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New guidelines may reduce prostate cancer mortality rate

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HEALTH TOPICS

September is Prostate Cancer Awareness Month. With an estimated 240,000 new cases of prostate cancer diagnosed and about 25,000 prostate cancer-related deaths a year in the United States, awareness of the disease is important if early diagnosis with timely, proper treatment for cure of the disease is to be achieved.

About a year ago, prostate cancer screening became a topic of some controversy. The issue is whether benefits outweigh the risks and whether screenings reduce the mortality rate of patients with prostate cancer, compared to those who are not screened.

"A research group in the Netherlands reported a 20 percent reduction of deaths for those who were screened compared to those not screened. In a recent report in AUA Daily Scope, a research group, headed by Dr. Jonas Hugosson, MD, of die Department of Urology at the University of Gothenburg, Sweden, reported screening men between 50 and 69 years reduced prostate cancer mortality by half during a follow-up period of 14 years. This is the best mortality result ever seen with prostatic-specific antigen (PSA), a blood test used in the screening process.

There are certain factors that increase the chance of developing a disease such as cancer. These are called risk factors. It is important for men to know about risk factors so they can try to change any unhealthy lifestyle behaviors or can choose to have the detection tests for cancer. Although the definite cause of prostate cancer is not clearly understood, researchers have - found several factors that increase the risk in the development of the disease.

The following are believed to be risk factors:

Age - The chance of having prostate cancer increases after age 50. About two thirds of prostate cancer is diagnosed in men over the age of 65.

Race - Prostate cancer occurs about 60 percent more often in African-American men than in white men. The black males are also more likely to be diagnosed at an advanced stage and twice as likely to die of prostate cancer as white men. The reason is unclear.

Family history - Having a father or brother with prostate cancer more than doubles a man's risk of developing the disease.

Diet - Men who eat a lot of red meat and high-fat products have a slightly higher chance of developing prostate cancer. On the other hand, certain foods -including lycopens, found in some fruits and vegetables such as tomatoes, pink grapefruits and watermelon - vitamins D and E, and selenium may lower prostate cancer risk. In a recent report in the AUA Daily Scope, green tea compound may help lower prostate cancer risk. It is believed that it lowers the level of proteins connected to the growth and spread of prostate cancer.

The recommended age to start screening was 50 years except for those with a family history of prostate cancer and African-Americans, who should start at age 40. However, at the recent 104th Annual Meeting of the American Urological Association (AUA), an updated best-practice statement calls for offering early detection of and risk assessment for prostate cancer to all men at age 40 with an estimated life expectancy of more than 10 years.

According to the AUA panel that issued the statement, men as young as age 40 years with PSA levels above the age-appropriate median are at greater risk of developing prostate cancer. Determining a baseline PSA level would help physicians and patients develop a strategy for monitoring prostate cancer risk.

Depending on the baseline reading, such a strategy involves annual PSA testing and digital rectal examination for men who are at above-average risk and less frequent testing for men at below-average risk. Part of the rationale is that younger men are more likely to have curable cancers, and the PSA is a more specific test in this segment of the population. Also, earlier and less frequent testing based on men having lower than median PSA levels might reduce healthcare costs.

Like most cancer, prostate cancer is curable if it is diagnosed in its early stage, localized and treated appropriately. Prostate cancer screening can detect early disease and potentially decrease mortality and morbidity.

Dr. Rafael A. Zaragoza, MD, FACS, is an associate urologist in practice with Dr. R.U. Hosmane, MD, FRCS, in Lewes. He is the chairman of the Bayhealth Medical Center Prostate Cancer Awareness Program. For more information, call 645-2274.





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