10 New Facts about Prostate Cancer

1. Predict Lethal Prostate Cancer with Midlife PSA:

Researchers conducted a nested case-control study to determine whether a baseline prostate-specific antigen level during midlife predicts lethal prostate cancer in a US population with opportunistic screening. Risk of lethal PCa was strongly associated with baseline PSA in midlife. They concluded that risk-stratified screening on the basis of midlife PSA should be considered in men age 45 to 59 years.

2. Previous Cancer Ups Prostate Cancer Mortality Risk:

Prostate cancer remains a significant cause of mortality when the diagnosis is made after another malignancy. More men died from prostate cancer after colorectal cancer, melanoma, and oral cancer but fewer after bladder, kidney, and lung cancer and leukemia and non-Hodgkin lymphoma. Patients who died from prostate cancer had higher grade and stage disease and received less treatment than patients who died from prior malignancy.

3. Prostate Cancer-Obesity Link:

Higher body mass index and waist circumference are tied to aggressive prostate cancer risk. Risk grew 10% with every 5 kg/m2 increase in BMI and 13% with 10-cm increases in waist circumference. Fatal prostate cancer risk went up 14% with every 5 kg/m2 increase in BMI and 18% with 10-cm increases in waist circumference. “Our results are in line with health advice for other non-communicable diseases,” the authors noted. “Men should try to maintain a healthy weight.”

4. Prostate Cancer Risk Advances With Age:

Probability of high-grade or high-risk prostate cancer is much higher in older men. The probability of Gleason score 8 to 10 or high-risk disease increased significantly with increasing age. Physicians and patients should take the higher risk of more aggressive or advanced disease in older men into account when they discuss the risks and benefits of PSA screening with healthy older men who have a substantial life expectancy.

5. Low Vitamin D Points to Aggressive Prostate Cancer:

Low vitamin D levels (below 30 ng/mL) may help predict aggressive prostate cancer (Gleason score of 8 to 10). The study showed only an association, but the researchers think low vitamin D levels might be used as a biomarker and help patients and their doctors decide whether to consider active surveillance rather than surgery.

6. Say Nuts to Prostate Cancer:

A recent analysis showed no link between consumption of nuts-eg, almonds, walnuts, Brazil nuts, and cashews-and a diagnosis of prostate cancer or prostate cancer–specific mortality. But the rate of overall mortality in patients who ate nuts 5 or more times a week after diagnosis-34%--was significantly lower than in those who ate nuts less than once a month.

7. Radiation Cut by Half Still Effective:

A 4-week radiation regimen for prostate cancer is noninferior to the standard 8-week regimen. Percentage of pre-defined failure events was similar in both 4- and 8-week treatment groups and there was a trend toward less toxicity overall in the 4-week group. Co-lead investigator Dr. Himu Lukka: “The fewer number of treatments will not only be more convenient … but … more patients can be treated with the same amount of resources.” In all, the study is being called “a game changer.”

8. Survivors Have Unmet Psychosocial Needs:

Prostate cancer survivors’ satisfaction with follow-up care is lower for psychosocial than physical aspects of care. Urinary, bowel, and sexual functioning were reported as moderate/big problems. Moderate/high unmet needs: changes in sexual feelings/relationships and managing fear of recurrence/uncertainty. Also: moderate-to-severe anxiety and depression. Strategies are needed to identify and help men who have ongoing problems.

9. Unrealistic Expectations:

Most patients with localized prostate cancer underestimated life expectancy without treatment and overestimated gains with treatment. Unrealistic expectations may compromise informed decision making and so contribute to overtreatment. Treatment chosen, age, and general health perception influenced expectations. Primary care physicians can help patients develop realistic expectations and make choices that support their treatment goals.

10. SHAREd Treatment Decisions:

For family physicians considering prostate cancer treatment options, shared decision-making between physician and patient is recommended. The 5-step

SHARE

Approach: 1.

S

eek patient’s participation, 2.

H

elp patient explore and compare treatment options, 3.

A

ssess patient’s values and preferences, 4.

R

each a decision with patient, 5.

E

valuate patient’s decision.