Study: Prostate Screening Isn't Saving Lives

By Marilynn Marchione

Europe - A big study of men in Europe gives mixed results about prostate cancer screening that may do little to change minds about its value.

The study finds that PSA blood tests every four years seem to cut the risk of death from prostate cancer. 

But it also finds that screening makes no difference in overall mortality rates because most men die of other causes — not their prostate tumors.

The results underscore a frustrating truth about this disease: most prostate cancers grow too slowly to threaten a man's life and there is no good way to tell which ones will. Finding cancer often leads to treatments that can cause impotence, incontinence and other problems. The PSA test also is just a measure of inflammation, which can be due to many things besides cancer.

"A man needs to make a choice for himself, realizing the benefits exist in theory, but the harms have been shown in every study that we've ever done in prostate cancer," said Dr. Otis Brawley, chief medical officer of the American Cancer Society. "If there is an overall mortality benefit from prostate screening it is very, very small."

He had no role in the study, which was published in Thursday's New England Journal of Medicine.

In October, a government-appointed panel of experts, the U.S. Preventive Services Task Force, recommended against screening with PSA tests. Only two big studies have looked at this — a U.S. one that found annual screening did not cut prostate cancer death risk and a European one that found screening every four years did. (In Europe, prostate screening is less common and is done at wider intervals than in the United States.)

The new research is longer follow-up from the European study: 11-year results on 162,000 men ages 55 to 69. Researchers found that 1,055 men would need to be offered screening and 37 cancers would need to be detected to prevent a single death from prostate cancer. Overall death rates did not differ between the group offered screening and the group not offered it.

About half of the cancers that were detected did not need to be treated, researchers estimate.

The study was led by Dr. Fritz Schroder of Erasmus University Medical Center in the Netherlands. Several authors hold patents or get fees from PSA tests.

Men who choose to be screened should be prepared for a tough discussion of whether to have a biopsy or to treat any cancer that is found, said Dr. Christopher Logothetis, prostate cancer research chief at the University of Texas MD Anderson Cancer Center in Houston.

Prostate cancer "is only one of the causes of death, and it is not the main cause of death in these patients," he said.

Others believe the study supports the value of PSA tests and think the benefit will become clearer with even longer follow-up.

"Urologists are very passionate about it because we see all the bad cases," said Dr. Stephen Freedland, a Duke University urologist who has consulted for a few makers of prostate cancer drugs.

"What we need to do is separate screening from treatment. Not everyone diagnosed needs to be treated. 

But the best way of knowing who to treat is getting a sense of how bad the cancer is," he said. Annual tests may be too often, "but I don't think the solution to that is to give up all screening."

Survey Reveals Alcoholism in Surgeons; Numbers May Be Higer

United States - A survey from the University of Washington revealed approximately 15 percent of surgeons have an alcohol abuse or dependency problem, but those numbers may be higher.

The survey, which was sent out to more than 25,000 surgeons but answered by only 722, showed a correlation between alcohol problems and major medical errors.

The fact only about 29 percent of the surveys were returned concerns Dr. Edward Livingston, a professor at the University of Texas Southwestern Medical Center who was unrelated with the study.

"If you have a low response rate, you don't know if it represents the universe of people you're trying to study because I think the folks who are less likely to respond may have shame and guilt and fear associated with their alcohol abuse and dependence that they don't want to report on the survey," he said.

The study didn't say why alcoholism is more prevalent than the general population, which is estimated at about nine percent, but some factors may be work, lifestyle, mood-related.

Justices Will Review Racial Preference for College

By Mark Sherman

Washington - The Supreme Court is setting an election-season review of racial preference in college admissions, agreeing Tuesday to consider new limits on the contentious issue of affirmative action programs.

A challenge from a white student who was denied admission to the University of Texas flagship campus will be the high court's first look at affirmative action in higher education since its 2003 decision endorsing the use of race as a factor.

This time around, a more conservative court could jettison that earlier ruling or at least limit when colleges may take account of race in admissions.

In a term already filled with health care, immigration and political redistricting, the justices won't hear the affirmative action case until the fall.

But the political calendar will still add drama. Arguments probably will take place in the final days of the presidential election campaign.

A broad ruling in favor of the student, Abigail Fisher, could threaten affirmative action programs at many of the nation's public and private universities, said Vanderbilt University law professor Brian Fitzpatrick.

A federal appeals court upheld the Texas program at issue, saying it was allowed under the high court's decision in Grutter vs. Bollinger in 2003 that upheld racial considerations in university admissions at the University of Michigan Law School.

