Two men share their personal stories about how cost-free prostate cancer screenings save lives

We are both men who have been diagnosed with prostate cancer. Our journeys to diagnosis were different: One of us was a firm believer in screening due to a family history of the disease, and the other was reluctant and uninformed.

However, after our individual diagnoses, we both became passionate advocates for early detection. We were both devastated but determined to fight our own battle while making other men aware of their own risks.

As Maryland residents, we were excited to learn about legislation from Del. Erek Barron and Sen. Malcolm Augustine that would help increase access and affordability for prostate cancer screenings. Finally, men aged 40-75 who, according to population data from 2018 account for almost half of Maryland’s men, will have the chance to beat the disease before it beats them.

In 2019, Maryland had the eighth highest prostate cancer incidence rate in the country. Now, in 2020, prostate cancer will be the most diagnosed cancer among men in Maryland — so much so that it’ll be diagnosed at a rate nearly double of the next most prevalent cancer for men in the state (lung and bronchus). With this legislation, Maryland can make history by becoming the second state in the nation committed to protecting the rights and wallets of prostate cancer patients. Like many medical tests, medical costs and fees can add up. No patient should be deterred from receiving a lifesaving test due to cost or unanticipated fees.

The newly introduced legislation from Delegate Barron and Senator Augustine removes all cost-sharing fees (co-pays, etc.) associated with prostate cancer screening tests — both the digital rectal exam (DRE) and the prostate-specific antigen test (PSA). Both tests are proven to detect cancer in the prostate gland and help inform treatment plans if cancer is indeed detected.

By making prostate cancer screening cost-free, the disease would finally have parity with breast cancer screenings (mammograms) and ovarian cancer screenings (pap smear). Both diseases have screenings that infer no cost-sharing fees and, further, are genetically linked to prostate cancer. Additionally, prostate cancer and breast cancer have similar incidence rates — both impacting about nearly 15 percent of the national population.

Prostate cancer often presents without symptoms making regular screening imperative to a man’s chance of survival. If caught early, the disease has a nearly 100% chance of survival. Alternatively, if the cancer is detected too late, the chance of survival drastically drops to only 30%. Removing barriers to prostate cancer screening and diagnosing prostate cancer at an earlier stage is much more cost-effective than treating late-stage prostate cancer.

It’s especially important to make screening for this awful disease accessible and affordable since prostate cancer deaths are on the rise. New reporting from the American Cancer Society shows that in 2020, the number of men who will die from prostate cancer will hit a record high over the last two decades with an increase of 5% since just last year. By making prostate cancer screening accessible and affordable, more Maryland men can have their lives saved from cancer.

Today, we both feel grateful, lucky and blessed. If it wasn’t for a prostate cancer screening, we wouldn’t be here today. It’s up to us, patients and survivors, to help save the lives of other men and make them aware of their disease risk. One way to do that is through this powerful new legislation, which has the power to save lives. Without cost-sharing fees attached to screening, more men can access prostate cancer screening without barriers. This means more lives saved, more families kept intact and more proof of the power of early detection and advocacy.

Written by Robert Ginyard and Phil Shulka, Baltimore
The writers are, respectively, chairman of the board of ZERO – The End of Prostate Cancer, and a volunteer and mentor to men recently diagnosed with prostate cancer with that organization.

Bill introduced to help VA tackle prostate cancer

Recently, Congressman Neal Dunn, M.D. introduced the Veterans Prostate Cancer Treatment and Research Act. Prostate cancer is the number one cancer diagnosed in the Veterans Health Administration with over 489,000 veterans undergoing treatment.

This new bill will direct the Secretary of Veterans Affairs to establish a national clinical pathway for prostate cancer and a standardized system of care for the treatment of what is the most commonly diagnosed cancer in the veterans’ health system.

“After everything our veterans experience while serving, the last thing they should be faced with is yet another enemy – prostate cancer,” Dunn said. “The key to overcoming prostate cancer is early detection. Veterans deserve a system that streamlines the pathway from early detection to successful treatment. This bill is a solid first-step forward to save fellow veterans lives and defeat this deadly adversary.”

