Prostate Cancer - The Public Health Perspective

"When medical experts don't have the answers, the only right decision is what's right for the patient." Dr. David Kessler, MD, JD, Dean, Yale School of Medicine

A Public Health Concern

Prostate cancer is the most common form of cancer, other than skin cancer, among men in the United States and is second only to lung cancer as a cause of cancer-related death among men. The American Cancer Society estimates that 189,000 new cases of prostate cancer will be diagnosed and that approximately 30,200 men will die of the disease in 2002.

The Facts

• About 80% of all diagnosed prostate cancers are in men aged 65 years of age or older.
• Fewer than 10% of men with prostate cancer die within 5 years of the diagnosis.
• African-American men have the highest rates of prostate cancer mortality.
• Asian/Pacific Islanders have low rates of incidence and mortality.
• Death rates decreased from 1990-1998 for all racial/ethnic groups except American Indian/Alaska Natives.

Prostate Cancer (Invasive) Death Rates,* by Race and Ethnicity, United States, 1990 - 1999

* Rates are age-adjusted to the 2000 U.S. standard population. ? Includes Hispanics of any race. Source: CDC, National Center for Health Statistics.

Can Prostate Cancer Be Prevented?

Researchers are trying to find out what causes prostate cancer and if it can be prevented. While all researchers do not agree on what impacts a man's risk, investigators are studying

• Use of herbal supplements.
• Diets high in fat or low in fruits and vegetables.
• Consumption of vitamin E or selenium.
• Certain infectious diseases.
• Men's hormonal characteristics.

How Is Prostate Cancer Detected?

The two most common tests used by doctors are the digital rectal exam and the prostate specific antigen test.

• The Digital Rectal Exam (DRE) has been recommended for years as a screening test for prostate cancer, yet it is limited in its ability to detect prostate cancer, or distinguish a cancer from something else.
• The Prostate-Specific Antigen (PSA) is a blood test that measures the PSA enzyme. The PSA test is limited in its ability to distinguish between a benign and cancerous tumor and other conditions, e.g., prostatitis (inflammation of the prostate).

The Centers for Disease Control and Prevention (CDC) does not recommend routine screening for prostate cancer because there is no scientific consensus on whether screening and treatment of early stage prostate cancer reduces mortality. CDC does support a man's right to discuss the pros and cons of prostate cancer screening and treatment with his doctor and his right to make his own decision about screening.

How Does CDC Address Prostate Cancer?

With fiscal year funding of approximately $14 million for prostate cancer activities, CDC is

• Enhancing prostate cancer data in cancer registries, especially with regard to stage of diagnosis, quality of care, and racial and ethnic information.
• Sponsoring research on whether screening for prostate cancer reduces prostate cancer mortality and exploring men's and health providers' knowledge and awareness of prostate cancer screening.
• Funding states, tribal organizations, and territories to implement prostate cancer activities that are priorities in their cancer plans.

Information gained from CDC's prostate cancer activities will further research efforts in developing and delivering appropriate public health strategies in prostate cancer and improve information sharing about decision-making between providers and the public.

Research Activities

Effectiveness of Prostate Cancer Screening

CDC is collaborating with four health plans to conduct a large-scale population-based, case-control study designed to assess the ability of the PSA test and DRE to reduce mortality from prostate cancer. Data collection (collection of information from medical records) has been completed for most of the cases and controls in the study. Data collection will be completed in August 2002 and a manuscript submitted for publication by early 2003.

Intervention Research

CDC is funding the University of California at San Diego to conduct an Internet-based intervention research project on informed decision-making and prostate cancer screening. A randomized trial will compare two different approaches to help men decide whether or not to be screened for prostate cancer using the PSA test. This study will help provide much needed information about the effectiveness of informed decision-making interventions.

Patterns of Care Research

The National Program of Cancer Registries is funding eight state cancer registries to study patterns of care for cancer patients, including those diagnosed with prostate cancer. This research will collect detailed clinical information (e.g., stage at diagnosis, treatment received) on a random sample of prostate cancer patients diagnosed in 1997 and followed for 3 years. Results are expected in September 2004.

