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Prostate Cancer Awareness Day 2015

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The Israel Cancer Association and the Ministry of Health mark Prostate Cancer Awareness Day and present new and up-to-date statistics

Big-Bullet-SQR.gif The following are the main findings of the National Cancer Registry of the Ministry of Health, reported by Dr. Lital Keinan-Boker - Deputy Director, Israel Center for Disease Control (ICDC), Ministry of Health:

In an international comparison* of incidence rates, Israel ranked in the middle (11th out of 21 countries), while Israel's mortality rate is the lowest compared to the countries participating in the global comparison. 

* The comparison of the incidence and mortality rates was conducted for 20 countries with the highest rates in Europe, according to data of the International Agency for Research on Cancer (IARC) for 2012.

bul3 Prostate cancer is the most common type of cancer among Jewish men (21% of all newly diagnosed patients in 2012), and the second most common type of cancer, after lung cancer, in Arab men (13% of all newly diagnosed patients in 2012).

bul3 In 2012, 2,484 new patients were diagnosed with invasive prostate cancer and 417 men succumbed to the disease.

bul3 Prostate cancer incidence is observed mainly among individuals aged 65 and over.  The average age of diagnosis in 2012 was 69.6.

bul3 Incidence trends - in recent years, rates have dropped among Jewish men and stabilized among Arab men. 

bul3 Mortality trends - mortality rates have been on a downward trend in recent years among both Jewish and Arab men alike.

bul3 A Prostate Cancer Seminar for patients, survivors, and their families will be held on 9 September 2015, led by Prof. Avishai Sela, Director of the Institute of Oncology, Assaf Harofeh Medical Center.

Detailed Statistics:

Big-Bullet-SQR.gif Prostate Cancer Incidence (Morbidity) Rates:

In 2012, 2,484 new patients were diagnosed with invasive prostate cancer, of whom 2,231 were Jewish (90%), 138 were Arab (5%) and 115 were Christians and 'religiously unaffiliated' (5%).

Trends: Prostate cancer incidence rates have been on an upward trend since the early 90s, when the Prostate Specific Antigen (PSA) test became available in Israel.  In recent years, incidence rates have dropped among Jewish men and have stabilized among Arab men (Diagram 1).

Diagram 1: Age-standardized Prostate Cancer Incidence Rate by Population Groups, Israel 1990-2012 (Jewish and Arab men)

Big-Bullet-SQR.gif Morbidity Rates by Age:

Invasive prostate cancer incidence rates increase markedly from around age 50, among Jewish and Arab men. Morbidity levels peaked in the age group of 70-74 among Jewish men, and 75+ among Arab men.

bul3 Prostate cancer morbidity rates by place of birth and survival rates are contained in the enclosed full report.

Big-Bullet-SQR.gif Invasive Prostate Cancer Rates:

Over 26,000 men have been diagnosed with invasive prostate cancer in Israel since 1990.

Big-Bullet-SQR.gif Prostate Cancer Mortality Rates:

Prostate cancer is the fourth leading cause of cancer deaths among men in Israel after lung cancer, colorectal cancer and pancreatic cancer. 

In 2012, 417 men died of invasive prostate cancer in Israel, of whom 376 (90%) were Jewish, 28 (6.7%) Arab, and 13 (3%) 'others'.

The vast majority of deaths occurred at an older age: 87% and 71% of all those who succumbed to prostate cancer, Jewish and Arab men respectively, were aged 70 or older.

Trends in mortality rates show a decline in recent years among Jewish and Arab men alike.

Big-Bullet-SQR.gif Global Comparison Incidence and Mortality Rates in Israel and in European Countries (2012):

Global Comparison of Prostate Cancer Incidence and Mortality Rates
Big-Bullet-SQR.gif Please click here for the complete "Prostate Cancer 2015" Report (in Hebrew).

The Israel Cancer Association Information Center Presents New Studies:

Big-Bullet-SQR.gif Can overdiagnosis of prostate cancer be reduced?

In a comprehensive overview of clinical studies, research scientists of the University of California in the United States surveyed the subject of solely implementing surveillance for prostate cancer, as opposed to surgery and radiation therapy.  The researchers focused only on individuals diagnosed with early stage low-risk prostate cancer.  

The survey comes against the backdrop of the fact that most men with prostate cancer are diagnosed with localised low grade disease, which is unlikely to become deadly, and in spite of this, almost all patients who have this cancer undergo surgical procedures or radiation therapy - treatments that involve significant long-term side effects, such as impaired sexual and/or urinary function.  (This state of affairs is termed 'overdiagnosis', which is defined as the diagnosis of a disease that would not have been detected if not for the fact that the patient underwent routine tests, and therefore, in all likelihood would not have led to his demise.)