Along with Dr. Dunn, Congressman Joe Cunningham is the lead Democrat co-sponsor of the legislation.

“Prostate cancer is the most common cancer diagnosis among veterans, and more prevalent among African American veterans than anyone else – one of the many health disparities that African Americans face,” Cunningham said. “This bipartisan legislation will go a long way toward improving health care outcomes for our veterans by standardizing treatment options and expanding access to cutting-edge clinical trials.”

It has been shown that veterans who have been in contact with toxins, such as Agent Orange, are at higher risk for prostate cancer. The establishment of a clinical pathway will standardize treatment options and result in improved outcomes for these patients. This bill will also create a real-time registry to track patient progress and will allow patients greater access to cutting edge clinical trials.

“The AUA is proud to support this important piece of legislation, which we believe will standardize treatment options and result in improved outcomes for prostate cancer patients. The VHA – as a national system for healthcare delivery – is perfectly positioned to create this program,” said AUA President Dr. John H. Lynch.

Air Force will have answer on pilot cancers next year, study goes on despite COVID-19

The United States Air Force has finalized the terms of a groundbreaking study sought by former fighter pilots in order to determine whether military aviators are more likely to be diagnosed with cancer.

Retired Air Force fighter pilots have pressed the service for more than a year to look at the number of aviators who have either died from, or are fighting various types of cancers, and to look for potential causes.

Late in 2019 the Air Force announced that it would conduct a first-of-its-kind study of all cancers among its former pilots, a review that may be replicated by the Navy for its aviators depending on what the results reveal.

In newly-released details, the Air Force said it had finalized the design for the study and was committed to reviewing all of its pilots dating back to 1970, which would capture medical histories of pilots who flew earlier versions of military jets that carried more powerful radars in the cockpits.

Many of the pilots have suspected that cockpit radiation generated by those radars may be linked to their cancers.

The new study will also compare former pilots’ cancer rates to cancer rates among the general population. Other previous military cancer studies had focused on internal comparisons between active duty personnel, such as comparing active duty ground crew to active duty pilots. Those studies had not found higher rates.

In October in an exclusive investigation, “Stricken” it was reported that the rates of treatment at VA health care centers for many types of cancers rose sharply over the last two decades of war. When researchers looked across all services, treatment rates for urinary cancers — which include bladder, ureter and kidney cancers — have jumped 61 percent from fiscal year 2000 to 2018. Along with those findings, prostate cancer treatment rates have risen 23 percent. The Marine Corps recorded the sharpest increase, with a 98 percent jump in urinary cancer treatments.

An earlier investigation found that since fiscal year 2000, the rate of treatment for Air Force prostate cancers at Veterans Affairs health care facilities had increased 44 percent and urinary cancer treatment rates including kidney, bladder and ureter cancers, had increased 80 percent.

A small group of former Air Force aviators from the Red River Valley Fighter Pilots Association, which represents about 3,700 veterans who flew all types of aircraft, worked behind the scenes with the Air Force surgeon general to convince the service to look deeper into the issue.

The expanded scope will also use multiple military medical databases, including the Defense Department’s Automated Central Tumor Registry and Air Force Mortality Registry.

LYNPARZA Demonstrated Overall Survival Benefit in Phase 3 PROfound Trial for BRCA1/2 or ATM-Mutated Metastatic Castration-Resistant Prostate Cancer

Only PARP Inhibitor to Improve Overall Survival vs. New Hormonal Agent Treatments for Advanced Prostate Cancer, A Key Secondary Endpoint

AstraZeneca and Merck & Company have announced further positive results from the Phase 3 PROfound trial evaluating LYNPARZA in men with metastatic castration-resistant prostate cancer (mCRPC) who have a homologous recombination repair gene mutation (HRRm) and whose disease had progressed on prior treatment with new hormonal agent (NHA) treatments (e.g. enzalutamide or abiraterone).

Results from the trial showed a statistically significant and clinically meaningful improvement in the key secondary endpoint of overall survival (OS) with LYNPARZA vs. enzalutamide or abiraterone in men with mCRPC selected for BRCA1/2 or ATM gene mutations, a subpopulation of HRR gene mutations.

