Prostate Cancer in Maryland

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Prostate Cancer in Maryland

• Preliminary Report of the Prostate Cancer
  Committee

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Prostate Cancer Committee Members

• Donna Cox, co-chair,
  Johns Hopkins
• Katherine Farrell, MD, co-chair, Anne
  Arundel County Health Department
• Members
• THANK YOU!

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Prostate Cancer - Incidence

• Most common cancer among men (excluding skin
  cancer).
• 3,869 new prostate cancer cases diagnosed in MD
  in 1999.
• MDs incidence rate is significantly higher than
  U.S. incidence rate.

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Prostate Cancer - Incidence
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Prostate Cancer - Incidence
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Prostate Cancer - Mortality

• 574 men died of prostate cancer in MD in 1999.
• Prostate cancer is the 2nd leading cause of
  cancer death in MD and US.
• MDs prostate cancer death rate is significantly
  higher than US.
• MD has 10th highest prostate cancer mortality
  rate among states and D.C.

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Prostate Cancer - Mortality
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Prostate Cancer - Mortality
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Prostate Cancer Stage at Diagnosis

• Most (83) men are diagnosed at early stages
  (local or regional).
• (Source SEER, 1992 - 1997.)

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Prostate Cancer - Primary Prevention

• A diet high in fat may increase the risk of
  prostate cancer. (PDQ, 6/2002)
• Vitamin E and selenium may reduce the risk of
  prostate cancer, but studies have been
  inconsistent. (PDQ, 6/2002)
• Other agents (lycopene, Vitamin B, etc.) are
  being studied. (PDQ, 6/2002)
• Conclusion More research is needed.

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Prostate Cancer Screening Methods

• Prostate specific antigen (PSA) - blood test
• Digital rectal exam (DRE)

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Prostate Cancer - Screening

• 75 of men in Maryland have ever had a PSA
  test.
• 58 of men in Maryland report having a PSA test
  in the past year.
• (Source MD BRFSS, 1999.)

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Prostate Cancer Screening

• What we know
• PSA increases detection of prostate cancer.
• PSA increases detection of prostate cancer at
  earlier stages.
• What we dont know
• Whether screening decreases mortality.
• How to distinguish slow-growing, non-clinically
  significant tumors from clinically significant
  tumors.

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Prostate Cancer - Treatment Options for Early
Stage Disease

• Surgery (surgical removal of prostate gland)
• Definitive radiotherapy
• Watchful waiting

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Prostate Cancer Treatment - Issues

• Lack of consensus regarding optimal treatment for
  localized disease.
• Significant complications from treatment
• Complications from surgery
• Impotence (60-90)
• Urinary Incontinence (50 - 60)

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Informed Decision Making

• Because of the lack of certainty of the benefits
  of screening and the complications of treatment,
  INFORMED DECISION MAKING is recommended for
  patients - before screening for prostate
  cancer and - after a diagnosis of
  prostate cancer.

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Recommendations - Primary Prevention

• Increase public awareness of prostate cancer as a
  disease.
• Promote a healthy, active lifestyle as a general
  guide to good health.
• Interpret and translate research findings
  regarding primary prevention to the public.

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Recommendations - Secondary Prevention (Early
Detection)

• Promote informed decision making prior to
  screening with PSA and DRE.
• Convey benefits and risks of screening to health
  professionals, community leaders, the general
  public and men to be screened.
• Encourage documentation of informed consent prior
  to prostate cancer screening.

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Recommendations - Secondary Prevention (continued)

• Educate African American men and men with a
  family history of prostate cancer in a first
  degree relative about prostate cancer and what
  can be done about it.
• Increase awareness among health professionals of
  the Prostate Cancer Minimal Elements for
  Information, Screening, Diagnosis and Treatment
  developed by the Prostate Cancer Medical Advisory
  Committee of DHMH.

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Recommendations - Secondary Prevention (continued)

• Promote the use of the Minimal Elements document
  for all prostate cancer screenings which take
  place outside of a physicians office.

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Recommendations - Tertiary Prevention

• Educate men about prostate cancer treatment
  options, including watchful waiting.
• Educate men that they may seek a second opinion
  from various specialists after diagnosis
  regarding different treatment options.
• Educate men about their right to ask questions
  regarding the expertise of the provider in
  treating prostate cancer (e.g. number of
  procedures performed, complication rate, etc.).

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Recommendations - Tertiary Prevention (continued)

• Disseminate information about support groups and
  other supportive resources for men diagnosed with
  prostate cancer and their significant others.
• Encourage support for prostate cancer patients
  throughout treatment.
• Advocate for funding for treatment for uninsured
  men diagnosed with prostate cancer.

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Recommendations - Research

• Educate men about participation in clinical
  trials and observational research in all areas of
  prostate cancer.
• Increase prostate cancer research in all areas
  (primary, secondary, tertiary prevention)

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Recommendations - Research (continued)

• Encourage research into all aspects of prostate
  cancer. For example
• Risk factors for primary prevention.
• Whether screening reduces mortality.
• Which tumors need treatment vs. those that are
  not clinically significant.
• Biochemical failures after apparent cure.
• How culture affects screening and treatment
  decisions.