A Larger Conversation On Health Disparities
Factors leading to health disparities for prostate cancer in African Americans include stress, income, lifestyle and poor diet. Biological differences and medical access also contribute.
Prostate cancer is diagnosed in about 164,000 American men every year. It kills about 29,000 a year, according to the American Cancer Society. And African American men have about a 15 percent chance of developing prostate cancer in their lifetimes, compared to about a 10 percent chance for white men, according to the National Institutes of Health.
Previous studies most notably the SEER trial have shown that African American men have the highest rates of new prostate cancer diagnoses and are twice as likely to die from the disease as white men. Although this disparity is nothing new, researchers have been unable to provide concrete answers as to why it exists.
While the new JAMA Oncology study does not answer the question of why black men develop prostate cancer more often than white men, it does highlight several factors that black men should be aware of when addressing their health.
Final Datasets And Best Estimate Of Lifetime Risk
The all ethnicity-combined lifetime risk calculations confirmed the need to account for the discrepancy in overall number of deaths between the PHE-supplied and the ONS data. Lifetime risk calculations, by ethnic group, were therefore conducted using two sets of mortality data: the PHE mortality data as supplied and the PHE data with the additional ONS deaths included . This second dataset, however, further compounded the issue of unknown ethnicity as any additional mortality counts from ONS lacked an ethnic classification. Table shows the effect that the different sources of data and methods of assigning ethnicity had on the number of prostate cancer incident cases, prostate cancer deaths, and all-cause deaths by ethnic group. Irrespective of the method used, the majority of the incident cases and deaths were assigned to the White category, as the majority of the population, and therefore also of the known cases, were White. When including the additional deaths from the ONS data , the number of all-cause deaths with unknown ethnicity increased from 34,839 to 147,573 .
Although this study is based on data from England only , the results can be assumed to be representative of men across the United Kingdom, as in the PROCESS study .
The full dataset of raw and manipulated data can be found in Additional file .
Da Vinci Robotic Surgery: A Less Invasive Surgical Procedure:
If surgery is the recommended prostate cancer treatment, a da Vinci Robotic Surgery, a less-invasive surgical procedure called robotic prostate surgery may be the right option. Robotic surgery incorporates a state-of-the-art surgical system which enables a precise surgical procedure with reduced risks, minimal side-effects, and quick recovery time for patients.
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Prostate Cancer Survival Rates Are Favorable Overall
Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.
To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides what’s called the relative survival rate for prostate cancer.
Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, we’re not counting men with prostate cancer who die of other causes:
- 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
- Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.
Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:
- the relative 10-year survival rate is 98%
- the relative 15-year survival rate is 96%
When You Quit Smoking Your Body Starts To Heal And Your Risk Of Being Cured Of Localized Prostate Cancer Goes Way Up
Platz puts it bluntly: Smoking is a risk factor for prostate cancer death. If you start with a group of men who dont have a diagnosis of prostate cancer, and they smoke, in the future theyre more likely to die of prostate cancer. Men who have prostate cancer, if they continue to smoke, are more likely to die of prostate cancer. Men who have been treated for prostate cancer, if they keep smoking, are more likely to die. Even if they had surgery, the cancer is more likely to recur.
Platz and other scientists know the connection between smoking and prostate cancer is powerful, but they dont know exactly why and how smoking makes the body so susceptible to lethal prostate cancer. The reason why more is not known about the mechanisms at work here, frankly, is that nobody cares about smoking anymore even though it accounts for most of the cancers in the United States and it really does explain a chunk of prostate cancer deaths. Smoking-related research funding is harder to come by. It seems like its an old story, so no one wants to talk about it anymore, despite it being so important: Smoking causes premature births, causes lung cancer, causes heart attacks, causes so many bad things.
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The bottom line: At any point in your life, if you stop smoking, you are less likely to die of prostate cancer.
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Prostate Cancer Its More About Living Well With The Disease Than The Risk Of Dying From It
Maintaining a good quality of life with the disease requires early detection and appropriate treatment
Prostate cancer affects one in eight men over the age of 50, impacting their life over time. However, unlike with many other types of cancer, most men diagnosed with prostate cancer do not die from the disease. This being the case, the detection and appropriate treatment of prostate cancer is primarily aimed at living better with the disease, rather than avoiding mortality. So, knowing this, how can men live better with a prostate cancer diagnosis? The answer includes the fact that the earlier a cancer is detected, the more options there are to minimize the progression of the disease and reduce the impact it has on the quality of a mans life.
