- Highest increase among men ages 55 to 69, who could benefit the most from screening and early treatment
- Disease is more advanced when finally diagnosed
- “Screening saves lives,” urologists stress. “If I were a patient, I would want to be vigilant.”
CHICAGO — The number of new cases of metastatic prostate cancer climbed 72 percent in the past decade from 2004 to 2013, reports a new Northwestern Medicine study. The report considers whether a recent trend of fewer men being screened may be contributing to the rise, or whether the disease has become more aggressive — or both.
The largest increase in new cases was among men 55 to 69 years old, which rose 92 percent in the past decade. This rise is particularly troubling, the authors said, because men in this age group are believed to benefit most from prostate cancer screening and early treatment.
In addition, the average PSA (prostate-specific antigen) of men who were diagnosed with metastatic prostate cancer in 2013 was 49, nearly double that for men diagnosed in 2004 with an average PSA of 25, indicating a greater extent of disease at diagnosis.
The blood level of PSA, a protein produced by cells of the prostate gland, is often elevated in men with prostate cancer.
“One hypothesis is the disease has become more aggressive, regardless of the change in screening,” said senior study author Dr. Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine and Northwestern Medicine. “The other idea is since screening guidelines have become more lax, when men do get diagnosed, it’s at a more advanced stage of disease. Probably both are true. We don’t know for sure but this is the focus of our current work.”
Schaeffer also is a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
The paper will be published July 19 in Prostate Cancer and Prostatic Diseases, a journal from Nature.
Schaeffer’s research team analyzed information from the National Cancer Data Base. It included 767,550 men from 1,089 facilities nationwide who had been diagnosed with prostate cancer between 2004 and 2013.
Over the past decade, there has been a substantial reduction in the number of men being screened for prostate cancer and an associated decline in the overall number of new cases of prostate cancer being reported.
“The fact that men in 2013 who presented with metastatic disease had much higher PSAs than similar men in 2004 hints that more aggressive disease is on the rise,” Schaeffer said. “If I were a patient, I would want to be vigilant. I firmly believe that PSA screening and rectal exams save lives.”
If a patient is diagnosed with localized prostate cancer that is aggressive, treatment can be curative. If men present with metastatic prostate cancer, treatments are not curative and only slow disease progression. Most patients with metastatic prostate cancer eventually die from the disease.
“There could be a significant increase in prostate cancer death rates if more people are diagnosed with metastatic disease, because treatments can only slow progression, it’s not curable,” Schaeffer said.
The study measured the total number of cases of metastatic prostate cancer, not the incidence, for example, of cases per 100,000. In addition, metastatic disease began rising in 2008, before the change in screening recommendations from the U.S. Preventive Services Task Force. Thus, investigators said, they can’t definitively link the increased cases to reduced screening alone.
Three percent of those included in the study had metastases, which means prostate cancer cells had spread to other parts of their bodies by the time the cancer was diagnosed. The number of cases of metastatic prostate cancer in 2013 (2,890) was 72 percent greater than that in 2004 (1,685). In middle-aged men 55 to 69 years old, the number rose 92 percent from 702 new cases in 2004 to 1,345 in 2013.
“The results indicate that screening guidelines and treatment need to be refined based on individual patient risk factors and genetics,” said lead author Dr. Adam Weiner, a Feinberg urology resident. “This may help prevent the growing occurrence of metastatic prostate cancer and potential deaths associated with the disease. This also can help minimize overdiagnosing and overtreating men with low-risk prostate cancer who do not need treatment.”
“This will be particularly critical for population health economics in the U.S., considering the added cost of care for metastatic prostate cancer and an aging constituency whose population over the age of 65 will double to over a projected 80 million by the year 2050,” Schaeffer noted.
The research was supported by National Institutes of Health grant 5U01CA196390 and the Prostate Cancer Foundation.
