Black Men Both Get And Die From Prostate Cancer At A Higher Rate The Reasons Are Complex And Not Fully Understood
Black men are 50% more likely to develop prostate cancer in their lifetime and twice as likely to die from the disease. Vincent Laudone, MSKs Chief of Surgery at the Josie Robertson Surgery Center, explains that there are many factors that can increase the risk and worsen the outcome of prostate cancer not just being of African descent. These include age, family history, smoking, limited physical activity, and obesity.
The higher risk may be related to social and environmental issues involving nutrition, access to health care, and exposure to environmental pollutants, he says. Disparities in outcomes also can be affected by differences in when the cancer is diagnosed and how the men are treated after diagnosis.
Additionally, prostate cancer in Black men may have biological characteristics associated with more aggressive disease. There is evidence suggesting that this is partly related to inherited genetic factors, says medical oncologist Andrew Laccetti. There may be differences in tumor biology that cause this cancer in Black men to progress faster or be harder to treat, but we need to investigate this possibility further to learn more.
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The authors performed a multivariable analysis to identify factors associated with treatment regret. They found that moderate or substantial sexual dysfunction was the most commonly cited factor associated with decision regret, mentioned by 39 percent of men with regret. The only other significant factors were moderate or substantial bowel function bother, and concerns about rising PSA levels.
Older age at cancer diagnosis and informed treatment decision making had inverse associations with regret, the authors reported.
This story was originally published by MedPage Today. Hoffman disclosed no relevant relationships with industry. One or more co-authors disclosed relationships with Blue Cros & Blue Shield, Astellas, Dendreon, Medivation, and royalty/patent interests.
Study Finds 15 Percent Of Men With Normal Psa Had Prostate Cancer
Shared by Will Sansom
San Antonio Some men who have received good marks on the prostate-specific antigen test from their physicians may be getting a false sense of confidence about not having prostate cancer, according to a study released May 27 in The New England Journal of Medicine.
The results of the Prostate Cancer Prevention Trial were announced last June in Washington, D.C. Additional information gleaned from this study has enabled researchers to study the risk of prostate cancer in men who had what physicians consider normal PSA scores under 4.0 nanograms per milliliter . Of 2,950 men who throughout the trial always had PSA scores below 4.0, a surprising 15 percent had prostate cancer. Not only that, 67 of the men had high-grade cancers, the type of cancer that poses the greatest risk.
There are many men who have been told that, based on their PSA score, they dont have prostate cancer, said lead author Ian M. Thompson Jr., M.D., professor of surgery and chief of urology at The University of Texas Health Science Center at San Antonio, one of the institutions that participated in the PCPT. Based on this study, we now know they have a substantial risk of cancer and some can have high-grade disease. Waiting for a PSA level to go above 4.0 may be too late in some men.
The number of U.S. men who have been told they have normal PSA readings is estimated at 25 million to 35 million, researchers said.
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The findings leave little doubt about the importance of informed decision making and the need for physician-patient discussions prior to deciding a course of action for early-stage prostate cancer, said Dr. Otis Brawley, chief medical officer for the American Cancer Society in Atlanta.
I think that this whole paper is a huge cry that we need to make sure that people are informed and are taking part in their treatment decisions, Brawley told MedPage Today.
The lower rate of regret among men on active surveillance might also reflect on the informed decision-making process, although the study did not specifically examine that issue, he added.
In the United States, its almost impossible to put someone on observation, after you have told them they have cancer, and not inform them, the way I think someone should be informed, said Brawley. Its very easy to tell someone you have cancer and were going to do a radical prostatectomy next Monday and not inform them. It may very well be that the people who got observation were more fully or better informed and better understood what they were facing, compared with the people who got aggressive therapy.
A study reported earlier this year reinforced the need for informed decision making based on physician-patient discussions about treatment options. The study showed high rates of regret among men who relied primarily on internet-based information about prostate cancer treatment to decide how their own disease should be treated.
Diagnosis And Treatment Of Prostate Cancer
JOHN NAITOH, M.D., University of California, Los Angeles, School of Medicine, Los Angeles, California
REBECCA L. ZEINER, M.D., Southern California Kaiser Permanente Medical Group, West Los Angeles, California
JEAN B. DEKERNION, M.D., University of California, Los Angeles, School of Medicine, Los Angeles, California
Am Fam Physician. 1998 Apr 1 57:1531-1539.
Prostate cancer is second only to lung cancer as the leading cause of cancer deaths in American men. In 1997, approximately 209,900 new cases of prostate cancer were diagnosed, and more than 41,800 deaths were attributed to this malignancy.1 At present, chemotherapy and immunotherapy cannot cure prostate cancer once it has spread beyond the gland. Therefore, curative treatment for localized tumors may be the best hope of lowering the mortality rate for prostate cancer.1 According to this viewpoint, the primary focus of prostate cancer management should be the detection and aggressive treatment of tumors while they are still confined to the prostate.