Lets start before prostate cancer is even detected. Maintaining a well-balanced diet, keeping ones weight in check, reducing alcohol consumption and avoiding smoking, are all key to an overall healthy lifestyle. Regular exercise, while also a part of any wellness regime, has a specific benefit for prostate health. Prostate cancer reacts strongly to steroids in the body, and regular exercise helps to stabilize steroid levels by counterbalancing the everyday stresses that flood the body with adrenaline.
Understanding the warning signs is key. For example, any urinary disfunction exhibited after the age of 50 should be a signal to have a clinical visit with a urologist these specialists are very adept at detection.
Processed And Red Meat
Eating red and processed meat increases your risk of some types of cancer. We don’t know if it increases the risk of prostate cancer. Red meat includes beef, pork, lamb or goat. Processed meat includes ham, bacon and other cured or preserved meats.
The World Cancer Research Fund recommends eating no more than 500g of cooked red meat per week , and avoiding processed meat. A medium portion of cooked roast beef is usually about 90g and a medium cooked steak is 145g.
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Risk Of Mace Similar With Degarelix And Leuprolide In Prostate Cancer
Degarelix did not reduce the risk of major adverse cardiovascular events when compared with leuprolide in patients with prostate cancer and cardiovascular disease, according to a real-world study published in JAMA Network Open.
Researchers used electronic health record and administrative claims data to emulate the ongoing PRONOUNCE trial and compare the cardiovascular safety of degarelix and leuprolide.
The study included 7800 patients with prostate cancer and cardiovascular disease who were receiving degarelix or leuprolide and met eligibility criteria for PRONOUNCE.
After propensity-scored matching, 1113 patients each received degarelix and leuprolide. For both groups together, the median age was 76 years , 69.9% of patients were White, and the median Charlson comorbidity index score was 5 .
The researchers found no significant difference in the risk of MACE between the 2 groups. The event rate for MACE, per 100 person-years, was 10.18 in the degarelix group and 8.6 in the leuprolide group .
Similarly, there were no significant differences between the groups when it came to myocardial infarction , stroke , or angina .
However, there was a significantly higher risk of death from any cause with degarelix. The death rate, per 100 person-years, was 7.43 in the degarelix group and 4.99 in the leuprolide group .
Reference
Prostate Cancer: What’s Your Risk
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Images: Thinkstock Prostate cancer risk statistics can be misleading. Although 15% of American men will be diagnosed in their lifetimes with prostate cancer, 3% of all men will actually die because of the disease. |
Age, family history, and race are the main influences.
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- Find the best treatments and procedures for you
- Explore options for better nutrition and exercise
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Whos At Risk For Prostate Cancer
All men are at risk of having prostate cancer. About one man in nine will be diagnosed with it during their lifetime, but only one in 39 will die of this disease. About 80% of men who reach age 80 have cancer cells in their prostate. Besides being male, there are other things that contribute to the risk.
Regular Aspirin Use May Reduce Risk Of Dying From Prostate Cancer
A large observational study has found that men who take aspirin regularly may have a lower risk of dying from prostate cancer.
Men who took aspirin regularly after their prostate cancer diagnosis were less likely to die from the disease.
However, aspirin did not affect the overall incidence of prostate cancer.
It is premature to recommend aspirin for prevention of lethal prostate cancer, butmen with prostate cancer who may already benefit from aspirins cardiovascular effects could have one more reason to consider regular aspirin use, said lead study author Christopher Brian Allard, MD, Urologic Oncology Fellow at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, Massachusetts.
When discussing potential benefits of aspirin with their doctors, in terms of both cardiovascular health and risk of prostate cancer death, men should also consider potential risks of regular aspirin use.
Many studies have looked at medications and supplements that help reduce the risk of death from prostate cancer among healthy men or prolong survival of men with prostate cancer.
Prior studies on aspirin and prostate cancer prevention have reported conflicting findings.
According to the authors, this is the first study to specifically focus on prevention of lethal cancer, clarifying the role aspirin may play in prevention of advanced disease.
The researchers analysed data from 22,071 men enrolled in the Physicians Health Study.
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Death From Other Causes
The mean age at metastatic prostate cancer diagnosis in the study was roughly 71 years. Most of the cohort was White and had a diagnosis of stage M1b metastatic prostate cancer , which means the cancer had spread to the bones.
Among men in the cohort, the rates of death from septicemia, suicide, accidents, COPD, and cerebrovascular diseases were significantly increased compared with the general US male population, the team observes.