But there have been changes in the Supreme Court since then. For one thing, Justice Samuel Alito appears more hostile to affirmative action than his predecessor, Sandra Day O'Connor. For another, Justice Elena Kagan, who might be expected to vote with the court's liberal-leaning justices in support of it, is not taking part in the case.

Kagan's absence probably is a result of the Justice Department's participation in the Texas case in the lower courts at a time when she served as the Obama administration's solicitor general.

Fisher, of Sugar Land, Texas, filed a lawsuit along with another woman when they were denied admission at the university's Austin campus. They contended the school's race-conscious policy violated their civil and constitutional rights. By then, the two had enrolled elsewhere.

The other woman has since dropped out of the case. The state has said that Fisher is a Louisiana State University senior whose impending graduation should bring an end to the lawsuit. But the Supreme Court appeared not to buy that argument Tuesday.

The Project on Fair Representation, which opposes the use of race in public policy, has helped pay Fisher's legal bills. "This case presents the Court with an opportunity to clarify the boundaries of race preferences in higher education or even reconsider whether race should be permitted at all under the Constitution's guarantee of equal protection," said Edward Blum, the group's director.

The project also issued a statement in Fisher's name. "I hope the court will decide that all future UT applicants will be allowed to compete for admission without their race or ethnicity being a factor," she said.

Most entering freshmen at Texas are admitted because they are among the top 10 percent in their high school classes. Fisher's grades did not put her in that category.

The Texas Legislature adopted the Top Ten Percent law after a federal appeals court ruling essentially barred the use of race in admissions.

But following the high court ruling in 2003, the university resumed considering race starting with its 2005 entering class. The policy at issue applies to the remaining spots beyond those filled by the top 10 percent and allows for the consideration of race along with other factors

Texas said its updated policy does not use quotas, which the high court has previously rejected. Instead, it said it takes a Supreme Court-endorsed broader approach to enrollment, with an eye toward increasing the diversity of the student body.

"We must have the flexibility to consider each applicant's unique experiences and background so we can provide the best environment in which to educate and train the students who will be our nation's future leaders," said Bill Powers, president of the University of Texas at Austin.

Before adding race back into the mix, Texas' student body was 21 percent African-American and Hispanic, according to court papers.

By 2007, the year before Fisher filed her lawsuit, African-Americans and Hispanics accounted for more than a quarter of the entering freshman class.

Fisher's challenge says the Top Ten Percent law was working to increase diversity and that minority enrollment was higher than it had been under the earlier race-conscious system.

Fitzpatrick said two other states, California and Florida, use similar "top 10" plans, although California law 

explicitly prohibits the consideration of race.

"But the vast majority of schools that are selective are using affirmative action, though they don't like to advertise it for fear of being sued," he said.

The case is Fisher v. University of Texas at Austin, 11-345.

Man Who Got House for 16 Dollars Forced Into Leaving

Flower Mound, Texas - A man who gained some face for getting a $340,000 house for $16 has been evicted, or more accurately willingly left his house.

Kenneth Robinson moved into the house, formerly owned by William Ferguson for $330,000 who abandoned three years later due to his inability to pay for the house. Now however, in a move that's all-too-familiar with people across the country, Robinson lost the house - which he acquired under Texas' adverse possession law - to Bank of America.

The finance giant is seeking possession of the house and asked a judge to give Robinson until February 13th to appeal or leave the house. Instead of appeal he took the option to unceremoniously leave.

Robinson, who states on his website he isn't a lawyer, gave Texas citizens tips on how to stay on adverse possession, some of which was used by people to keep their houses in the face of foreclosure. He says he started a paradigm shift by helping people keep their own or claim abandoned homes, which if they go into disrepair, can bring down the property value of surrounding homes. The website, he says, is to minimize the likely damage the media and others - such as some of his unsympathetic neighbors - would bring to him.

""They think some bum off the street came and paid $15 to get a $300,000 house by filing a piece of paperwork. That is not the case. That is the sum of what happened."

Adverse possession statutes can be found in most states, Brian C. Rider, a real estate lawyer and professor at the University of Texas. Someone who has openly taken charge of abandoned land for an extended period of time — using a driveway on a neighbor's property, for example — could try to claim that land later, he said.

Robinson hasn't been charged with a crime but police said they responded to several calls from his neighbors. One neighbor attended Monday's hearing and was smiling after the eviction was ordered.

"We're going to throw a party," he said.