The controversial aspects of prostate cancer screening are reviewed in this article. An attempt is also made to identify the patient groups that definitely would benefit from prostate cancer screening. Current treatment approaches for tumors confined to the prostate are also reviewed.
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Prostate Cancer In Central America/caribbean
Among the Central American countries, Costa Rica leads with an ASR of 53.8 cases per 100,000 people, followed by Mexico and Cuba with 28.9 and 24.3 cases per 100,000 people respectively . Unfortunately, epidemiological data are scarse for those regions. Trends are available only for Costa Rica which showed an annual increase in incidence of 3.8% per annum over the period 19972008. ASR on mortality put Belize at first place with 28.9 cases per 100,000 people followed by Cuba and Mexico with 24.1 and 17.0 cases per 100,000 people for the period 20032010, respectively. Costa Rica stops at 14.8 cases per 100,000 people . The most recent data on Central America published by GLOBOCAN 2020 shows an ASR incidence of 43.8 and mortality of 11.0 cases per 100,000 people . No active screening program are currently in place in Central America. Between 2004 and 2006, in Monterrey a screening program was run, using PSA and DRE screening of 973 men, 40 years of age, showed that only 44% of the men who had an abnormal result underwent prostate biopsy, and 27% of these were diagnosed with prostate cancer, mostly with high grade lesions .
Prostate Cancer In Us Hispanic Men
Hispanic Heritage Month runs from September 15 to October 15. Below, Dr. Scarlett Gomez, a professor of epidemiology and biostatistics at the University of California, San Francisco, and an expert on cancer disparities, describes how prostate cancer is affecting Hispanic/Latino men.
- Prostate cancer remains a significant burden for Hispanic/Latino men in the U.S.
- Hispanic/Latino men may have barriers to prostate cancer screening. They are less likely to have a regular doctor and may not have access to educational materials about prostate cancer and PSA screening in their preferred language.
- When they are diagnosed, Hispanic/Latino men may be less likely to receive optimal treatment.
- Research has identified many of the reasons for these gaps in care, and they can be addressed.
PCF remains committed to identifying and overcoming disparities in prostate cancer care. PCF researchers are leading efforts to define the genetics of prostate cancer risk in Latino men and strategies to increase recruitment of minorities, including Spanish-speaking patients, into prostate cancer clinical trials.
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How To Find Out If You Have Prostate Cancer
Ah, the dreaded, stigmatized prostate exam: a necessity for every man over 50. As weve learned, an symptom of prostate cancer is an enlarged prostate, so the main way doctors test for it is by feeling the prostate. Formally called a digital rectal exam, doctors place a lubricated finger, covered with a glove, up your rectum and feel for the prostate, which is right next to the rectum. The doctor feels for any abnormalities, like if its larger than it should be, feels different than it should, or the shape of it is different. But a DRE is not the be-all, end-all of prostate tests. There are plenty of tests doctors run to confirm a diagnosis. These tests include:
Who Gets Prostate Cancer
Prostate cancer develops mostly in older men.1 It is extremely rare for it to be diagnosed before age 45. Just under 10 percent of cases are diagnosed between ages 45 and 54. Over 70 percent of diagnoses occur between 55 and 74. Less than 20 percent of cases are diagnosed at age 75 or older.1
African American men have the highest rates of prostate cancer, followed by Caucasian, Hispanic, Asian/Pacific Islander, and Native American men. African American men also tend to get more aggressive prostate cancer compared to Caucasian men.
Black men in the Caribbean and Europe also have higher rates compared to their neighbors. However, men living in Africa have much lower rates. This suggests that both genes and environment play a role in who gets prostate cancer.1,4
New cases of prostate cancer peaked in the 1990s and began to decline after 2010. Five year survival rates have improved from 66 percent in 1975 to 99 percent in 2011, and continue to decline. Scientists believe the wide-spread use of PSA tests are catching cancer earlier and treatments have improved.1,4
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Which Age Groups Have The Highest Incidence Of Prostate Cancer
Prostate cancer incidence increases as men age as many as 60% of men over 65 years of age may be diagnosed with prostate cancer. Prostate cancer is most often diagnosed in men aged 65-74 years median age at diagnosis is 66 years.
However, men as young as 17 years are experiencing an increasing incidence of prostate cancer in much of the world, including the United States, according to data from the Surveillance, Epidemiology, and End Results program and the Institute for Health Metrics and Evaluation Global Burden of Disease database. These younger patients frequently present with more advanced cancer and have worse survival than middle-aged and older men. Worldwide, the incidence of prostate cancer has increased in men ages 15 to 40 years at a steady rate averaging 2% per year since 1990. In the United States, this age group was more than 6 times more likely than older men to have distant disease at diagnosis.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov. 68 :394-424. .
