The Israel Cancer Association and the Ministry of Health to mark Prostate Cancer Awareness Day on 15 September 2013
New and up-to-date findings
Dr. Lital Keinan-Boker - Deputy Director, Israel Center for Disease Control (ICDC), Ministry of Health: presented up-to-date statistics of the ICDC, Ministry of Health regarding prostate cancer: prostate cancer is the most common type of cancer among men in Israel (the most common cancer among Jewish men, and the second most common cancer among Arab men, after lung cancer).
There are currently some 22,000 men have been living with prostate cancer in Israel.
In 2010, 2,557 new patients were diagnosed with invasive prostate cancer, of whom 2,314 were Jews (90%), 123 were Arabs (5%) and 120 were others (non-Arab Christians and 'religiously unaffiliated').
There has been an upward trend in age-standardized invasive prostate cancer incidence rates since the early 90s. These rates reached a peak in 2007, dropped over the past few years, and have currently stabilized. The rate among Jewish men was 52.3 per 100,000 in 2000 and 60.4 per 100,000 in 2010.
The invasive prostate cancer incidence rates rose mainly during the late 80s, and in the early 90s, when PSA testing became frequent and available in Israel.
Morbidity Rates by Age
Invasive prostate incidence rates increase from around age 50 in all population groups. In 2010, morbidity was mainly observed among persons aged 65 years and above. Among Jews morbidity levels peaked in the age group of 70-74, and among Arabs in the age group of 75 years and over.
Morbidity Rates by Place of Birth
In 2010, there were no significant differences in the age-standardized invasive prostate cancer incidence rates, between the various ethnic groups among the Jewish population.
The highest rate was observed among those of European and American origin (64.8 per 100,000) and the lowest rate was observed among those of Asian origin (57.9 per 100,000).
There is an upward trend in the relative survival rates for prostate cancer, and the 5-year relative survival rate exceeds 90%.
Prostate cancer is the fourth leading cause of cancer deaths among men in Israel, after lung cancer, colorectal cancer and pancreatic cancer.
In 2010, 380 men died of invasive prostate cancer in Israel, 348 (91.6%) of whom were Jewish.
In recent years, there has been a downward trend in age-standardized invasive prostate cancer mortality rates among Jewish men: in 2000, the mortality rate was 8.53 per 100,000, compared to 2010, in which morality rates were 6.56 per 100,000. A downward trend has also been evident among Arab men, and mortality rates have stabilized in this population over the past year.
According to the International Agency for Research on Cancer (IARC) 2008 statistics, which compare the age-standardized invasive prostate cancer incidence rates and mortality rates in Israel to those of the top 20 countries with the highest rates in Europe, it emerges that the rates are relatively low in Israel and are similar to those reported in Italy and Spain.
Click here for complete data: Prostate Cancer in Israel 2013 (in Hebrew)
In keeping with yearly tradition, the Israel Cancer Association will be holding its annual Prostate Cancer Seminar for patients, survivors, and their families, free of charge. The seminar is scheduled to take place on Wednesday, 11 September 2013 at "Kfar Hamaccabiya" located at 10 Peretz Bernstein St. in Ramat Gan. The seminar, featuring multi-disciplinary experts in this field, will be led by Dr. Wilmush Marmorshtein, Deputy Director of the Oncology Dept., Soroka Medical Center in Beer Sheva, and Chairman of the Israeli Society for Clinical Oncology and Radiation Therapy (ISCORT).
During Prostate Cancer Awareness Day the ICA launches a public information campaign via the various media, and advises men over the age of 50, and men at high risk, to schedule an appointment with their attending physician for consultation.
What do you tell a patient about prostate cancer screening tests?
Guidance Statement From the American College of Physicians - An American Society of Clinical Oncology (ASCO) provisional clinical opinion (PCO) offering timely clinical direction
Prostate cancer is the fourth leading cause of cancer-related death among men in Israel. In the United States 1 in every 6 men will be diagnosed with prostate cancer at some time in his life - 2.9% will die of the disease.
It is difficult to estimate the percentage of men who have been diagnosed with prostate cancer, but never have any clinical symptoms. It is estimated that the percentage ranges from 23% to 66%.
According to the prevalent global view, the harms of PSA-based (prostate-specific antigen) screening outweigh its benefits, and therefore, in Israel, as well as in most countries of the Western world, there is no all-encompassing recommendation to implement the screening test.
The ten guidelines that have been formulated are aimed at assisting physicians to enable patients to make a well-informed decision regarding the prostate cancer screening test:
1. The ACP recommends that men between the ages of 50 and 69 years old should discuss the limited benefits and possible harms of the prostate-specific antigen (PSA) test with their physicians. The ACP's first guideline recommends that physicians base their decision to order a PSA test on the risks and benefits of screening, taking into account each man's individual risk factors for prostate cancer and their life expectancy, and according to the patient's personal preferences. In men who don't express a clear preference for screening, the ACP advises physicians not to use the PSA test.
