September 24, 2013
By Durado Brooks, MD, MPH
When the US Preventive Services Taskforce (USPSTF) made their startling recommendation against screening for prostate cancer last year there was a widespread outcry from prostate cancer doctors and patients. Resistance was especially strong among black prostate cancer survivors and the doctors who care for them, arguing that the scientific studies that led to the USPSTF recommendation did not include many black men. Is this simply another case of "political correctness?" Isn't prostate cancer colorblind? Doesn't cancer behave the same in all men, regardless of race?
In reality there are a number of differences in how prostate cancer impacts black men compared to men of other racial and ethnic backgrounds. Black men are 60% more likely than white men to be diagnosed with prostate cancer during their lifetime, and are more than twice as likely to die from the disease. Black men are also diagnosed at a younger age (about 3 years younger on average) and are more likely to have "high grade" tumors - the kind of tumors that grow rapidly, spread to other parts of the body, and often cause death. Research has given us some insights on why these differences exist and what they mean for black men who face decisions about prostate cancer screening and treatment. More...
June 13, 2013
By Durado Brooks, MD, MPH
Much of the recent news about prostate cancer has focused on screening. In reality, screening is only one piece of the prostate cancer picture. More than 238,500 men in the United States will be diagnosed with prostate cancer this year. Most of these men will have to weigh a variety of treatment options and make a series of decisions about managing their disease.
So let's look at some of the important questions men need to ask when facing a diagnosis of prostate cancer, and information they can use to help make these important decisions.
Question: "Does my cancer need to be treated?"
Answer: The fact that this is even a question comes as a big surprise to many men. The idea that they have cancer - but not treating the cancer - runs counter to the widely held belief that doing something is always better than doing nothing. In fact, most prostate cancers grow very slowly, and men diagnosed with prostate cancer often have other health concerns (like heart disease or lung disease). In many cases these other health issues pose a greater threat to a man's health than does the prostate cancer. It is also clear that the most commonly used treatments for prostate cancer can all cause significant side effects and complications (detailed in the next sections) in some men. This combination of slow growing cancer + other health issues + possible treatment complications means that, many times, treating the cancer will cause harm to the man but will not improve his health or extend his life. In other words, the treatment can actually be worse than the disease for some men. More...
February 20, 2013
By Durado Brooks, MD, MPH
Thousands of men are diagnosed with prostate cancer each month. These men and their loved ones often turn to the internet to learn about their disease and treatment options, and these searches may lead to medical centers offering proton beam therapy. These centers espouse the benefits of this treatment approach, and some include glowing testimonials from men who have undergone the treatment.
So is proton therapy the "magic bullet" for prostate cancer?
The difference between proton therapy and traditional radiation
Proton therapy is a type of radiation treatment. Traditional radiation therapy has been used to treat cancers for a century using radioactive energy rays called "photons." When radiation is directed at a cancerous tumor inside the body the rays must pass through normal, healthy tissue in order to reach the cancer cells. In doing so, photons often cause harm to these healthy cells in their quest to get to the tumor.
In the case of prostate cancer, the radiation beams must pass through the skin, the bladder and the rectum on the way to the prostate gland, and once they reach the gland they encounter normal prostate cells and the nerves that control penile erections. Damage to these tissues can lead to the complications that often accompany radiation treatment for prostate cancer, including bladder problems, rectal leakage or bleeding, and difficulty with erections.
Proton therapy is a new way to deliver radiation to tumors using tiny, sub-atomic particles (protons) instead of the photons used in conventional radiation treatment. Proton therapy uses new technology to accelerate atoms to 93,000 miles per second, separating the protons from the atom. While moving at this high-speed, the particles are "fired" at the patient's tumor. These charged particles deliver a very high dose of radiation to the cancer but release very little radiation to the normal tissue in their path. In theory, this approach minimizes damage to healthy organs and structures surrounding the cancer. More...
January 18, 2012
By Durado Brooks, MD, MPH
Imagine being told by your doctor, "You have cancer." Then imagine that their next words are "... but we probably don't need to do anything about it." Many people would immediately start looking for another doctor. But hold on just a moment.
Last month the National Institutes of Health (NIH) brought together experts from around the world for a summit to examine the state of our scientific knowledge on "active surveillance" as a management strategy for prostate cancer. For those of you who are unfamiliar with the term, active surveillance essentially means monitoring the cancer closely and delaying active treatment (surgery or radiation, for instance) until there are signs it is needed; the delay may be months, years, or forever. This summit pointed out that while there is still much we need to learn about this once-controversial approach, there is a wealth of data supporting the potential value of active surveillance for a large number of the 240,000 men in the United States who are diagnosed with prostate cancer each year. More...
October 05, 2011
EDITOR'S NOTE: This blog was originally published on June 29. Due to recent questions on this topic, it's been reposted. News reports say the United States Preventive Services Task Force will next week release new recommendations saying that healthy men should no longer receive a PSA blood test to screen for prostate cancer. Reports say the USPSTF will say the test does not save lives and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence. Otis W. Brawley, M.D., chief medical officer of the American Cancer Society, says the Society cannot comment on the evidence review or on the recommendations until they are made public.
By Otis W. Brawley, MD, FACP
Prostate cancer is a major public health problem. The American Cancer Society estimates that 240,890 American men will be diagnosed with prostate cancer in 2011 and 33.720 will die of it. It is the second leading cause of cancer death among men, only surpassed by lung cancer.
Prostate cancer screening became common in the U.S. in the early 1990s and dramatically changed the demographic of cancer in the U.S. Prostate cancer quickly became the most commonly diagnosed non-skin cancer. Today an American male has a lifetime risk of prostate cancer diagnosis of about 1 in 6 and a lifetime risk of dying of only 1 in 36. In Western European countries where screening is not common, the lifetime risk of prostate cancer diagnosis is much lower, about 1 in 10, and the lifetime risk of death is the same.
Screening began without the completion of the scientific research to show that it saves lives. For most advocates of screening and aggressive treatment, there was and is a desire to do something that might be beneficial to the population of men at risk. Unfortunately, the history of medicine is filled with examples of physicians "jumping the gun" and using possible interventions before they are fully evaluated. More...
May 25, 2011
By Colleen Doyle, MS, RD
I admit it; I'm a java junkie. I LOVE my morning (and mid-morning) cups of coffee. So any study that looks at the potential health benefits of coffee gets my adrenaline pumping, whether I'm revved up on caffeine or not.
A study just published in the Journal of the National Cancer Institute looked at whether or not coffee consumption was related to prostate cancer risk. The researchers were particularly interested in whether or not coffee consumption reduced the risk of advanced prostate cancer (by advanced, they mean that the cancer has spread beyond the prostate at the time of diagnosis). As a matter of fact, this study is the first of its kind looking specifically at the relationship between coffee consumption and advanced prostate cancer. While prostate cancer is one cancer I don't need to personally worry about, on behalf of all the men in my life, I took a look. More...