In this overview, the writers examine two methods of surveillance treatment for individuals diagnosed with prostate cancer: 

bul3 Watchful Waiting: geared toward men aged 65 or older, who have been diagnosed with low-risk prostate cancer.  These men are at a higher risk of mortality due to a different cause and not prostate cancer-specific mortality.

bul3 Active Surveillance: geared toward men aged 65 or older, who have been diagnosed, using a biopsy, with low-risk prostate cancer.  For them, the monitoring will be different, and will include repeated biopsies and rectal examinations as well as PSA tests.

Upon the processing of the survey results of the various research studies, the writers indicate: 

bul3 One of the two surveillance programs should be suggested only for men diagnosed with low-risk prostate cancer.

bul3 Among those for whom 'active surveillance' is designated, a repeat biopsy is to be performed within 3-6 months after the initial diagnosis, to rule out a more aggressive disease.  The researchers survey various technologies enabling more precise detection of a more aggressive disease.

bul3 Among those selected for the 'active surveillance' program over the course of 20 years, the risk of mortality due to a different cause, is much greater than the risk of prostate cancer mortality.

bul3 Despite the fact that 'active surveillance' does not impair quality of life, (as opposed to surgery and/or radiation therapy, it prevents impotence and urinary incontinence), younger men, and those who are monitored for a longer period of time, experience anxiety and depression.  Although, generally speaking, as stated, depression is not common among patients undergoing active surveillance.

The researchers conclude that the choice of treatment with one of the two methods of surveillance, while carefully selecting the appropriate patients for each method, have led to impressive long-term results both in survival, and in low incidence of related diseases.   Adopting this method of treatment will help reduce the rate of overdiagnosis in men with low-risk disease and will make funds available for identifying and treating men with more aggressive disease.

The writers emphasize that there should be Individualized decision-making regarding treatment, while the advantages and disadvantages of each treatment method, should be examined along with the patient, in view of the knowledge accumulated on this subject.

This survey was published in the July 2015 issue of CA - A Cancer Journal for Clinicians

Big-Bullet-SQR.gif The relationship between nutritional status and mortality among men diagnosed with non-metastatic prostate cancer

Researchers of different universities in the United States, including the University of California and Harvard University, sought to investigate to what extent nutritional status of men diagnosed with non-metastatic prostate cancer, over the years post-diagnosis, affects prostate cancer-specific mortality and all-cause mortality.

926 men with an average age of 69 participated in the study; they were requested to complete a questionnaire regarding their nutritional habits over the past 5 years from the diagnosis of their disease.  The questionnaire encompassed 39 groups of food and beverage groups.

After they completed the questionnaire, the researchers monitored the research participants over the course of a decade.

Food products were classified into two groups of eating patterns: "a balanced eating pattern", which included vegetables, fruits, soy products, fish, and whole grain products.  And a "Western eating pattern" which included processed meats, red meat, high-fat dairy products, snacks, etc., while each eating pattern was divided into 4 consumption levels: from the lowest quarter, meaning low adherence to the eating pattern, to the highest quarter - high adherence to eating pattern.

Following a weighting of additional data such as: smoking, weight, other background diseases, engaging in physical activity, etc., the researchers discovered that there is a significant direct link between a "Western eating pattern" and prostate cancer mortality: men who were classified into the highest quarter of this eating pattern, were found to be at a 2.5 fold higher risk of prostate cancer-specific mortality, than men who were classified into the lowest quarter of this eating pattern.  This risk emerged to be clearly related to the consumption of processed meat products.

Conversely, an inverse relationship emerged between the "balanced eating pattern" and all-cause mortality: participants classified into the highest quarter of this eating pattern, meaning men who made sure to consume a large amount of healthy foods such as vegetables, fruits, whole grain products, fish, etc. were found to be at a 36% lower risk of mortality, than participants classified into the lowest quarter of the "balanced eating pattern".

To conclude, the researchers indicate that adhering to a healthy diet which includes foods such as vegetables, fruits whole grain products, fish, etc. can increase life expectancy and quality of life (due to life without disease), of patients diagnosed with non-metastatic prostate cancer.

The article was published in the June 2015 issue of the Cancer Prevention Research Journal

Big-Bullet-SQR.gif Ways of reducing overdiagnosis of prostate cancer 

For every 20 radical prostatectomies, it is estimated that the life of one patient is saved.