2. The second guideline recommends against routine screening for men who are not at high risk, are under 50 or over 69 years old, or men with a life expectancy of less than 10 to 15 years. Despite the fact that physicians are advised not to order a PSA test for men who are who do not request the test, there are still men who would prefer to undergo this test. Under these circumstances, it is advised that the decision be made jointly by the physician and the patient.
Ten important points that the physician should indicate to and clarify for the patient:
1. Prostate-specific antigen (PSA) testing is controversial [because of the challenge in balancing the benefits and risk of screening].
2. The PSA test can diagnose prostate cancer; however for most men, the possible harms of the test will outweigh its benefits.
3. A small number of prostate cancers may cause mortality. In the majority of cases, prostate cancer will develop slowly and does not cause death.
4. Most men who choose not to take the PSA test will not be diagnosed with prostate cancer during their lifetime, and will die of other causes.
5. Patients who choose to take the PSA test will have a higher chance of being diagnosed with prostate cancer.
6. Sometimes, the PSA test does not differentiate between deadly cancer and a non-lethal cancer. However, men with a high PSA level (over 10 mg/L) have a lower risk of dying from prostate cancer, if they undergo surgery.
7. The small advantage of the prostate cancer screening test is inherent in the prevention of the death of 1 in 1,000 men who have been monitored over a period of 11 years.
8. PSA testing is associated with harms such as:
- An error in interpreting the results.
- An elevated PSA level could be due to a (benign) prostatic enlargement, and not due to cancer, or alternately, the PSA level may be low despite the presence of prostate cancer.
- If a biopsy is required, it may also involve risks. A biopsy requires the use of needles which are penetrated into the prostate under local anesthesia, and there is a risk of infectious complications, bleeding and hospitalization.
- If cancer is detected, it is usually treated with surgery, or radiation, [prevention] methods which also involve risks. There is also a small risk of death during surgery. Additionally, each one of these methods involves a 37% increase in risk of impotence (erectile dysfunction), and incontinence, which requires the use of diapers (an 11% increased risk), compared with the risk without surgery.
9. The PSA test is not a simple blood, test, this is a test that may "open the doors" to other tests and treatments that may be detrimental to the patient's well-being. The chances of the person incurring damage outweigh the possible benefits from the test. Therefore, each person must be well-informed so that they can decide whether to take the test.
10. Research studies are conducted on a regular basis, such that physicians may learn more about the benefits and the harms involved in prostate cancer screening. Efforts are being made to develop more efficient detection tests and treatment methods, such that recommendations may change with time.
Can the consumption of tomatoes prevent prostate cancer?
In a survey of research studies, scientists have demonstrated the impact of lycopene as a potential agent for the prevention of cancer in general and prostate cancer in particular.
There are reports that indicate that 30% of men in the United States between the ages of 20-40 carry microscopic tumors in the prostate, these tumors may develop into prostate cancer. Therefore, intervention with the help of nutritional supplements is of significant importance, in order to reduce the growth and advancement of these small tumors.
Lycopene is a fat-soluble molecule that is contained mainly in red fruits and vegetables, such as: tomatoes, water melon, apricots, pink guava and papaya. The anti-oxidant activity of lycopene is based on this compound's ability to trap free radicals in cell-culture and live models.
Various epidemiological and clinical research studies have sampled the link between increased consumption of tomato products and the reduced risk of malignant tumors, and a close link between the concentration of lycopene in plasma and malignancy of the pancreas and bladder.
Several research studies have reviewed the link between the consumption of tomato products, the absorption of lycopene into the blood stream and the risk of developing cancer, and specifically, prostate cancer. The most impressive statistics regarding the consumption of tomato products and the prevention of malignant tumors were obtained vis-à-vis prostate cancer.
A reverse link was discovered between the consumption of lycopene from various tomato products, and the risk of prostate cancer. A nearly 35% decrease in the risk of prostate cancer was observed in relation to a consumption frequency of 10 servings, or more, of tomato products a week.
The protective effects are even stronger in cases of advanced or aggressive prostate cancer. It has also been found that lycopene may reduce the symptoms of prostate cancer, particularly reducing the pain, and alleviating urination. However, statistics that were obtained are not unequivocal.
There are research studies that have not found a link between the consumption of lycopene and prostate cancer and others as mentioned that attest to the fact that high lycopene consumption, or high lycopene concentrations in the blood reduce the risk of prostate cancer by 30%-40%, especially aggressive prostate cancer.
It is estimated that the processing and heating up of tomato products increase the biological availability of lycopene, and the presence of fats in food increases the absorption of lycopene. Therefore, processed tomato products such as ketchup, are a good source of lycopene.
As mentioned, further research is required to support these findings.
Medicine, Volume 152, edition no. 8, August 2013. "Survey of research studies on the consumption of lycopene and tomato products and the treatment or prostate cancer or its prevention", Tali Zilberstein, Soroka medical Center, Eldad Zilberstein, Ben Gurion University, and Oshra Sapir, the Sami Shimon Academic College.
