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!

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 - IncidenceFigure 2. Prostate Cancer Incidence Rates by Race

Maryland and United States, 1992-1998

0

100

200

300

MD White 190.7 167.5 147.7 151.7 136.3 134.1 121.1

MD Black 256.4 267.6 245.5 255.7 247.7 210.0 187.2

US White 190.5 166.2 143.2 135.4 134.9 138.5 130.9

US Black 262.5 278.4 255.8 229.9 228.3 224.9 216.2

1992 1993 1994 1995 1996 1997 1998

Age-adjusted rate per 100,000 population

Prostate Cancer - IncidenceFigure 3. Prostate Cancer Age-Specific Incidence Rates

Maryland and United States, 1994-1998

0200400600800

100012001400160018002000

MD 6.0 36.0 142.1 364.4 694.9 1002.6 1164.8 1121.3 1030.6 1104.2

US 4.5 29.1 118.9 294.9 555.7 859.5 1084.0 1056.8 936.9 852.0

40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Age-specific rate per 100,000 population

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 - MortalityFigure 7. Prostate Cancer Mortality Rates by Race

Maryland and United States, 1992-1998

0

10

20

30

40

50

60

70

MD White 26.9 25.9 24.4 22.2 23.1 18.9 20.3

MD Black 57.0 55.9 58.1 57.7 57.6 60.1 47.2

US White 24.4 24.2 23.7 22.8 21.9 20.6 19.6

US Black 55.6 56.2 55.1 53.4 53.6 49.9 48.7

1992 1993 1994 1995 1996 1997 1998

Age-adjusted rate per 100,000 population

Prostate Cancer - MortalityFigure 8. Prostate Cancer Age-Specific Mortality by Race

Maryland and United States, 1994-1998

0

200

400

600

800

1000

1200

1400

1600

1800

MD White 28.2 57.0 122.3 222.5 425.7 744.3

MD Black 69.4 178.8 368.9 610.4 1035.8 1634.4

US White 27.1 62.4 127.0 227.3 403.6 722.8

US Black 86.7 167.9 357.1 555.3 922.4 1323.8

60-64 65-69 70-74 75-79 80-84 85+

Age-specific rate per 100,000 population

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.