I was recently diagnosed with prostate cancer. My father and uncle also had the disease. My doctor says it is much more common in African American men than in white men.
Prostate cancer is now the
most common cancer in American men. The dramatic rise in incidence may
be due to the aging of the American population and to improvements in cancer
diagnostic technologies. For unknown reasons, prostate cancer incidence
and mortality rates for African American men are the highest of any race
or ethnicity in the world. Men with a family history of the disease are
at especially high risk. Determining why these rates are so high in African
American men has been a tremendous challenge to scientists, and research
is progressing along several lines of investigation. Answering this question
may lead to effective prostate cancer prevention and may benefit all men.
There seems to be a lot of controversy about prostate cancer screening and treatment. My other male relatives--including my sons--don't know if they should be screened or what they can do to keep from getting prostate cancer.
Screening for prostate cancer is available, but whether it should be done is disputed among experts in the field. Current screening technologies are effective at diagnosing a large number of early stage prostate cancers, but these may be either slow-growing prostate tumors that will not cause medical problems or fast-growing aggressive tumors that need treatment. Until we have a better understanding of the cell biology and genetics of prostate cancer and develop tests that can distinguish between indolent and aggressive tumors, men who choose screening risk receiving unnecessary treatment if a tumor is found. Men need to know these facts. To determine the efficacy of prostate cancer screening and answer other cancer screening questions, the NCI started the 16-year Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) in 1993, which will ultimately enroll 74,000 men and 74,000 women.
At this time, there is no known way of preventing prostate cancer. A number of epidemiologic studies are trying to determine the avoidable causes of prostate cancer. The Prostate Cancer Prevention Trial (PCPT) is a clinical trial involving 18,000 healthy men over age 55. Lasting nearly 10 years, it will determine if the drug finasteride can prevent prostate cancer. The PCPT may also help better define who is at risk for clinically significant prostate cancer and improve early detection and screening technologies.
You know, you have to learn a lot about cancer once you have it. It was disturbing that my doctor couldn't tell me for sure which option for treating my localized prostate cancer would be best, but he helped my wife and me talk over all of the pros and cons, and I chose the treatment that seemed right for me.
Therapy for localized prostate cancer is usually either surgical removal of the prostate (radical prostatectomy) or external beam radiation therapy. Recent surgical improvements include anatomic (nerve-sparing) radical prostatectomy, which minimizes the risk of post-surgical impotence and incontinence. Conformal beam approach radiation therapy focuses the radiation beam more closely on the prostate, sparing damage to other pelvic tissues. NCI Cancer Centers are also assessing the effectiveness of freezing the prostate (cryotherapy) and radioactive seed implantation (brachytherapy).
The variable course of prostate cancer suggests that many men may not need aggressive therapy. The Prostatectomy Intervention Versus Observation Trial (PIVOT) is assessing patient outcomes with radical prostatectomy or "watchful waiting" to try to determine who needs aggressive therapy.
NCI studies of prostate cancer treatment have had strong minority participation and have shown that equal treatment yields equal outcomes among the races. However, NCI studies of medical practice patterns have demonstrated racial disparities and geographic differences in how prostate cancer is treated in the U.S. Now that these inequities have been discovered, health professional and public education can be targeted to address them and ensure the best possible prostate cancer treatment and survival for all American men.