The Phase 3 PROfound trial had met its primary endpoint in August 2019, showing treatment with LYNPARZA significantly improved radiographic progression-free survival (rPFS) in men with mutations in BRCA1/2 or ATM genes, and had met a key secondary endpoint of rPFS in the overall HRRm population.

The safety and tolerability profile of LYNPARZA was generally consistent with previous trials. The most common adverse events (AEs) ≥20% for LYNPARZA compared to abiraterone or enzalutamide were anemia (47% vs. 15%), nausea (41% vs. 19%), fatigue and asthenia (41% vs. 32%), decreased appetite (30% vs. 18%), and diarrhea (21% vs. 7%). Grade 3 or above AEs were anemia (22% vs. 5%), fatigue and asthenia (3% vs. 5%), vomiting (2% vs. 1%), dyspnea (2% vs. 0%), urinary tract infection (2% vs. 4%), nausea (1% vs. 0%), decreased appetite (1% each) and diarrhea (1% vs. 0%).

Dose interruptions due to an AE of any grade occurred in 45% of patients receiving LYNPARZA and 19% of those receiving an NHA; dose reductions due to an AE occurred in 22% of LYNPARZA patients and 4% of patients who received an NHA. Discontinuation due to AEs occurred in 16% of LYNPARZA patients and 9% in patients who received an NHA.

Dr. José Baselga, executive vice president, oncology R&D, AstraZeneca, said, “Overall survival in metastatic castration-resistant prostate cancer has remained extremely challenging to achieve. We are thrilled by these results for LYNPARZA and we are working with regulatory authorities to bring this medicine to patients as soon as possible.”

Dr. Roy Baynes, senior vice president and head of global clinical development, chief medical officer, Merck Research Laboratories, said, “LYNPARZA has demonstrated significant clinical benefit across key endpoints in PROfound, including overall survival for patients with BRCA or ATM mutations, and this reinforces its potential to change the treatment standard for patients with metastatic castration-resistant prostate cancer. These data further support Merck and AstraZeneca’s commitment to uncovering the ways in which LYNPARZA can help patients impacted by cancer.”

This data will be presented at a forthcoming medical meeting.

LYNPARZA was granted Priority Review by the U.S. Food and Drug Administration for patients with HRRm mCRPC in January 2020, with regulatory reviews ongoing in the European Union and other jurisdictions. AstraZeneca and Merck are exploring additional trials in prostate cancer, including the ongoing Phase 3 PROpel trial, with first data expected in 2021, evaluating LYNPARZA as a first-line therapy for patients with mCRPC in combination with abiraterone acetate.

About PROfound

PROfound is a prospective, multi-center, randomized, open-label, Phase 3 trial evaluating the efficacy and safety of LYNPARZA vs. NHA (e.g. abiraterone or enzalutamide) in patients with mCRPC who have progressed on prior treatment with a new hormonal anticancer treatment and have a qualifying tumor mutation in one of 15 genes involved in the HRR pathway, among them BRCA1/2, ATM and CDK12.
The trial was designed to analyze patients with HRRm genes in two cohorts: the primary endpoint was rPFS in those with mutations in BRCA1/2 or ATM genes and then, if LYNPARZA showed clinical benefit, a formal analysis was performed of the overall trial population of patients with HRRm genes (BRCA1/2, ATM, CDK12 and 11 other HRRm genes; key secondary endpoint).

Other secondary endpoints included OS, objective response rate, time to pain progression, rPFS in patients with HRRm genes, and safety.

Gleason Score; What Does it Mean When it Comes to Prostate Cancer?

The Gleason score plays a major role in helping patients who have been diagnosed with prostate cancer determine their outlook and treatment plan.

After a doctor diagnoses prostate cancer, a biopsy of the cancer cells in the prostate will be done. The Gleason score is then used by the doctor to help explain the results, determine how aggressive the cancer is and to plan the best course of treatment.

What is a Gleason score?

The Gleason score is a grading system devised in the 1960s by a pathologist called Donald Gleason and it measures the progress of a cancer call from normal to tumorous.

Five decades ago Mr. Gleason discovered that cancerous cells fall into five different patterns; these patterns change from normal cells to tumorous cells. He determined that these patterns they could be scored on a scale of 1 to 5.

