Prostate Cancer: Education & Outreach

Center for Cancer Prevention & ControlPrevention and Health Promotion AdministrationMaryland Department of Health & Mental Hygiene

April 2013

Prevention and Health Promotion Administration April 2013 *

What is Prostate Cancer?Prostate cancer starts from the prostate gland which is:Found below the bladder and in front of the rectumThe size of a walnut or golf ballMakes the fluid that is part of semenNational Cancer Institute

Prevention and Health Promotion Administration April 2013 *

How many men get prostate cancer and die from it?

USA (in 2011-estimate)*240,890 new cases of prostate cancer will be diagnosed 37,660 men will die from prostate cancer

Maryland (in 2011--estimate)*5,060 men will be diagnosed with prostate cancer710 will die from it

Cancerresearchuk.org

Prevention and Health Promotion Administration April 2013 *

World Health Ranking: Prostate Cancer Death Rate Per 100,000Selected Countries:

RankCountryRate1DOMINICA46.851AUSTRALIA8.858UK8.2103USA6.1135INDONESIA4.3157PHILIPPINES2.9160JAPAN2.7179THIALAND1.1190NORTH KOREA0.5192KIRIBATI0.0

Worldlifeexpectancy.com

Prevention and Health Promotion Administration April 2013 *

For Filipinos, prostate cancer is most common for men after lung cancerProstate cancer develops in 19 out of every 100,000 Filipinos, according to PH DOH.

Prostate cancer is the third most common male cancer in the entire world and half a million new cases continue to be diagnosed every year Dr. Eliza Raymundo, Clinical Associate Professor of UP Manila, Philippine General Hospital.She revealed that while there is low reported incidence among Asian countries compared to Caucasians yet it still alarming since patients are diagnosed in late stages stage 3 and stage 4 prostate cancer.

unilab.com.ph

Prostate Cancer n the Philippines

Prevention and Health Promotion Administration April 2013 *

We do not know the exact cause/s of prostate cancer

Most likely the cause is related to changes in the genetic material (DNA) in our cells.

DNA changes can be passed down through families, or can occur due to environment or lifestyle.

cancer.org Causes of prostate cancer

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Risk factors for prostate cancerAge is the strongest risk factor 63% of prostate cancer occurs in men over the age of 65.

Race More common in African American men than other men (the reasons are unknown)

ACS and NCI

Prevention and Health Promotion Administration April 2013 *

Risk factors for prostate cancer (continue)

Family history-Men who have first-degree family members with prostate cancer appear to have double the risk of getting the disease.Genes Account for about 5-10% of prostate cancerOther areas that need more research include:Diet, obesity, exercise, and sexually transmitted diseases (STDs)

Higher red and processed meat consumption, low level of vitamin D, obesity, elevated blood levels of testosterone, high blood pressure, many lifetime sexual partners, starting sexual activity early in life, these and othersare associated with higher risk of prostate cancer.

Use of Statins, frequent ejaculation (over 21 times per month on average), vegetarian diet (lycopene and selenium), diets rich in cruciferous vegetables, soy, beans , legumes, regular exercise, these and others are associated with lower risk of prostate cancer.

ACS and NCI

Prevention and Health Promotion Administration April 2013 *

What is the lifetime risk of prostate cancer?African American man19% chance (1 in 5) of being diagnosed with prostate cancer

5% chance (1 in 20) of dying from prostate cancer

General population16% chance (1 in 6) of being diagnosed with prostate cancer

3% chance (1 in 33) of dying from prostate cancerCDC

Prevention and Health Promotion Administration April 2013 *

Symptoms of prostate cancerProstate cancer may not produce symptoms in its early stages. A man can look healthy, feel fine, and not know he may have a problem.

If signs and symptoms are present, they may include: blood in the urine; the need to urinate frequently, especially at night; weak or interrupted urine flow; pain or a burning feeling while urinating; inability to urinate; and regular pain in the lower back, pelvis, or upper thighs.CDC, ACS, NCI

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Ways to find prostate cancerPSA (prostate-specific antigen)PSA is a protein produced by cells of the prostate gland.PSA test measures the level of PSA in the blood.

DRE (digital rectal exam)Doctor feels the surface of the prostate gland for bumps, hard spots, and any other abnormalities

Digital Rectal Exam

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What can increase the PSA level?Prostate cancer

BPH (benign prostatic hyperplasia)Enlargement of the prostate gland (not cancer)

AgePSA level tends to go up with age

ACS, NCI

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What can increase the PSA level (continued)?