Thus, the study authors were concerned with not only with death from metastatic prostate cancer, but death from other causes.
That concern is rooted in the established fact that there is now improved survival among patients with prostate cancer in the US, including among men with advanced disease. “Patients tend to live long enough after a prostate cancer diagnosis for noncancer-related comorbidities to be associated with their overall survival,” they write.
The editorialists agree: prostate cancer “has a high long-term survival rate compared with almost all other cancer types and signals the need for greater holistic care for patients.”
As noted above, cardiovascular diseases were the most common cause of non-prostate cancer-related deaths in the new study.
As in the management of other cancers, there is concern among clinicians and researchers about the cardiotoxic effects of prostate cancer treatments.
The study had no specific funding. The study authors and editorialists have disclosed no relevant financial relationships.
Prostate Cancer Is Common With Aging
After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.
Only 1 in 36 men, though, actually dies from prostate cancer. That’s because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes — not their prostate cancer.
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Impact Of Age On Treatment
The rising number of men diagnosed with prostate cancer is a result of increasing life expectancy as well as the current practice of screening by prostate-specific antigen blood tests. Besides PSA and Gleason score, age is considered a key prognostic factor in treatment decision making. Although organ-confined disease can be cured by radical prostatectomy and full-dose local radiation therapy, treatment options for advanced- stage disease remain palliative. They include active surveillance, or watchful waiting, early versus delayed hormonal therapy to control disease progression, and continuous or intermittent androgen deprivation. Observational studies of older men with early stage disease have suggested conservative management as a viable option.,
Chodak and associates evaluated 828 men who were managed expectantly in a series of nonrandomized trials. Median follow-up was approximately 6.5 years. Patients with poorly differentiated cancers had a 10-fold increased risk of death from prostate cancer as compared with men showing highly differentiated prostate cancer. A 5-year disease-specific survival of only 34% was found in men with poorly differentiated prostate cancer. In contrast a 5-year disease-specific survival of 87% was described in men with well-or moderately differentiated cancers.
Lower Your Risk Of Dying From Prostate Cancer
Want to Lower Your Risk of Dying from Prostate Cancer? Dont Smoke. Also, Lose Weight.
For several years now, doctors have known that there was a link between prostate cancer and smoking. They couldnt prove that smoking caused prostate cancer, but they knew that men who smoke cigarettes if they developed prostate cancer were more likely to have aggressive disease, and to die of it.
They know more now. Scientists led by Johns Hopkins epidemiologist Elizabeth Platz, Sc.D., M.P.H., studied men who had prostatectomy for localized prostate cancer. Those who continued to smoke after their diagnosis and treatment were more than two times more likely to have their cancer come back than men who never smoked. But men who had quit smoking had a similar risk of recurrence as men who never smoked.
Lets just stop for a second: This is really important and hopeful, because it shows that
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Are Older Men Undertreated
Schwartz and colleagues 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 colleagues 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.
Dairy Products Increase Prostate Cancer Risk
- Prostate cancer is the most common cancer for men that occurs due to diet-related factors
- Prostate cancer risk is high in men with high dairy intake
- Whereas eating more plant-based foods is shown to protect prostate health
The risk of prostate cancer is doubled in men with high dairy intake, whereas eating more plant-based foods can lower prostate cancer risk and its recurrence, according to research published in the journal Epidemiological Reviews.
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How Much Physical Activity Should I Do
Regular physical activity is good for your general health. People who keep active are more likely to be a healthy weight and less likely to develop health problems such as heart disease, type-2 diabetes and some cancers.
We dont yet know whether physical activity can help prevent prostate cancer, but some studies suggest it may help to lower your risk, particularly of aggressive prostate cancers. Vigorous exercise may be better than light exercise, but any exercise is better than none at all.
- Aim to do at least 150 minutes of moderate exercise every week, such as brisk walking, cycling or pushing a lawnmower. This doesn’t have to be all in one go.
- You could start gently for short periods of time, such as 10 to 15 minutes, and slowly increase this to 30 minutes five times a week.
- Find a sport or activity you enjoy or do lots of different ones so you dont get bored.
- You might find it more fun to exercise with other people. Ask a friend to come with you, or join a sports team or running group.
- If you often drive or take the bus for short journeys, try taking a brisk walk instead.
- Try to spend less time sitting down. You could move about while you watch TV, or choose more active video games. And don’t forget to stand up regularly if you sit down to work.
- You might find it helpful to write down everything you do in an activity dairy so you can see how well you’re doing.