Controversies around screenings and hormone therapy have experts questioning which best practices for prostate cancer help men live longer.
Prostate cancer, the second most common cancer for men in the United States, is no longer a death sentence.
According to the American Cancer Society, one in seven American men will be diagnosed with the disease at some point.
However, as the 2.9 million living men who have survived prostate cancer can attest, the 15-year survival rate is up to 94 percent.
As September is Prostate Awareness Month, screenings and treatments have been at the forefront of discussion.
Some recent findings have shed light onto prostate cancer treatments and may impact how prostate cancer is treated in the near future.
Supplementing the human body with hormones is a touchy issue.
From athletes juicing for better performance to older men being targeted for the new condition known as “low testosterone,” researchers are still discovering how the body reacts to extra boosts of hormones.
A new study in the Journal of the American Medical Association suggests current treatments for high-risk prostate patients may have some unwanted consequences.
Researchers at several university hospitals followed up on 17 years’ worth of data on men with prostate cancer who underwent six months of androgen deprivation therapy (ADT) and radiation therapy compared to those who were treated by radiation therapy alone.
The researchers found men who underwent androgen deprivation therapy — which prevents hormones like testosterone from helping prostate cancer cells to grow — had a significantly higher risk of dying from heart-related problems.
This, researchers concluded, suggests that using hormone therapy in prostate cancer patients should be weighed seriously.
Leslie Schlachter, senior physician assistant and director of the Mount Sinai Men’s Health Program at the Icahn School of Medicine at Mount Sinai in New York, said the relationship between androgen deprivation and cardiovascular events is a newer association that many people neither know about nor discuss.
“The idea behind androgen deprivation for prostate cancer is to starve the body’s testosterone, thus making prostate cancer growth halt or slow. Unfortunately, some of the potential side effects of androgen deprivation are decreased muscle mass, increased fat especially in the abdominal region, insulin sensitivity, and increased cholesterol levels, specifically triglycerides and LDL,” Schlachter, who was not involved in the study, told Healthline.
“The theory is that androgen deprivation can cause a metabolic syndrome. What we know to be true is that metabolic syndrome is one of the underlying causes of cardiovascular risk,” she said. “Increased cholesterol levels, insulin sensitivity resulting in high levels of glucose, and increased abdominal obesity can lead to cardiac events like heart attack or stroke.”
At Mount Sinai, patients on hormone therapy are required to meet with diet and lifestyle experts who closely monitor the patients’ blood levels, weight, and other indicators of health.
“Because all the changes to the body can negatively affect the patient, we try to counteract this proactively by placing the responsibility on the patient to take charge of their body’s health,” Schlachter said. “Most importantly, we take initiating ADT the most seriously. We do not place patients on androgen deprivation unless it is medically necessary to prolong survival or cure.”
In 2012, the U.S. Preventive Services Task Force released its recommendation against prostate-specific antigen (PSA)-based screening for prostate cancer.
The rationale was that excess testing led to overdiagnosis and overtreatment, essentially creating more harm than good.
And wouldn’t you know, not everyone is on board with their decision.
In the current issue of the Journal of Urology, Dr. Daniel A. Barocas, assistant professor of urologic surgery at Vanderbilt University Medical Center in Nashville, argues that since the advent of PSA screenings in the late 1980s, deaths from prostate cancer have decreased by 40 percent.
Barocas and other investigators discovered that a month after the new guidelines were instituted, the number of prostate cancers dropped by more than 12 percent but diagnoses of colon cancer remained stable.
While overall diagnoses of prostate cancer have dropped between 23 to 29 percent in men over 70 — those most likely to develop it — researchers argue this could result in missed opportunities to save men’s lives.
“While some of the effects of this guideline may be beneficial in terms of reducing harms of overdiagnosis and overtreatment, the reduction in intermediate and high-risk cancer diagnoses raises concern for delayed diagnoses of important cancers associated with inferior cancer outcomes,” Barocas said in a press release.
Schlachter said PSA testing and digital rectal exams remain the standard of care.
“The bottom line is, if a man over the age of 50 chooses to forgo a yearly rectal exam and PSA testing, he could be missing a serious cancer that could be deadly,” she said.
Here are some tips Schlachter has for men concerned about their prostate health:
- Get a yearly PSA test and rectal exam.
- See your primary care physician once a year for a blood pressure check, cholesterol check, weight check, and basic blood work with an exam.
- Keep a healthy, active lifestyle with cardiovascular exercise, weightlifting, and a healthy diet.
- Cut out any unhealthy lifestyle habits like smoking, drugs, excessive alcohol intake.
- Keep your stress levels low. “Life can be difficult; added stressors can cause serious conditions,” she said.
- Get a healthy amount of sleep. More than six hours is recommended.
Schlacter says the old saying, “What we don’t know can’t hurt us,” isn’t true.
“It’s always better to know what is happening inside of your body and take ownership of it,” she said. “Being comfortable with your physician is paramount, as it should be a team approach with doctor and patient.”