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Prostate Cancer in Maryland. Preliminary Report of the Prostate Cancer Committee. 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 in Maryland

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Prostate Cancer in Maryland

Preliminary Report of the Prostate Cancer Committee

Prostate Cancer Committee Members

  • Donna Cox, co-chair, Johns Hopkins

  • Katherine Farrell, MD, co-chair, Anne Arundel County Health Department

  • Members


Prostate Cancer - Incidence

  • Most common cancer among men (excluding skin cancer).

  • 3,869 new prostate cancer cases diagnosed in MD in 1999.

  • MD’s incidence rate is significantly higher than U.S. incidence rate.

Prostate Cancer - Incidence

Prostate Cancer - Incidence

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.

  • MD’s prostate cancer death rate is significantly higher than US.

  • MD has 10th highest prostate cancer mortality rate among states and D.C.

Prostate Cancer - Mortality

Prostate Cancer - Mortality

Prostate Cancer – Stage at Diagnosis

  • Most (83%) men are diagnosed at early stages (local or regional).

  • (Source: SEER, 1992 - 1997.)

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.

Prostate Cancer Screening Methods

  • Prostate specific antigen (PSA) - blood test

  • Digital rectal exam (DRE)

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.)

Prostate Cancer Screening

  • What we know

    • PSA increases detection of prostate cancer.

    • PSA increases detection of prostate cancer at earlier stages.

  • What we don’t know

    • Whether screening decreases mortality.

    • How to distinguish slow-growing, non-clinically significant tumors from clinically significant tumors.

Prostate Cancer - Treatment Options for Early Stage Disease

  • Surgery (surgical removal of prostate gland)

  • Definitive radiotherapy

  • “Watchful waiting”

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%)

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.

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.

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.

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.

Recommendations - Secondary Prevention (continued)

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

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.).

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.

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)

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.

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