ProstatitisInfection/inflammation of the prostate gland

EjaculationIncreases PSA levels for a short timeMen are asked to abstain from ejaculation for 2 days before testing

Clearly, factors other than prostate cancer can increase PSA level.ACS, NCI

Prevention and Health Promotion Administration April 2013 *

In May 2012, The United States Preventive Services Task Force (USPSTF) recommendeds against PSA-based screening for prostate cancer.USPSTF decided that the expected harms outweigh the possible benefitsThere are no exceptions to the recommendation due to race or ageThe American Urological Association recommends:No screening in men under age 40No routine screening in men between ages 40 to 54Two years interval between routine screeningRoutine PSA screening is not recommended in men 70 or 10-15 year life expectancy

If doctor is concerned that you might have prostate cancer based on either a PSA level or a rectal exam, a biopsy ( a lab testing of a small amount of tissue from the prostate) will be the next step. This is the only way to positively identify the presence of cancer.

Webmd.comScreening for Prostate Cancer?

Prevention and Health Promotion Administration April 2013 *

Possible Benefit of Prostate Cancer Screening1 man in 1,000at mostavoids death from prostate cancer because of screening for prostate cancer over 10 years (based on current information)DHMH Prostate Cancer Minimal Elements, 2012

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Expected Harms of Prostate Cancer ScreeningFor every 1,000 men who are screened with the PSA test:30 to 40 men will develop erectile dysfunction or urinary incontinence due to treatment2 men will experience a serious cardiovascular event, such as a heart attack due to treatment1 man will develop a serious blood clot in his leg or lungs due to treatmentFor every 3,000 men who are screened with the PSA test:1 man will die due to complications from surgical treatmentDHMH Prostate Cancer Minimal Elements, 2012

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Can prostate cancer be prevented?It is not known yet how to prevent prostate cancer. However, the key behaviors in cancer prevention, such as:not-smoking, healthy diet, physical activity, and healthy weight help to lower the risk of many types of cancer, while also reducing the risk of heart disease, diabetes, and stroke.

Prevention and Health Promotion Administration April 2013 *

The role of education and outreach (1)Enlist the support of local and regional government officials to fund and support a series of seminars or town hall meetings regarding prostate cancer. Encourage men to speak with their doctors to learn more about: their personal risks for prostate cancer, options for screening, and the pros and cons of prostate cancer detection and treatment.

Prevention and Health Promotion Administration April 2013 *

The role of education and outreach (2)

Lobby the regional or even national government to designate a day/week/month for prostate cancer awareness.

Submit proposals to WHO, NIH, ACS, medical agencies, NGOs and Foundations for funding research toward the cure, management and prevention of prostate cancer.

Prevention and Health Promotion Administration April 2013 *

The role of education and outreach (3)Educate men about prostate cancer including:Risk factors for prostate cancerSymptoms for prostate cancerScreening testsConditions other than prostate cancer that can elevate the PSA

Provide men accurate information about prostate cancer screening using publications from credible sources (e.g., ACS, NCI, DHMH)

Prevention and Health Promotion Administration April 2013 *

The role of education and outreach (4)Inform men that the decision to get prostate cancer screening is between them and their doctor

Encourage men to speak with their doctors to make an informed decision, and to get tested if they decide to.

Prevention and Health Promotion Administration April 2013 *

The role of education and outreach (5)Inform men that if prostate cancer is diagnosed:

Get all the information.

The decision about the type of prostate cancer treatment is between the man and his doctor(s)Surgery, radiation therapy, and active surveillance are possibilities.

Active surveillance is where the man has further testing over time before deciding whether more invasive treatment is needed.

Prevention and Health Promotion Administration April 2013 *

Alexander DD, Mink PJ, Cushing CA, Sceurman B (2010). A review and meta-analysis of prospective studies of red and processed meat intake and prostate cancer. Nutirtion journal 9:50.

Dennis LK, Dawson DV (January 2002). Meta-analysis of measures of sexual activity and prostate cancer. Epidemiology (Cambridge, Mass.) 13 (1): 72-9.

http://www.cancerresearchuk.org/cancer-info/cancerstats/world/cancer-worldwide-the-global-picturehttp://

Gann PH, Hennekens CH, Ma J, Longcope C, Stampler MJ (August 1996). Prospective study of sex hormone levels and risk of prstate cancer. J. Natl. Cancer Inst. 88 916):1118-26.