Is there a link between drinking coffee and the recurrence of prostate cancer?
In a study conducted by scientists from the Fred Hutchinson Cancer Research Center in the United States, the coffee and tea consumption of 630 men diagnosed with prostate cancer was monitored from 2002-2005 in the State of Washington.
The scientists obtained statistics about the coffee and tea consumption of the study subjects over a two-year period prior to diagnosis. The subjects were not asked to report the type of coffee, regular coffee or decaffeinated coffee, nor to report the type of tea, and the scientists assume that regular black tea is involved.
In addition to the questionnaire, the scientists reviewed health related events concerning the subjects over a period of six and a half years after the diagnosis.
A follow up questionnaire was conducted in 2011, reporting statistics about the recurrence of the disease, treatments and tests conducted during the follow up period, etc. During these years, 140 cases of disease recurrence or its advancement were reported, with recurrence defined as prostate cancer mortality, detection of metastatic tumors, receiving additional treatment for the disease, or elevated PSA level.
Statistics regarding coffee consumption were divided into 5 categories: less than a cup a week, 2-6 cups a week, a cup a day, 2-3 cups a day and over 4 cups a day.
About 61% of the patients consumed less than a cup of coffee a day, 12% consumed over 4 cups a day.
It emerged that the consumption of coffee was related to a lower risk of recurrence, or advancement of the disease. Patients, who consumed 4 cups of coffee a day, were at a 59% lower risk of disease recurrence or advancement, than those who were in the lower category - consumption of one cup a week.
The scientists discovered that consumption of tea was unrelated to the risk of disease recurrence or advancement. Similarly, no link was found between the consumption of coffee and prostate cancer mortality or other causes of mortality.
In view of the fact that past research studies have found that the consumption of coffee is linked to a reduced risk of developing several types of cancer, scientists estimate that coffee contains certain ingredients that have an anti-cancer effect. Seeing as another research study regarding the consumption of regular coffee and decaffeinated coffee indicated a similar link regarding aggressive prostate cancer, research scientists have proposed the hypothesis that perhaps this involves an ingredient other than caffeine per se. They place an emphasis on the need for larger and more comprehensive research studies, to support these findings. On the other hand, it is worth noting that the results of this research study match the findings of Harvard's Health Professionals Follow-up Study which discovered that men who drink 6 or more cups of coffee a day reduced the risk of metastatic prostate cancer by 60%, compared with men who did not drink coffee.
This research study was published in the Cancer Causes & Control Journal, August 2013 edition. (Milan S. Geybels, et al.).
Active surveillance as a treatment option for prostate cancer, among patients with very low risk cancer who have benign prostatic hyperplasia
In a research study conducted in the Urology Dept. of the Carolinas Medical Center in North Carolina in the U.S., research scientists using the method called 'active surveillance' monitored patients diagnosed with very low risk prostate cancer, and who were treated with drugs due to benign prostatic hyperplasia.
Considering the advanced age of many of those diagnosed with prostate cancer, and the possible side effects that could result due to the treatment for this disease, active surveillance appears to be a therapeutic option for a certain group of patients. The American National Comprehensive Cancer Network (NCCN) recommends active surveillance for those diagnosed with prostate cancer who have a life expectancy of less than 20 years and who are at a very low risk of spread. Very often, these men also suffer from benign prostate hyperplasia.
Treatment for men with benign prostatic hyperplasia, with urinary tract symptoms and diagnosed with very low risk prostate cancer, poses a dilemma for physicians, as it is feared that the medicinal treatment for benign prostatic hyperplasia will aggravate the very low risk cancer that has been diagnosed.
82 men who were diagnosed with a very low level malignant cancer (Gleason score equal to or less than 6) as well as with Benign Prostatic Hyperplasia (BPH), and were treated with Proscar or Avodart for this problem, took part in this study. The treatment was designed to reduce the volume of the prostate gland and reduce PSA levels. The active surveillance included monitoring PSA levels every six months, biopsies a year after diagnosis, and two years after.
The scientists discovered that during the 3 years of active surveillance of these men who developed very low risk prostate cancer, and were treated with drugs to reduce benign prostatic hyperplasia, about 70% of the men saw no advancement in the disease, or their biopsies came out negative.
Among the 82 patients, 76 had undergone another biopsy a year later. 41 of these men (54%) showed no signs of cancer whatsoever, 16 (21%) continued to be at a very low risk, and 19 (25%) of the patients showed signs of the disease advancing to 'low risk', or medium risk. No patient had 'high risk' disease, and those who underwent a second biopsy did not show any signs of 'high risk' disease either, two years later.
Only 22 (about 27%) of the 82 patients did not suffice with active surveillance and received treatment for prostate cancer. Their results after 3 years of surveillance did not differ from those who were solely under active surveillance.
This research study was published in the Urology Journal May 2013 edition (Peter Q. Shelton et al.)