Low Gleason scores

Cells that score a 1 or 2 look similar to normal cells and are considered to be low-grade tumor cells.

High Gleason scores

Cells that score closest to 5 are considered high-grade. These have mutated so much that, in comparison to the low grade cells, they have mutated so much that they no longer look like normal cells.

How is the Gleason score worked out?

The results of a biopsy are used to determine the Gleason score. During a biopsy, the doctor takes tissue samples from different areas of the prostate. Because cancer is not always present in all parts of the prostate, several samples are taken.

Using a microscope to examine the samples, the doctor finds the two areas that have the most cancer cells and assigns the Gleason score to each of these separate areas. Each sample area is given a score of between 1 and 5. The scores are added together to give a combined score, often referred to as the Gleason sum. In most cases, the Gleason score is based on the two areas described above that make up most of the cancerous tissue. However, there are some exceptions to the way scores are worked out.

When a biopsy sample has either a great deal of high-grade cancer cells or shows three different types of grades, the Gleason score is then modified to reflect the prediction of how aggressive the cancer will be.

What do the results mean?

When a doctor tells a patient their Gleason score, it will be between 2 and 10. Although it is not always the case, generally the higher the score, the more aggressive the cancer tends to be. Typically, lower scores indicate less aggressive cancers.

In most cases, scores range between 6 and 10. When biopsy samples score 1 or 2 they are generally not used because they are not usually the predominant areas of cancer.

A Gleason score of 6 is usually the lowest score possible. Prostate cancer with a score of 6 is generally described as well-differentiated or low-grade. This indicates that the cancer is more likely to grow and spread slowly.

Scores between 8 and 10 are referred to as poorly differentiated or high-grade, and in these cases, the cancer is predicted to spread and grow quickly.

In some cases, a patient may receive multiple Gleason scores because the grade may vary between samples within the same tumor or between two or more tumors. In these instances, the doctor is likely to use the highest score as the guide for treatment.

UroNav Fusion Biopsy System Improves Prostate Cancer Detection and Treatment

A high-tech MRI-ultrasound imaging system can result in fewer biopsies and better treatment decisions for prostate cancer patients. Dr. Robert Gaertner and Dr. Christopher Knoedler are experts in the UroNav® fusion biopsy system and have this technology available for their patients.

UroNav is a unique technology that fuses images from magnetic resonance imaging (MRI) with ultrasound to create a detailed, 3-D view of the prostate. When physicians use this improved view, it helps them perform biopsies with much higher precision, and increases prostate cancer detection.

Many prostate cancer specialists feel that UroNav revolutionizes how they diagnose prostate cancer and make treatment decisions. Before UroNav was available, when prostate cancer was suspected due to results of a PSA blood test or digital rectal exam, a physician performed a prostate biopsy which typically involved sticking a needle into 12 different areas of the prostate. This traditional method can miss a tumor. Because of this fact, physicians were led to falsely conclude that either the patient didn’t have cancer, or they were forced to perform one or more additional biopsies to find the suspected tumor.

When this new fusion biopsy system is used, the patient undergoes a MRI exam before undergoing a biopsy. The MRI is used to detect and pinpoint lesions in the prostate that may be cancerous. The MR image is fused with ultrasound imaging in real time during the actual biopsy. The system employs GPS-type technology to let the doctor guide the biopsy needle directly to the exact lesions detected by the MRI, leading to significantly fewer needle biopsies.

This technology when compared with traditional biopsy techniques that randomly sample the prostate, is a vast improvement. It is instrumental in helping physicians detect hard-to-find and often aggressive prostate cancers and can help provide greater certainty regarding the extent and aggressiveness of the disease. In many cases it makes it possible for patients to avoid multiple and unnecessary repeat prostate biopsies.

Biopsies guided by MRI/ultrasound fusion will also enable physicians and patients to opt for active surveillance, instead of surgery when appropriate. When patients are put under active surveillance, they hold off on having surgery or radiation and instead undergo periodic digital rectal exams, PSA tests and ultrasounds to see whether the cancer is growing.

