Screening for prostate cancer – an old argument revisited

Links to material quoted are given fully at the end of this post.

Gee! It's almost two years since your Grumpy Old Journo – also known as a Happy Prostate Cancer Survivor – put up some posts disagreeing with Simon Chapman, a strong opponent of screening for prostate cancer. On November 6, 2007, I said:

Gee! Me against the Professor of Public Health at the University of Sydney. This should be a one-sided debate. But here goes.

If you've dipped into this blog over the past year or so, you'll know I'm passionate in urging mature men to ask their doctor for a prostate cancer check.

And although I've read Professor Chapman's article in Monday's Sydney Morning Herald [November 5, 2007, headed “Prostate screening not worth it”] – and was already familiar with the arguments he has put – I will not change my advocacy.

I went on to explain:

The reason is simple. Early detection of prostate cancer, before any symptoms became apparent, may have saved my life. At the very least, it saved me from having to make decisions about more risky treatment of an aggressive cancer after it had spread further. I hope you'll bear with me.

I'm trying to explain that screening is worthwhile for most mature men, provided the guy (and his wife and friends) understand its limitations.

All treatment options – including non-treatment, ranging from "watchful waiting" to "no point
worrying about it at your age" – have risks and shortcomings. What's the right treatment for one guy might be ill-advised for the next.

So now, almost two years later, Professor Chapman, in an article jointly authored by a colleague, Associate Professor Alexandra Barratt, has returned to the SMH's pages to reiterate opposition to screening.

Under the heading, “Irresponsible prostate proposal ignores risk of harm to men”, the professors attacked last Wednesday's call by the Urological Society of Australia and New Zealand for men to have prostate cancer tests at age 40 instead of the previously recommended age of 50.

The professors' argument, basically, is that studies show screening fails to save many more lives despite higher costs to the public health budget. They ask:

What are the costs of close monitoring of half the nation's men aged in their 40s? What health-care services are going to be cut to cover the additional costs? Or must the health care budget be increased?

Cost-effectiveness? The Urological Society's recommendation means that men should ask their family doctor to order a blood test for PSA – prostate specific antigen – and to do a digital rectal examination at age 40.

Most guys should have a general medical check-up around that age, involving heart, blood pressure and blood testing of cholesterol, so why shouldn't they also ask for a prostate cancer check?

Apart from the pathologist's charge for the PSA test, where's the significant extra cost? And close monitoring? That will only happen if your doctor believes your PSA or DRE results are a cause for concern – and brother, if your doctor thinks that, won't you be glad you asked for the test?

“Risk of harm to men” are the words in the heading. This refers both to the risks involved in a biopsy, and to possible over-aggressive surgery or radiation treatment when cancer is found.

But my experience is that despite the risk of infection from a biopsy, it's worth that risk because it will allow your urologist to avoid aggressive treatment if it's not needed. For some men the biopsy may show there's no need to begin treatment, but to accept "watchful waiting" with PSA tests from time to time.

It would be unproductive to run a longer post arguing my position. The following links should help anyone seeking more understanding of the debate.

My November 2007 post outlined my arguments at length – indeed, it was so long I followed with an “executive summary”.

Last Wednesday, the Urological Society published its new policy here and also issued this media release.

The next day, professors Chapman and Barratt had their article published in the SMH. And here's Professor Chapman's SMH article published in November '07.

Last week, the SMH published letters contesting the professors' views on Friday (including a letter from Urological Society president Dr David Malouf denying the society advocated a screening program, instead saying it recommended 40-year-old men "should be offered a prostate cancer test to assess their risk") and another letter yesterday (on each of these letters pages you'll need to read down a way to find the relevant letters).

You'll also find a good explanation of prostate cancer and its treatment options in Wikipedia.

.

The National Times – reborn as a sickly child, stranded out of its time

You have to have lived the times to understand what The National Times meant to many of us. And to understand why we're so disappointed with the National Times reborn this week as an online member of the Fairfax Digital Media stable.

Each Thursday, we'd stop in to a newsagent to pick up the new edition of this remarkably bold – radical even – newspaper produced within the staid halls of the Sydney Morning Herald establishment. Usually, we also bought the weekly Nation Review, grubstaked by the left-supporting millionaire Gordon Barton.

