September is Prostate Cancer Awareness Month. Prostate cancer is the most common cancer among men in the United States, after skin cancer. It is also the second leading cause of death from cancer in men. Data from the National Cancer Institute show that prostate cancer occurs more often in African-American men than in white men and that African-American men with the disease are more likely to die from it than their white counterparts.
According to the American Cancer Society, one in seven men will be diagnosed with prostate cancer in his lifetime. Some 233,000 new cases are diagnosed annually; Nearly 3 million U.S. men currently live with prostate cancer And ACS estimates that 27,540 will die from the disease in 2015. However, most men with prostate cancer — about two-thirds — are older than 65, and do not die from the disease but from other causes.
Finding and treating prostate cancer before symptoms occur may not improve health or help men live longer; nor does every diagnosis warrant intervention. In 2012, the U.S. Preventive Services Task Force recommended against routine prostate-specific antigen (PSA)-based screening for prostate cancer, concluding that the expected risks of PSA screening are greater than the potential benefit. These risks include false positives that can lead to unnecessary treatment, with serious side effects for what is typically a very slow-growing disease.
The task force found that treatment of the cancers found by the PSA test can have important, often lasting harms, such as erectile dysfunction (impotence) from surgery, radiation therapy or hormone therapy. Other potential harms are urinary incontinence from radiation therapy or surgery; problems with bowel control from radiation therapy; and a small risk of death and serious complications from surgery. Yet according to this New York Times story, older men still get PSA tests in spite of the USPSTF recommendations.
The American Cancer Society takes no position on treatment for low-risk prostate cancer in older males. They suggest that an informed decision be made by a patient in consultation with his provider. “The concerns are justified, but there are many misunderstandings about how often side effects occur, how severe they really are and what can be done to manage them and counteract their occurrence,” the Prostate Cancer Foundation website cautions. “Many of the side effects that men fear most following local treatment are often less frequent and severe than they might think.”
To add to the confusion, this article from Reviews in Urology points out that treating frail men over age 70 could deprive them of years of life. Aggressive treatment is not necessarily effective or appropriate, depending on a patient’s age, comorbidities, and type of cancer, this Medscape story points out.
For journalists covering prostate cancer, this list of prostate cancer organizations can help find expert sources and those who have been diagnosed. It could be interesting to compare those who opted for a particular treatment or combination therapy and those who did not. Check out this disease guide from The New York Times, which provides an excellent in-depth look at prostate cancer.
- Speak with an urologist at a local teaching hospital for insight into prostate cancer’s impact on your community. How does your city compare with national statistics?
- Some local facilities tout minimally invasive approaches like cyberknife, radioactive seed implants, high-intensity focused ultrasound, intensive lifestyle changes, hormone therapies or immunotherapy. How effective are they? What are the side effects? What is the cost compared with traditional approaches?
- There are also walks, runs and other local events that can provide opportunities to speak with men who were diagnosed, or their families.
UPDATE: Since posting, the American Cancer Society has clarified that their guidelines cover early detection, not treatment, and that informed decision making is part of early detection. They have no recommendation on treatment. The blog has been updated to reflect this.