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Twenty years ago, Craig Cooper—co-founder of Boost Mobile USA, serial entrepreneur, health advocate, founder and president of Cooperative Health and Performance Research Labs, and, most recently, author—embarked on a journey into the world of health initially to stave off a number of serious medical issues that doctors told him were his “genetic destiny.” His book, Your New Prime: 30 Days to Better Sex, Eternal Strength, and a Kick-Ass Life After 40, is written for men approaching middle age and is the direct result of that 20-year quest.
On the nutrition front, Cooper is adamant: “I look at food as fuel. If I am sitting all day in my car, I am not NICraigCoopergoing to eat the same dinner when I get home as I would if I were active all day training. That just wouldn’t make sense.” Cooper knows not only the right carb-to-protein balance needed for a middle-aged man to perform at his peak but also describes in his book his use of “IF” (intermittent fasting), which he utilizes to keep his blood sugar in check. “Basically, I fast on Tuesdays; nothing complicated,” he says with a laugh. Cooper finds he “looks forward to those days,” citing studies indicating intermittent fasting decreases insulin levels and inflammation and boosts HGH levels. When talking about effects on insulin, Cooper asks, “Adult-onset diabetes is an epidemic; 30 years ago, we never even heard about it, did we?”
Having been diagnosed with a high PSA, often an early warning of impending prostate cancer, Cooper feverishly researched nutritional links and preventive measures, which are discussed at length in his book and shared on his foundation’s website, Prostate.net. The website’s primary goal is to educate men about prostate cancer risk and prevention strategies.
While we know Prostate Cancer affects 239,000 men a year, new data suggests prostate cancer is on the rise. The article, which was published in men’s journal states:
“Prostate cancer among young men has increased sixfold in the past 20 years, according to a new University of Michigan analysis. Even scarier, the disease usually spreads faster and is deadlier in guys younger than 55 compared to men in their 70s and 80s.
“The type of prostate cancer younger men get seems to be more aggressive than the ‘typical’ prostate cancer, which is often slow growing and non-life-threatening,” says Dr. Robert Mordkin, chief of urology and director of robotic surgery at Virginia Hospital Center, who was not involved in this research.
Nobody is really sure why prostate cancer is on the rise. “One hypothesis is that we are screening for prostate cancer better than before,” says Mordkin, meaning that since more young men are getting PSA screenings, more cancers are being detected at earlier stages. “But this new data suggests screenings are not the reason [for the uptick in cancer cases]—although the researchers aren’t sure what is.”
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Electronic cigarettes (E-cigarettes) are the newest hot product. What exactly is an E-cigarette? This is a device powered by a battery that heats up liquid nicotine. Then the user inhales the vapors that are released. This is supposed to be a bridge to quitting. It is also marketed as a safer version of the traditional cigarette. Why are they so dangerous then?
The device itself is refillable. Here is the first problem. Liquid nicotine comes in large refillable containers. The nicotine is very concentrated. It only takes a small amount to cause toxicity in humans (just a few milliliters). Children are even more susceptible than adults requiring less nicotine to cause poisoning. Adults leave these large containers lying around the house and they are easy for children to get into. They come in different flavors and packaging that attracts children. Nicotine is easily absorbed through the skin in its liquid form. This is not seen with traditional cigarettes that require inhalation or ingestion.
The early signs of toxicity are gastrointestinal distress (nausea, vomiting, abdominal pain), cardiac dysfunction (racing heart, high blood pressure), neurological abnormalities (tremors, seizures), salivation, and excess mucus production in the lungs resulting in breathing difficulties. Late signs of toxicity include low blood pressure, low heart rate, shock, respiratory failure, seizures, coma, and paralysis.
Unfortunately, there is no antidote. Treatment is supportive with IV fluids, benzodiazepines (Valium, Ativan, Versed) for seizures, intubation and mechanical ventilation for respiratory failure. Medications like atropine are used to dry up secretions and increase heart rate.
The good news is that E cigarettes don’t expose the people around you to the products of burning tobacco such as tar and smoke. They do however expose those around you to vaporized nicotine and the chemicals that are used to dissolve the nicotine. Time will tell how this affects victims of second hand inhalation.