Martin RM, Vatten L, Gunnel D, Roundstad P (March 2010). Blood pressure and risk of prostate cancer: cohort Norway (CONOR). Cancer Causes Control 21 (3): 463-72

Rosenblatt KA, Wicklund KG, Stanford JL (Jun 15, 2001). Sexual factors and the risk of prostate cancer. AmericanJournal of Epidemiology 153 (12): 1152-8.

Sarma AV, Mclaughlin JC, Wallner LP, Dunn RL, Cooney KA, Schottenfeld D, Montie JE, Wei JT (September 2006). Sexual behavior, sexually transmitted diseases and prostatitis: the risk of prostate cancer in black men. The Journal of Urology 176 (3):1108-13.

Scardino, P (2005). Comprehensive textbook of genitourinary oncology (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. P. 16.

Shannon J, Tewoderos S, Garzotto M, Beer TM, Derenick R, Palma A, Farris PE (August 2005). Statins and prostate cancer risk: a case-control study. Am. J. Epidemiol 162 (4): 318-25.

References

Prevention and Health Promotion Administration April 2013 *

Prevention and Health Promotion Administration April 2013 *

American Cancer Spciety Guidelines on Nutrition and Physical Activity for Cancer Prevention (PDF). Last Revised: 1/11/2012

American Dietetic Association and Diieticians of Canada Jume 2003). Position of the American and Diietetic Asociation and Dietitians of Canada: Vegetarian diets. Journal of the American Dietetic Association 103 (6): 748-65.

Maricione, M (12 October 2011). Prostate testings dark side: Men who were harmed. Associated Press.

Research, World Cancer Research Fund ; American Institue for Cancer 92007). Food, nutrition, physical activity, and the prevention of cancer a global perspective (PDF). Washington, D.C.: American Institute for Cancer Research. P. 76.

Wigle DT, Turner MC, Gomes J, Parent ME (March 2008). Role of hormonal and other factors in human prostate cancer. Journal of Toxicology and Environmental Health. Part B, Critical Reviews 11 (3-4): 242-59.

www.cancer.org/acs/groups/content/@editorial/documents/document/prostatecancerpowerpointpackag.pdf

www.unilab.com.ph/consumers/articles-and-advisories/physical/prostate-cancer-in-the-philippines/ncer/guide/psa?page=2http://

http://www.webmd.com/prostate-cahttp://

www.worldlifeexpectancy.com/cause-of-death/prostate-cancer/by-country/

Zeegers MP, Jellema A, Oster H (2003). Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma: a meta-analysis. Cancer 97 (8): 1894-903.

References

Prevention and Health Promotion Administration [Date] *

THE END

Prevention and Health Promotion Administration April 2013 *

Prevention and Health Promotion Administration April 2013 *

Prevention and Health Promotion Administration April 2013 *

Risk factors for prostate cancerAge is the strongest risk factor 63% of prostate cancer occurs in men over the age of 65.

Prevention and Health Promotion Administration April 2013 *

How many men get prostate cancer and die from it? USA (in 2011-estimate)*240,890 new cases of prostate cancer will be diagnosed 37,660 men will die from prostate cancer

Maryland (in 2011--estimate)*5,060 men will be diagnosed with prostate cancer710 will die from it* American Cancer Society's Cancer Facts and Figures 2011

Prevention and Health Promotion Administration April 2013 *

How many men get prostate cancer and die from it? USA (in 2011-estimate)*240,890 new cases of prostate cancer will be diagnosed 37,660 men will die from prostate cancer

Maryland (in 2011--estimate)*5,060 men will be diagnosed with prostate cancer710 will die from it* American Cancer Society's Cancer Facts and Figures 2011

************************This graph shows the percent of Maryland men 50 years and older who report that they have EVER had a PSA (the rate is stable at about 75-79%) and have had PSA in the LAST YEAR (about 60% of men 50 years and older). Clearly, many men choose to be tested for PSA.*This shows the Prostate Cancer mortality rates in US and Maryland men, Black and White. It shows that Marylands mortality rate from Prostate Cancer is about the same as the US rates; that African American men have over twice the rate of death from prostate cancer as white men, but that the difference between African American and White men is narrowing.**