University Research

• The University of New Mexico Health Sciences Center (UNMHSC) and the University of Alabama (UA), individually, will compare the quality of life and health status of men with prostate cancers detected by screening to cancers diagnosed through the medical science of disease symptoms.
• The University of North Carolina at Chapel Hill addresses PSA screening, race, and prostate cancer treatment choice. The study will compare the health status and health-related quality-of-life outcomes of asymptomatic men whose cancers are detected by screening to men whose cancers are discovered because of symptoms. A complementary cohort study of black and white men from rural and urban areas in North Carolina will be developed to evaluate the impact of race and setting on treatment choice and quality of life outcomes.
• Loma Linda University, in California, is focusing on prostate cancer screening behaviors among African-American men. Researchers will examine the relationship between what primary care physicians report telling their patients about prostate cancer preventive messages and how men perceive those messages.

Development of Educational Materials

CDC is developing a brochure to target men who are considering a first-time prostate cancer screening or who want more information on regular screening. The brochure will

• Increase knowledge and awareness about the prostate, prostate cancer, and prostate cancer screening.
• Encourage men to discuss screening with their doctor or health care provider.
• Educate men to make informed decisions about screening.

The brochure is the first step in a series of materials that will include a two-part video for men and a video and brochure guide for health care providers. Additionally, CDC funded the Association of State and Territorial Chronic Disease Program Directors and its member organizations to develop and disseminate information about prostate cancer screening and treatment to educate state and local policy makers concerning the complicated issues around prostate cancer screening. The group developed and released an informational booklet titled "Prostate Cancer Screening: A Matter of Routine or Patient Choice."

Partnerships

State/Tribal Organization Partnerships

The Colorado state program will conduct random statewide surveys of men aged 50-75 years of age. The state added six questions about prostate cancer screening and awareness related to DRE and PSA testing to the 1999 Behavioral Risk Factor Surveillance System (BRFSS) survey.

The North Carolina Department of Health and Human Services will launch a statewide awareness campaign on the importance of prostate cancer clinical trials and will provide information on prostate cancer.

The Massachusetts program will collect baseline data to evaluate physician practice of prostate cancer screening.

The Texas Department of Health will conduct a physician survey to identify their practice patterns, knowledge, and attitudes on prostate cancer.

The Northwest Portland Area Indian Health Board will survey American Indian/Alaskan Native males in Washington, Idaho, and Oregon to assess their knowledge, attitudes, and behaviors about prostate cancer.

The Michigan Cancer Control Initiative/Prostate Cancer Awareness Program will develop and test public education materials to increase awareness of prostate health, prostate cancer, and early detection options.

The significant growth of cancer prevention and control programs has resulted in recognizing that improved coordination is essential to maximize resources and achieve desired cancer control outcomes. There are many benefits to a comprehensive cancer control approach, including increased efficiency for delivering public health messages and services. States and tribal organizations are valuable resources in implementing an integrated and coordinated approach to comprehensive cancer control. This approach is expected to contribute to a reduction in cancer incidence, morbidity, and mortality. In fiscal year 2002, CDC will provide additional funding to states/tribal organizations to support their priority prostate cancer activities.

Identifying the Public Health Role for Prostate Cancer

In December 2000, CDC sought expert advice from approximately 100 medical and public health practitioners, researchers, and representatives from community organizations and volunteer associations to help develop the role of public health in prostate cancer prevention and control. Experts discussed what the public health role should be related to understanding risk factors and disease burden, primary and secondary prevention, treatment, and quality of life. Discussion focused on four areas of public health: surveillance and monitoring, research, services and programs, and communication.

This Web site is intended for information only and is not a substitute for medical care or treatment by a qualified professional. Any person who has or might have a health problem should consult a professional health care provider.

Courtesy ofUnited States Department of Health and Human Services. Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health Promotion. Division of Cancer Prevention and Control.