of the data that led to the approval of Provenge. It is worth knowing about, as is the intense interest in this vaccine from the financial community as well as patient advocacy groups. Be sure to read the whole article to get a balanced perspective. If you have the time, I also recommend reading a companion article that is linked on the Reuters page. Negative scientific studies are never published, nor do news writers bother making the few that are published into headlines. Companies like Amgen who have to put their resources where their “beliefs” lie do us a favor when they look into sensational claims.

2 Comments

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2 responses to “The eye of the beholder.

  1. Dan

    Dr Glode,
    Thanks for this post.
    As a Patient with a rising psa it is very hard stop a treatment that may work or is working to slow down psa to start a treatment that does not lower psa nor shrink tumors. This article sheds new light on it as well.
    Is there any evidence that Provenge helps other treatments to work better?
    thanks,
    Dan

    • We did a study that combined provenge (or not) with starting hormone therapy. There was evidence of slowing of PSA rise but it did not reach statistical significance in terms of the time to PSA going back up after a single 3 month leuprolide injection. I don’t think any evidence was generated regarding survival. I haven’t seen any data regarding combining it with chemotherapy or the other new agents. Here is the ref of the study I participated in:
      http://meeting.ascopubs.org/cgi/content/abstract/25/18_suppl/5059

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