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Prostate Cancer in Maryland

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Prostate Cancer in Maryland Preliminary Report of the Prostate Cancer Committee – PowerPoint PPT presentation

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Title: Prostate Cancer in Maryland


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.
  • MDs 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.
  • MDs 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 dont 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 physicians 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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