We are looking for volunteers to evaluate the effectiveness of UK Prostate Link and other websites as a source of information for prostate cancer.

We want to study in detail how people search websites for prostate cancer information, and how useful they find the information they find.

This will involve us capturing your thoughts and comments on various websites in "real time" while you search them. We will also ask about your experiences of finding prostate cancer information on the internet generally.

Our findings will be written up and shared with the signatories of the Prostate Cancer Charter for Action (www.prostatecharter.org.uk).  Individual contributions will be anonymised.

The sessions will take place on the 12th-13th January in central Oxford.  They will last no more than 2 hours.

All volunteers will receive £50 as a thank you gesture and reimbursed travel expenses.

If you can’t make it along to one of these sessions you can still let us know what you think by completing this questionnaire.

We would particularly welcome help from the following groups:

• Patients with an early prostate cancer diagnosis
• Patients with advanced disease
• Family and friends of prostate cancer sufferers
• General Practitioners
• Specialist Nurses
• Urologists
• Oncologists

Further information

For further information please contact:

Emily Withington, 01865 727876, talk@minervation.com

Please register your interest by Friday 11th December

CancerHelp is one of the (if not the) most important websites for patient information about cancer.  The site contains many thousands of pages about all aspects of all types of cancer.

It also comes with the backing of the UK's biggest cancer charity - Cancer Research UK.  It is not surprising, therefore, that the site receives many millions of hits every month.

One of the things we always liked about this site was its simple, plain format.  There is very little extraneous information on the page, and users are not impeded by unnecessary graphics or promotional material.

Therefore, when we heard the site had been redesigned to bring it into line with the CRUK brand identity, we wondered whether some of this simplicity would be lost.

We needn't have worried:  the new site succeeds in style. 

• Visit the new CancerHelp UK website
• View CancerHelp UK information on UK Prostate Link

• Take the online survey

As part of our ongoing evaluation of this website, UK Prostate Link has created a short survey to identify unmet information needs in prostate cancer.

We'd also like to recruit some people to take part in face-to-face testing of various websites, including prostate link.  We want to study in depth what makes these websites useful (or otherwise) and how they can be improved.

We'll share the results with our funders - the Department of Health and the Prostate Cancer Charter for Action - to ensure that your needs are shared as widely as possible.

What you can do to help

• Firstly, take our online survey and tell us what you think.  It's short!  It'll only take ten minutes.
• Secondly, get in touch if you would be interested in taking part in a face-to-face test of several different prostate cancer websites.  Although surveys are useful, you can't beat empirical data about how people search for prostate cancer information, and how they use different websites.
  

A recent systematic review from The Cochrane Library summarises all of the published evidence for green tea in preventing cancer.

A systematic review is a rigorous attempt to find, evaluate and combine all of the research on a topic.  The great thing about systematic reviews is that they can, potentially, find a definitive answer to a question, where individual studies often prove inconclusive.

The main limitation of this particular systematic review is its very broad scope, encompassing all types of cancer.  It is questionable whether any summarised answer would be applicable to individual cancer types.

The reviews only found one clinical trial on prostate cancer, and it was focused on men with prostatic intraepithelial neoplasia (PIN).  It found that only one of the men in the study who took green tea went on to develop prostate cancer compared with nine of the men who were in the control group.  In spite of the small samples size (60), this was a statistically significant benefit.

The reviewers concluded:  "The evidence that the consumption of green tea might reduce the risk of cancer was conflicting. This means, that drinking green tea remains unproven in cancer prevention, but appears to be safe at moderate, regular and habitual use."

Links:

• Green tea (Camellia sinensis) for the prevention of cancer (Cochrane Library)
• Information about prostatic intraepithelial neoplasia (PIN) from UK Prostate Link
• Information about preventing prostate cancer from UK Prostate Link
  

It is broadly recognised that the PSA test is not an ideal screening test for prostate cancer.  Some new research enables us to be more specific about exactly how useful it is, or isn't.

A team of Swedish researchers studied 1,500 men who had been given a PSA screening test prior to developing any prostate cancer symptoms. They then looked at the proportion of men developing prostate cancer afterwards. 

They found that the PSA performed poorly when used as a screening instrument to predict subsequent prostate disease.  This was the case for PSA "cut-off" (threshold) values of 3, 4 or 5 ng/ml.

Making sense of this paper depends on understanding a bit about how diagnostic tests are evaluated.

The first thing to realise is that few tests are 100% accurate all the time.  PSA is one such test.  You may have a raised PSA and not have prostate cancer;  conversely, you may have a low PSA yet still go on to develop prostate cancer. 

The key question is "what is the likelihood that a man with a given PSA test result will go on to develop prostate cancer"?

Getting to grips with the numbers

The study presented its results as "likelihood ratios".  A likelihood ratio tells you how much more likely the disease is given a particular test result. For example, if a PSA test result of 4ng/ml or higher had a likelihood ratio of 2 it would mean that men with this PSA score would be twice as likely to develop prostate cancer as men with a lower score.

To put things in perspective, a test is usually considered to "rule out" a disease if a negative result has a likelihood ratio of 0.1 or less. It is considered to be good at ruling in the disease if its likelihood ratio is 10 or more. 

In this study, the authors found that the likelihood ratios for ruling in or ruling out prostate cancer lay in between this range, meaning that the PSA test on its own is not definitive enough to act as a screening instrument.

• Read more about likelihood ratios and diagnostic tests on the Agency for Health Care Research and Quality (AHRQ) website.

Links

• British Medical Journal: Holstrom et al, Prostate specific antigen for early detection of prostate cancer: longitudinal study BMJ 2009, 339:b3537. [Full text]
• Comment from The Prostate Cancer Charity
• More about prostate cancer screening on UK Prostate Link
• More about the PSA test on UK Prostate Link

Healthy Eating: The Prostate Care Cookbook received considerable press coverage last week.

It's always good to see practical advice on how to have a healthy diet.  However, we note the authors' claim that "a controlled diet can provide the most effective form of treatment".  NHS Choices points out that there is no clear evidence to support this claim.

The media coverage is also variable.  For example,  the Independent quotes the authors' more sober statement that "Some of the evidence is very flimsy ...[but] on the other hand the principle is that there is nothing here that is going to do you any harm."

Find out more

• The Prostate Care Cookbook from the Prostate Cancer Research Foundation
• News story in The Independent
  
• NHS Choices' Behind the Headlines review
• Information about diet as a risk factor for prostate cancer and prostate cancer prevention
  

We recently received an enquiry from a man who had previously received the male hormone testosterone as a treatment for a disease and has now been diagnosed with prostate cancer.

His concern was whether that treatment could have caused his prostate cancer.

We know that testosterone is linked to prostate cancer;  hormone therapy aims to reduce or eliminate the action of the male hormone testosterone, for example. 

However, we don't yet know the exact nature of the link.  A recent summary of the evidence by the US National Cancer Institute shows that there is conflicting evidence of a link between testosterone levels and risk of prostate cancer.  They concluded that there is no evidence for using testosterone levels in the blood as a basis for estimating a person's risk of getting prostate cancer.

We also note a review by the UK Centre for Reviews and Dissemination, which looked at the risk of getting prostate cancer after having received testosterone treatment.  They found no evidence of increased risk of prostate cancer after testosterone treatment for hypogonadism.