New data on prostate cancer mortality rates is good information for men to know, but it may not make decisions about treatment any easier. Furthermore, the new research probably won’t end the longstanding debate in the medical community questioning the use of PSA screening for the cancer or whether or not to even treat the disease in some men.

According to the new study, if you have prostate cancer you have about an 11% chance that you’ll die from it. The odds are more likely that’s you’ll die of something else--like cardiovascular disease.

The study authors say their research reinforces the idea that the key to longevity is embracing an overall healthy lifestyle--like eating a balanced diet, managing your weight, getting regular exercise, and not smoking.

Study Details

The study used data from the U.S. Surveillance, Epidemiology, and End Results Program and the Swedish Cancer and Cause of Death registries to analyze the causes of death among more than 700,000 men. The U.S. data was for 1973-2008 and the Swedish data covered 1961-2008.

• Over these periods, 52% of the Swedish men with prostate cancer died and 30% of American men with prostate cancer in the study.
• Of these deaths, only 35% of the Swedish men died directly from prostate cancer and only 16% of American men died from the disease itself, the investigators found.
• As the study continued, fewer men died from prostate cancer while deaths from heart disease remained the same.
• By the last five years of the study, 29% of Swedish men with prostate cancer died from it as did 11% of American men, the researchers calculated.
• Deaths from prostate cancer varied by age and year of diagnosis. The most deaths were among older men and among men diagnosed before screening for PSA began, they added.

Clinical Implications

When doctors were asked to comment on the study findings, opinions varied widely. Some believe the study is justification for screening only high-risk men for prostate cancer, which includes African-American men and men with a family history of prostate cancer. Others like Dr. Durado Brooks, director of prostate and colon cancer at the American Cancer Society, argue against PSA screening saying that it too often "leads down the path of unnecessary treatment."

"Men should understand that not every prostate cancer needs to be found and every prostate cancer that's found does not necessarily need to be treated," he said.

With such diverse opinions in the medical community, it’s easy to see why men need all the information available to make a decision about their health. There just isn’t a clear-cut answer on this issue.

Source:

Health Day

According to a recent study, the long-term risk for prostate cancer can be predicted from a 1-time prostate-specific antigen (PSA) test before the age of 50.

The study of more than 20,000 Swedish men indicates a PSA value above 1.5 ng/mL between the ages of 45 and 49 account for nearly half of the prostate cancer deaths over the next 30 years or so. Only 10% of the men in the study had such high PSA values at this relatively young age.

Therefore, the researchers believe that PSA values obtained in men in their 40s could allow doctors to stratify risk and identify those in the top 10% that need aggressive follow-up of either annual or biennial PSA tests.

According to current screening guidelines a lot of the men in the top 10% would be told, “You're fine.” However, in the study, 44% all of the prostate cancer deaths occurred in this top 10% of men. Current screening recommendations involving PSA testing do not involve risk stratification and suggest that biennial PSA tests starting at age 50 to age 70. This new research may challenge those recommendations.

A bigger challenge than getting high-risk young men to return to the clinic for close monitoring might be getting young men to have a PSA test in the first place. PSA testing has been in steady decline since 2003/04, when about 50% of all men older than 50 years reported being tested.

This study was similar to another study the team published in 2010 which indicated that most of the deaths from prostate cancer were among the 25% or so of men who had, at age 60, PSA levels higher than 2 ng/mL. The study suggested that repeat screening could be confined to that 25% of men whose PSA level is above 2 ng/mL at 60 years of age.

This was the first time that the researchers suggested that the PSA test offers clear recommendations for clinical practice. They asserted that risk-stratifying screening had 2 major benefits: it will reduce over diagnosis in men at low risk for prostate cancer death, and it will improve compliance with screening in men who will benefit the most.

Sources:

Medscape

Just as it's harmful for women who take a selective serotonin reuptake inhibitor (SSRIs) like fluouxetene (Prozac) and paroxetine (Paxil) or a cardiac or antipsychotic drug along with the breast cancer drug tamoxifen, the results of a prostate-specific antigen (PSA) test may be altered by the use of common drugs, like statins, thiazide diuretics and non-steroidal, anti-inflammatory drugs (NSAIDs).

The effect of 10 drugs in these three categories had on lowering serum PSA levels among more than 1,850 men (age 40 and older) with no history of prostate cancer was slight but noticeable after one year, with a high of 6 percent for thaizide diuretics (drugs used to treat edema and hypertension). Real change came at the five-year mark, however, when the use of any one kind of drug artificially and exponentially lowered PSA levels anywhere from four to six times below normal. For example, the use of thaizide diuretics reduced PSA levels by a surprising 26 percent.

The drop in PSA levels was even more pronounced after five years among men who took a diuretic along with a statin drug by 36 percent, although using a calcium channel blocker to treat high blood pressure inhibited that effect. And, because many older patients use at least one, if not more, of these medications at the same time, researchers estimate their effect on artificially lowering PSA levels among far greater numbers of men could be huge.

But there's one more tantalizing possibility scientists are considering: This trio of drug classes may create a protective effect against cancer, not at all a pipe dream, considering statin drugs and NSAIDs are already being studied for that reason.

Journal of Clinical Oncology August 2, 2010

Drugwatch.com August 9, 2010

healthfinder.gov August 6, 2010

You may recall a post I wrote about the extraordinary sense of smell many animals have that may detect the scent of various human diseases, including tuberculosis and some forms of cancer. This post-Father's Day study from Europe documents the training of a Belgian Malinois shepherd dog to sniff out prostate cancer, virtually without fail, in urine samples.

Science has been looking for more effective methods to detect malignant tumors linked to prostate cancer from benign ones to cut down on the needless tests and stress men face after receiving a positive result from a prostate-specific antigen (PSA) test.

Prostate cancer can be detected in a male patient's urine. In fact, some molecules exude a distinctive odor, but, unfortunately, there's no scientific testing available yet that can separate the variety of odors in urine and detect prostate cancer. That's where the talented snout of this Belgian Malinois shepherd, who has already been trained to sniff out bombs and bombs, comes in.

After two years of training on urine samples to ferret out which ones did or did not have prostate cancer, this beautiful dog was given the ultimate test: Identify which one of five samples contained prostate cancer. Out of 66 tests, the dog correctly spotted the right prostate cancer specimen in all but three cases (all false positives). Interestingly, among the three false positives the dog identified, a follow-up biopsy detected the presence of prostate cancer in one of them.

How prostate cancer detection will eventually "go to the dogs," and other animals is anyone's guess. All we know for the moment is how our pets save our lives just by being them…

Image source: Wikipedia

MedicineNet.com June 1, 2010

Los Angeles Times: Booster Shots June 1, 2010

WebMD June 2, 2010

Bloomberg Businessweek June 2, 2010