The NT launched its first issue on February 8, 1971. That, my generation will remember, was a time of profound social change in Australia and most of the western world. A growing women's rights movement. The Pill. Flower power and the Age of Aquarius. Hippies. Vietnam war and anti-conscription moratoriums. Some men even dared to let their hair grow long.

In hotel bars, long the domain of blokey men, young women in rainbow garb would tell you they'd studied iridology, stare deeply into your eyes, and pronounce: “No, you're not an alcoholic.” Then you'd have another half a dozen beers with them.

Some 22 months after the NT's launch, came “It's Time” – the slogan which helped Labor's Gough Whitlam become Australia's Prime Minister, winning government after years of conservative rule. Three years later, he was gone, dismissed by Governor-General John Kerr – the former Labor lawyer Whitlam had thought would be his man.

Today, many of us remember Whitlam for fiscal irresponsibility and his failure to rein in the wild antics of his Cabinet ministers.

But we should also remember he legislated to give women equal pay for equal work, to recognise indigenous land rights, to provide for no-fault divorce in place of the shameful and often fraudulent proving of adultery or habitual drunkenness against a “guilty party”. He provided allowances for single mothers, and appointed a special adviser on women's affairs.

He saw Australia's future lay in its relationships with Asian nations, and gave recognition to communist China – a move which will underwrite Australia's prosperity for decades to come.

He also helped Australia see itself as a proudly independent nation, and not an outpost of the declining British Empire (or Commonwealth of Nations, whatever that name was meant to signify).

Before Whitlam, Australians had to carry a British passport when they ventured overseas. His government provided Australian passports.

They were exciting times to be alive. And The National Times was part of that excitement. As Fairfax journalist David Marr (editor from 1980 to 1982) said the other day:

The paper's beat was spies, politics, prisons, rape, defence, politics, the US alliance, motoring, business, sex, politics, tax scams, education, health, the women's movement, the arts, crime and politics. The National Times pioneered a strange alliance between lifestyle and the gutter, between wine and crime. This was mocked and imitated . . .

We weren't planning the overthrow of capitalism. We weren't hell-bent on radical change. The National Times was giving voice to a brand of scepticism growing in Australia for decades. The
revolutionary thing was doing so from behind the conservative walls of fortress Fairfax.

The old National Times lasted until August 1, 1986. It never made a profit, and its circulation rarely reached 100,000. Fairfax changed its publishing day, and it battled on for five months as The National Times on Sunday, and until March 13, 1988, as The Times on Sunday.

When Fairfax began signalling the relaunch of The National Times as a website devoted to intelligent reviews and commentary, your Grumpy Old Journo was sceptical. The times have changed – the youthful irreverence of the 1970s and early 1980s, the optimism and the excitement, are little more than a memory in our materialistic society.

But also, I hadn't realised just how cheapskate Fairfax Digital Media could be.

The Sydney Morning Herald bounces on to my front porch about 3.30 each morning. I usually read it back in bed. For the last three mornings, I've gone on to check the National Times website – and what's this? I've already read most of the featured stories when I perused the morning newspaper. What's the point of that?

Not only that, for all the promotion of The National Times reborn, the website displays with a design and typography which positions it as just another page on the SMH website. So far, the verdict of other commentators agrees with mine, as shown here and here.

Washing away the cobwebs

Nothing blows away the cobwebs like a run on the motor-cycle. Yesterday, however, it was more like washing away the cobwebs.

I rolled out the motor-cycle and pointed it over the hills through Kulnura and later north along the old alignment of the Great North Road – you can still see the convict-built masonry walls and culverts along the way – before I pulled up in Wollombi.

Wollombi shops

It's a charming heritage township, and well worth a visit. As usual, my bike came to rest in front of the tavern best known for a fortified wine labelled Dr Jurd's Jungle Juice.

Me? I kept under the limit with two beers and a hamburger while I chatted with some of the other bikers along the veranda. Rode off at 1.45pm – just as the rain started. And it rained all the way home, through Cessnock and down the F3 freeway.

