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The Prostate Cancer Continuum. The Changing Face of Disparity: Taking Health into Our Own Hands. The real voyage of discovery consists not in seeking new landscapes but in having new eyes. - Marcel Proust. Pca is a Global Concern.

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the prostate cancer continuum
The Prostate Cancer Continuum
  • The Changing Face of Disparity:Taking Health into Our Own Hands
the real voyage of discovery consists not in seeking new landscapes but in having new eyes

The real voyage of discovery consists not in seeking new landscapes but in having new eyes.

- Marcel Proust

pca is a global concern
Pca is a Global Concern
  • Highest incidence of male cancer in U.S.; 2nd greatest cause of death; declining overall but increasing in minority populations(2)
  • #1 diagnosed cancer in Europe; deaths have increased by 16% since 1995(1) ”despite widespread use of PSA testing...”
        • Sources: (1) World Health Organization; (2) American Cancer Society
why we must be concerned
Why We Must Be Concerned
  • 1 in every 6 men get Prostate Cancer
  • 1 in every 4 Black men get Prostate Cancer
  • Latinos have the 3rd highest incidence rate
  • Blacks and Latinos are diagnosed at advanced disease stages at a 144% greater rate than whites
  • The 5 year survival rate for Blacks and Latinos is worse than for whites and getting worse
  • Black men die at a rate 240% higher than whites
national healthcare quality report 2007
National Healthcare Quality Report - 2007
  • “Preventive healthcare lags significantly behind other gains in healthcare.”
  • Access to care and information varied widely between racial/ethnic groups and by socio-economic status
          • Source:
u s world s best medical care new york times 12 august 2007
U.S. - World’s Best Medical Care? - New York Times, 12 August 2007
  • 37th in W.H.O. health system performance (France #1, Italy #2)
  • Last in overall quality: lack of coordination of care/access for preventive and critically ill
  • Only major industrialized country without universal health coverage
  • Life expectancies near the bottom of other industrialized nations
  • Worst Infant Mortality stats of any developed nation
          • Sources: Commonwealth Fund, Centers for Disease Control, W.H.O.
exacerbating the problem
Exacerbating the Problem
  • Increasing employee cost burden
  • Regulations on employers => increasing costs => decreasing competitiveness
  • Insurance compensation standards
  • Medicare reimbursement changes
american cancer society disparity study 2007
American Cancer Society Disparity Study - 2007
  • Cancer patients with private insurance are much more likely to be diagnosed early, increasing their long-term survival
  • Those uninsured patients or those with Government insurance are more likely to be diagnosed with advanced stage disease at first treatment
baby boom impact
“Baby Boom” Impact

Estimated Per Capita Health Expenditures

by Age and Sex, 1995

service provider impact
Service Provider Impact
  • Continuing nurse shortage
  • Resistance to greater use of nurse practitioners
  • Decline in doctors entering into Primary Care Medicine
  • Resistance to “Convenient Care” clinics
population impacts
Population Impacts
  • 12 million cancer survivors alive in the U.S. today
  • 3 out of 4 American families will have a family member diagnosed with cancer
  • 25% of American families living with cancer have children under the age of 18 living at home
  • More than 28% of children in America will be living in poor households
        • Sources: American Cancer Society, Institute of Medicine, World Health Organization, The Policy Press
treatment impact
Treatment Impact
  • Skeletal impacts of ADT
  • Cardiovascular issues related to hormone therapy
  • Conflicting preventive therapeutic recommendations
          • SELECT
          • Finasteride
          • PLCO Study
  • Emerging technologies with minimal curative benefit
  • Positive benefit of drug therapies
      • Targeted disease management
lifestyle impact
Lifestyle Impact
  • Meat becoming more popular in diets globally
      • 10.4% in the U.S.
      • 25% more in Korea
      • 49.7% in China
      • >2% in India
  • Higher birth weights in emerging countries
      • strong cancer association
          • Sources: Food & Agriculture Organization of the United Nations, AICR
business of medicine
Business of Medicine
  • The System often has other issues:
    • Equipment investment
    • Revenue production
    • Pharmaceutical alliances
    • Pay-for-Performance
  • Patients MUST become their own advocates
complicating the issue
Complicating the Issue
  • Women vs. Men
    • Comparable incidence and mortality
    • Research funds - 3X for breast cancer
    • Public health staffing - inconsistent
    • Government commitment - no agencies
    • Media focus - inordinately female focus
    • Men don’t communicate
why prostate cancer prevention
Why Prostate Cancer Prevention?
  • Significant public health risk
    • 186,000 new cases and 29,000 deaths yearly (2008)
  • Risk factors (age, race, genes) are not modifiable
  • Benefit of screening on mortality is controversial
  • Therapy is associated with morbidity