Many research studies are conducted in an effort to identify ways of reducing overdiagnosis of prostate cancer.  The treatment of the disease leads to increased risk of side effects with a significant impact on the quality of life of men treated, and reducing overdiagnosis rates may reduce these side effects.

bul3 Investigators of the University of Illinois in the United States employed an advanced lab technique to identify certain properties of prostate gland cells that have been surgically removed, among patients diagnosed with medium-grade prostate cancer.

Researchers found that the way in which rays of light refract in the cell tissue adjacent to the cancer cells contained in the prostate, indicates the level of risk for recurrence, as is observed at elevated levels of PSA.

The investigators explain that this technology can verify whether the prostate tissue is 'decentralized' or 'unorganized', which indicates a high risk of recurrence, or 'well organized', which indicates a low risk of recurrence.

The researchers, who examined 181 samples from the prostate gland, succeeded in identifying which men who had undergone surgery would experience recurrence of the disease and which wouldn't, based on the implementation of the sampling technology.

Those who conducted this research study hope that in the future, it will be possible to identify these values based on biopsies taken upon diagnosis, as they succeeded in identifying these values in samples from prostate gland surgeries, in order to use this technology to determine which men who developed the disease will benefit from surgery and which men can continue with active surveillance of the disease, which ultimately may not even develop.  

This study was published in the May 2015 issue of the Scientific Reports Journal

bul3 Researchers of the University of Texas in the United States sought to define the role of PSA as well as its level in the blood, so that it may be used to diagnose this life endangering disease.

The investigators monitored 3,000 men who, at the outset of the surveillance, were not diagnosed with prostate cancer.  During 12 years of follow up, 302 men were diagnosed with prostate cancer.

The researchers monitored the PSA levels in their blood and found that men whose PSA level was low (0.1-0.9 ng/mL) were at a very low risk (2%-5%) of developing prostate cancer over the course of 10 years, moreover,  90% of those who did develop the disease, were diagnosed with low-grade prostate cancer, which does not necessarily require treatment.

On the other hand, men whose PSA level was high (2.3-9.9 ng/mL), were at a 15%-39% higher risk of being diagnosed with prostate cancer.

The investigators conclude men whose PSA level ranges from 0.1-1 may be monitored once every 10 years.  This approach, the researchers say, will reduce the costs of multiple tests that are currently conducted, and will also reduce overdiagnosis rates that are very common today, as well as the related repercussions, and will make funding available for those who really need the treatment, in order to reduce mortality rates.

The research study was published in the July 2015 issue of the Journal of Urology

Big-Bullet-SQR.gif Is there are relationship between testicular cancer and the development of prostate cancer?

Researchers of the University of Maryland in Baltimore, United States, sought to investigate the relationship between a history of testicular cancer and the overall risk of developing prostate cancer, as well as the risk of developing medium to high-grade disease, further increasing risk of recurrence.

For the purposes of this research study, prostate cancer incidence statistics from the American Cancer Registry database for 10,365 men with a history of testicular cancer were compared with those of 120,000 men who developed melanoma, which as far as we know is unrelated to prostate cancer.

The investigators documented the statistics on men from both groups who developed normal grade or medium to high-grade prostate cancer (Gleason Score of 7 and up.  The Gleason score is a scale that assesses the aggressiveness of the tumor, and is obtained following a sampling of the tissue taken in a biopsy).  Only men who were diagnosed 5 years and more from the time of the original diagnosis of the disease were documented (testicular cancer or melanoma), and who were over the age of 60 at the time of diagnosis of prostate cancer.

Based on the research results, it emerges that prostate cancer incidence up to the age of 80, among those who have developed testicular cancer, was 12.3%, as opposed to 2.7% among the control group of men who developed melanoma in the past.  Medium to high-grade prostate cancer incidence stood at 5.7% among those who developed testicular cancer, and a mere 1.1% in the control group.

Similarly, the researchers discovered that testicular cancer patients' risk of developing average-grade prostate cancer was 4.7 fold greater than that of the control group, and their risk of developing average to high-grade disease was 5.5 fold greater than that of the control group.

To conclude, the researchers indicate that the history of testicular cancer is related to a significantly increased risk of developing either average risk or medium to high risk prostate cancer.   Researchers advise men who have a history of testicular cancer to consult with their attending physicians regarding the advantages and disadvantages inherent in periodic testing to detect prostate cancer.  Similarly, the investigators emphasize the need for additional research studies to reinforce these results.

The research statistics were reported at the 2015 Genitourinary Cancers Symposium, and the abstract was published in the March 2015 issue of the Journal of Clinical Oncology

 

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