It wasn't heavy rain, but steady. Soon my wet-weather gear was sodden. – and I was experiencing dread as I mixed it with the freeway traffic.

That gives me a subject for this post. But after building up the revs. I'll then speed through a few other topics I'd been looking at.

□ □ □ □ □ □ □ □

Hey guys, give me more room in the wet

We didn't have much rain, less than 6mm in the gauge back home. But that was more than had fallen in all of the month of August.

Steady light rain after a long dry spell means one thing to a biker –a treacherously slippery mix of dust, oil and water may be coating the tarmac. Often, you can feel it as you turn, accelerate or brake.

It's OK for you guys strapped in your metal boxes. If you slam into the car in front because you're travelling too fast or too close, and then someone slams into the rear of your car, you're still likely to walk away from the pile-up.

I know many of you dislike bikers for the way we zip past on sunny days, but surely not so much you'd not care if I slid under someone's tyres.

If I ride a prudent distance from the car in front, don't drop into it. I have to throttle back to restore the safe distance, and then the driver behind gets upset and tailgates me.

And please turn your lights on. I'm peering through a rain-spattered visor, using my mirrors to see what's coming up behind, and in the poor light and through the misty spray I can make out only the grey, blurry outlines of the semis and B-doubles about to pass me.

Let's be nice to one another in wet weather, and I'll promise to give you a cheery wave next time I zip past you on a sunny day.

□ □ □ □ □ □ □ □

And another thing about anti-smoking campaigns

Tougher measures against smoking moved closer this week with the Federal Government likely to accept the recommendation of its Preventative Health Task Force to push the price of a packet of 30 cigarettes up from around $13.50 to $20 – or from 45c to 67c per cigarette.

Grumpy Old Journo still has reservations about this. As this blog pointed out on July 13 (“Clearing away the smoke” [1] ), it may cause many to quit, but there will be some families from lower socio-economic groups who will just buy less food for their children.

And in newspaper reports, I see no support for two measures I suggested in the July post. First, that the government try to push down the price of nicotine lozenges, patches and chewing gum – for many heavily addicted smokers, the most effective way to quit.

Second, that we encourage people to treat directors, executives and PR staff of tobacco companies as scum. After all, they promote an industry which, in the ordinary course of its business, kills many Australians. And as Australian parliaments make it harder for them here, they just turn to killing many of our Asian neighbours to keep the profits rolling in.

Another point has occurred to me. As I walk near the local high school before classes begin, I see students in school uniform in groups around nearby corners – and many of them are smoking.

Most anti-tobacco advertising is aimed at persuading smokers to quit. Surely we can commission the best minds in the advertising industry to produce convincing campaigns which persuade teenagers not to start.

□ □ □ □ □ □ □ □

Appalling gun-lovers blackmail NSW

So it's happening, as forecast in mid-August (in “Appalling politicians”, posted on Aug 17 [2] ). The two members of the Shooters Party in the NSW State Legislative Council are refusing to vote for any government legislation unless the government agrees to let their gun-happy members hunt feral animals in the state's national parks [3] .

They hold the balance of power in the Upper House. Because of the preferential voting system by which members are elected, they got in with minuscule public support [4] .

It's a dreadful choice for the NSW Government – cave in to appalling people who kill animals for pleasure, or see vital legislation stalled.

And if it does cave in, what will these appalling people demand next? The Shooters Party policy includes a US-style right for all citizens to own and use firearms [5] .

□ □ □ □ □ □ □ □

John Della Bosca? What's left to say?

My sympathy is with the former NSW Labor Health Minister, who resigned from his ministerial post after a tawdry tabloid, Rupert Murdoch's top-selling Sydney Daily Telegraph, broke the story of his sexual affair with a woman aged 26 – half his age.

But I'm not putting my hand up to say so. It could lead to speculation, unwarranted of course, about some of my past.

However, you might find two feature articles in this morning's Sydney Morning Herald both informative and enjoyable.

In the first, legal affairs commentator Richard Ackland gives some interesting information about the affair and the Murdoch press's actions. He says the Daily Telegraph has damaged the media's case against tighter privacy laws [6].

In the second, Professor Rodney Tiffen offers a seven-point guide to ministers on how to survive sex scandals [7] .

.