That Leaves Prevention

phase iii chemoprevention trials
Phase III Chemoprevention Trials

RRR = 22.5%

RRR = 23.5%



5aris for biochemical recurrence
5ARIs for Biochemical Recurrence

Andriole et al, Urology 45:491, 1995

pcpt and reduce what did we learn
PCPT and REDUCEWhat did we learn?
  • Consistency of effect
  • Similar magnitude of risk reduction across all risk groups
  • No longer any grade issues
  • Conclusion
    • Use of 5-alpha reductase inhibitors is an effective primary prevention strategy
healthcare disparity
Healthcare Disparity
  • Disaffected classes
      • racial/ethnic minorities
      • high risk populations
  • Socio-economic impact
      • lack of/limited insurance
      • breaking the “social contract”
  • Equal Access:
          • education
          • preventive mechanisms
          • care
Moving the Bar Forward:

Success Stories and Templates for Change

technology for change
Technology for Change
  • 71% of the people in North America are online
  • 113 million Americans seek health information online
  • Almost half of adult users and 84% of teens will be on social sites
  • 40% of self-classified “non-users” became direct or indirect users after a cancer diagnosis
          • Sources: Internet World Stats, Pew Internet & American Life Project
social network integration
Social Network Integration
  • Credible peer-to-peer communications
          • “New” Prostate Cancer Infolink
          • “Pints for Prostate”
          • Prostate Cancer Internet Alliance
          • FaceBook

Opciones de Tratamiento

Investigación Traslacional

Toma de Decisión Informada


Gleason 7: ¿Una Nueva Categoría de Riesgo?


Terapia Citotóxica

¿Está considerando un Ensayo Clínico?


Medicina Alternativa / Complementaria

Espera Alerta

Terapias de Ataque

Soluciones Quirúrgicas

Manejo de Efectos Colaterales

Soluciones Oncológicas de la Radiación

Cuidado Paliativo

Manejo del Dolor

Fuentes de Información

Servicios de asistencia pacientes

Este sitio se ha producido con la ayuda de la familia de Roberto "Tito" Warat y una concesión educativa de la oncología de Sanofi-Aventis

reinforcing the message
Reinforcing the Message
  • “In The Know” newsletter
  • Hard Copy - 29M circulation
  • Online supplement - > 100M
  • Broad spectrum content
  • Audience diversification
    • consumers/patients
    • advocates
    • professionals
    • researchers
    • international
media syndication
Media Syndication
  • Mass impressions
  • Minimal cost
  • Increase reach

PodCasting for Health

  • Reinforce the print message
  • Portability for consumers
  • Viability for diverse situations:
  • personal
  • public health
  • clinical
  • research

Cell Casting for Health

  • Enhanced consumer interactivity
  • Opt-in network
  • 1.877.2CHECKNOW
  • Customized content
  • Applications for:
  • clinicians
  • researchers
  • public health
barbershop based health awareness initiative
Barbershop based Health Awareness Initiative
  • Project BHAI (Brother):
      • 48 shops in Jharkhand and Orissa Provinces - India
      • cancer prevention and tobacco control
          • enhance knowledge
          • enhance healthy behavior
          • create a sustainable environment
          • build on existing networks and partnerships
          • expand to co-morbid disease
creating a new network
Creating a New Network

The Prostate Net

Core Distribution:

80,000+ Website visits/month

1,200 Patient Support Group Leaders

1,000+ Public Health Workers

~ 6,000 Medical Oncologists

> 4,000 Urological Specialists

> 2,000 Cancer Researchers




> 5,000 Doctors





> 300

National Ass’n.

of Barber Boards

of America

~ 200,000 Barbers


create heroes
Create Heroes
  • Meet James
  • He came to a Health Fair
  • To give himself The Gift of Life!!
  • Warren brought his son to a Pca screening
  • To educate him about being responsible for his health

Why is all this needed?!

To Eliminate the Suffering and Death from Cancer

“If You’re Not the Lead Dog, the View Never Changes”

- Mike Ditka

thank you
Thank You!