No increase for the risk of prostate cancer for men who undergo a vasectomy according to Mayo Clinic Study

According to Mayo Clinic researchers in a study published in July of 2017, published in the journal JAMA Internal Medicine, there is no association between vasectomy and any form of prostate cancer. The researchers who published the story were from the main Mayo Clinic in Rochester Minnesota.

In the past, studies about the association between vasectomy and prostate cancer have shown conflicting results.

A number of studies in the late 1980s and in the early 1990s suggested an association between vasectomy and the risk of prostate cancer. In recent years, some studies have reported an association and some have not; all this discrepancy has contributed to the debate over whether there is indeed a link.

The Mayo Clinic researchers conducted a comprehensive review of previous studies and did a meta-analysis to determine if a vasectomy is associated with any form of prostate cancer, including high-risk prostate cancer, advanced prostate cancer, and lethal prostate cancer. A meta-analysis covers the combined findings of multiple studies.

Several types of research, including cohort, case-control and cross-sectional studies were covered by the study.

The definition of a cohort study is one that covers people who share a common characteristic or experience in a particular period. A case-control study compares two groups whose disease outcomes are different to try to find a reason for the difference. A cross-sectional study looks at information about a population at a point in time.

The Mayo Clinic analysis included 16 cohort, 33 case-control, and four cross-sectional studies. Together, the 53 studies covered almost 14.7 million patients.

The researchers wrote: “Of these, seven cohort studies (44%), 26 case-control studies (79%), and all four cross-sectional studies were deemed to have a moderate to high risk” of biased findings.

When the team focused on studies they considered to have a low risk of bias, they found a week association between vasectomy and prostate cancer in seven cohort studies. They also found an insignificant association between the two elements in six case-control studies.

“The association between vasectomy and prostate cancer was stronger when studies with moderate to high risk of bias were included,” the team wrote.

Overall, the findings supported the notion that there is no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer.

The study concluded: “Although patients should be appropriately counseled, concerns about the risk of prostate cancer should not preclude clinicians from offering vasectomy to couples seeking long-term contraception.”

The How’s and Why’s of Prostate Cancer Recurrence

Why and how does prostate cancer return? It’s important to face your fears and learn the facts.

With an overall five-year survival rate of close to 98 percent, prostate cancer is considered one of the most “curable” forms of cancer. However, many men continue to have the fear that their cancer persists long after the cancer itself may be gone. It is human nature to wonder “What if it comes back?” Some research studies done have estimated that as many as 70 percent of cancer patients are plagued with anxiety over a relapse. Patients should discuss these feelings, deal with them, and have a conversation with their doctor about their risk level.

Risk Factors for Prostate Cancer Recurrence

Before patients start worrying they need to understand what their risk of recurring prostate cancer really is. According to the Prostate Cancer Foundation, about 90 percent of all prostate cancer cases are diagnosed in the local or regional stages, when the five-year survival rate is nearly 100 percent. The majority men will be cancer-free throughout that time and beyond. Around 20 to 30 percent of cases, the cancer will relapse after the five-year mark.

If prostate cancer does come back, it may return in (or close to) the site of the original cancer, which is called a local recurrence. The cancer may also show up in the bones or other distant places, which is called a metastasis.

Listed below are risk factors that can help determine if a man’s prostate cancer is likely to return:

• The stage of your cancer at diagnosis. The higher the stage of prostate cancer at diagnosis, the greater the likelihood of a recurrence.
• Where the cancer spread. If your prostate cancer spread to the lymph nodes, you may be at an increased risk of recurring prostate cancer.
• The tumor itself. The larger the tumor at diagnosis, the greater the risk of a prostate cancer recurrence.
• Your Gleason score. This system measures what type of cancer cells are in the tumor, and how aggressive they are. The higher the score, the greater the risk of prostate cancer recurrence.

At the time of the initial diagnosis there are also certain warning signs that the prostate cancer could recur. Doctors might find certain measures of aggressiveness during the biopsy that initially diagnoses prostate cancer, and these could indicate the likelihood of a recurrence. Very aggressive tumors have more tendency to recur.