American Cancer Society. Cancer Facts & Figures 2021. Available at . Accessed: February 2, 2021.
Komyakov BK, Sergeev AV, Fadeev VA, et al. . Urologiia. 2017 Sep. 42-5. .
Preventing The Fear Factor
I have written many blogs on lifestyle factors that experts consider worthwhile for reducing PCa risk: diet, exercise, stress management, and a supportive social network with positive family/friend relationships. In fact, an interesting longevity study demonstrated that modifiable lifestyle factors can help men over age 70 live to an even riper old age with good health.
The 2008 study was titled Exceptional longevity in men: modifiable factors associated with survival and function to age 90 years. The research team used data from the Physicians Health Study . These were records on 2357 healthy men, average age 72 at the time of their enrollment. Based on their baseline physical health and lifestyle compared with their self-report and medical records 16 years later, 41% survived to at least age 90! The study showed that
a 70-year-old man has a 54% chance of reaching the age of 90 if he does not smoke or have diabetes, has healthy weight and blood pressure, and exercises. But cutting out exercise and becoming more sedentary reduces the chances of reaching 90 to 44%. The chances dropped further with high blood pressure , obesity and smoking . Any three of these cut the chances of living to 90 to 14%.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
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Symptoms Of Prostate Cancer
Now that we know what prostate cancer is, how can we tell if we have it aside from being tested regularly? A lot of the symptoms of the disease have to do with discomfort while urinating while ejaculating. According to the Prostate Cancer Foundation, these can include:
- Blood in your urine
- Frequently having to urinate especially at night and not being able to hold it back
- Pain while urinating
- Trouble getting and maintaining an erection
- Loss of control of your bladder and bowels
- Pain in your hips, back, spine, and other parts of your body close to your prostate, indicating the cancer may have spread
- Pressure in your rectum
In its earliest stages, none of these symptoms may be present, which is why its important to get ahead of the disease with testing.
Clues In Diet And Lifestyle
To clarify the prognosis for a tumor, HSPH researchers are homing in on other factors that might affect susceptibility to prostate cancer, especially the aggressive form of the disease. Edward Giovannucci, professor of nutrition and epidemiology, recently looked at nine diet and lifestyle factors. He found that smoking, obesity, and lack of physical activity raise the risk of developing a more virulent cancer. According to Giovannucci, The question is whether there are two types of prostate canceran aggressive and nonaggressive formor whether certain factors cause a nonaggressive form to become more aggressive. Evidence provided by HSPH researchers suggests that an increase in insulin in the bloodstream, caused by obesity and physical inactivity, may encourage tumor growth.
Other investigations have linked dietary factors to the disease. A 2011 study by HSPH research associate Kathryn Wilson, together with Mucci and Giovannucci, professor of nutrition and epidemiology Meir Stampfer, and other colleagues, found that men who drank coffee had a notably lower risk of aggressive prostate cancer. Those who consumed six cups or more a day were 20 percent less likely to develop any form of the disease, and 60 percent less likely to develop a lethal disease those who consumed one to three cups a day showed no difference in developing any form of the disease, but had a 30 percent lower risk of developing a lethal form.
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Why Is There Increasing Concern At This Time Regarding Erectile Dysfunction Issues Following Radical Prostatectomy
The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.
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Are You At Risk
In the UK, about 1 in 8 men will get prostate cancer in their lifetime.
Prostate cancer mainly affects men over 50, and your risk increases with age. The risk is even higher for black men and men with a family history of prostate cancer.
Find out more about your risk.
See and share our infographic on prostate cancer risk.
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Are Older Men Undertreated
Schwartz and colleagues44 reviewed the treatment decisions and factors influencing them in a cohort of men with localized prostate cancer. Age, comorbidity, and Gleason score were found to be independent predictors of suboptimal treatment. It was concluded that most men older than 70 years with moderately or poorly differentiated tumors and no to mild comorbidity were given suboptimal treatment. Most of these men were undertreated, receiving watchful waiting therapy when potentially curative therapy could have been applied. With optimal treatment, clinical outcomes could have been improved.
Thompson and colleagues46 investigated otherwise healthy octogenarians diagnosed with prostate cancer who underwent radical prostatectomy. At the last follow-up visit, 10 patients had survived more than a decade after surgery, and 3 patients had died within 10 years of surgery. The remaining 6 patients were alive at less than 10 years of follow-up. Seventy-four percent of patients were continent. No patient had died of prostate cancer, and the 10-year, all-cause survival rate was similar to that observed in healthy patients 60 to 79 years old undergoing radical prostatectomy. These findings indicate that careful selection of patients even older than 80 years can achieve satisfactory oncologic and functional outcomes after surgery. It is important to note, however, that the rate of urinary incontinence after surgery exceeds that of younger counterparts.