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Prostate Cancer in Maryland

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!.

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Prostate Cancer in Maryland

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  1. Prostate Cancer in Maryland Preliminary Report of the Prostate Cancer Committee

  2. Prostate Cancer Committee Members • Donna Cox, co-chair, Johns Hopkins • Katherine Farrell, MD, co-chair, Anne Arundel County Health Department • Members • THANK YOU!

  3. 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.

  4. Prostate Cancer - Incidence

  5. Prostate Cancer - Incidence

  6. 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.

  7. Prostate Cancer - Mortality

  8. Prostate Cancer - Mortality

  9. Prostate Cancer – Stage at Diagnosis • Most (83%) men are diagnosed at early stages (local or regional). • (Source: SEER, 1992 - 1997.)

  10. 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.

  11. Prostate Cancer Screening Methods • Prostate specific antigen (PSA) - blood test • Digital rectal exam (DRE)

  12. 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.)

  13. 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.

  14. Prostate Cancer - Treatment Options for Early Stage Disease • Surgery (surgical removal of prostate gland) • Definitive radiotherapy • “Watchful waiting”

  15. 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%)

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  21. 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.).

  22. 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.

  23. 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)

  24. 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.

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