If Prostate Cancer Returns There Are Treatment Options Available

The prostate cancer treatment that is best for you will depend on the treatment you first received to battle the cancer. Hormone therapy, radiation and chemotherapy are all options to treat recurring prostate cancer.

Dealing With Your Fear

Make sure to discuss your concerns about prostate cancer recurrence with your doctor. It’s important not to let fear and anxiety lead to depression and other emotional and mental health issues. Talking about your concerns and being educated on your risks and treatment options can help in preparing for what may happen.

Prostate Cancer: Coping With the Disease By Using Relaxation Techniques

It’s been proven that simple relaxation techniques can actually help ease the stress and anxiety of prostate cancer diagnosis and treatment.

Patients who have received a diagnosis of prostate cancer can feel stress, anxiety and even depression. It may seem overwhelming to deal with a diagnosis of prostate cancer, the treatments for it, and the side effects. These feelings are perfectly normal. Learning to manage that stress is can be an important positive step to managing your condition.

According to a recent study, easing stress prior to prostate cancer surgery could help speed up both physical and psychological recovery. Researchers followed more than 150 men and found that those who underwent stress management sessions prior to their treatment experienced higher immunity and improved mental health months after the operation.

If you feel like your stress and anxiety are completely out of hand, by all means talk with your doctor. But there are some simple steps you can take to help you feel more calm.

Learn Some Techniques to Help You Relax

Four great ways for patients to learn to help themselves are through relaxation, breathing, medication, and guided imagery. The beauty of these tools is that they can help you get through almost any kind of stress over and above medical issues. Meditation can help center a person and give them balance and a calm feeling. Prostate cancer patients have many ways to teach their bodies to relax and release stress.

• Guided imagery. When you feel stressed or anxious, try creating a picture in your mind of peace and calmness.

• Relax your muscles. This is an exercise you can do just about anywhere. Focus on your body then tighten and release the muscles section by section. Once you experience how different each sensation feels, you can become more aware of a relaxed feeling. Many people start by relaxing their toes and work up to their head and neck.

• Breathe slowly and deeply. Take a long, slow, deep breath in through your nose. Breathe in until your chest and lungs are full of air. Hold it and then after a second or two, slowly breathe out.

• Meditation. This is another exercise that you can do just about anywhere. Even while resting, walking, receiving treatment, or simply sitting in your doctor’s office. Clear your mind of all thoughts to relieve stress.

How These Relaxation Techniques Help Prostate Cancer Patients

There are physical health benefits that come as a result of alleviating stress. Reductions in stress can slow heart and breathing rates, lower blood pressure levels, reduce muscle tension, and increase blood flow in the muscles.

Patients who practice these relaxation methods are often:
• More energetic.
• Able to do more during the day.
• Experiencing less pain.
• Experiencing less anger.
• Better able to concentrate, problem-solve, and make decisions.

Prostate Cancer; When Watchful Waiting is the Answer

Patients are used to asking the question, “When do we starting treating it and what type of treatment will we use?”. But with prostate cancer in many cases the answer could be “We’re not going to treat it.” The “wait and see” approach may well be the right option for your prostate cancer.

Watchful Waiting/Active Surveillance

Also called “active surveillance” the term “watchful waiting” describes one way to “treat” prostate cancer. It is used to describe cases where the prostate cancer patient has opted to refuse surgery, radiation, hormone therapy, and any other medication to treat the prostate cancer. Instead of treatment doctors will rely on prostate-specific antigen (PSA) tests and digital rectal exams (DRE) to monitor disease progression. If and when one of these tests show that the cancer is progressing, at that time other more active treatment options may be considered.

Certain types of prostate cancer can be very slow to progress; some men who have it will never experience any symptoms or problems. Occasionally the disease can actually be less damaging than the treatment. Prostate cancer can be monitored regularly with frequent testing — about every six months — and without surgery or radiation. According to a large, long-term study of nearly 800 men with prostate cancer, the risk of dying from a “low-risk” tumor is similar whether you choose observation or treatment.

Are You a Good Candidate for Watchful Waiting?

Not all patients are good candidates for watchful waiting. Younger men or men who have aggressive prostate cancer are often recommended to take a more proactive approach to treatment, but older men who are concerned about side effects — commonly, impotence and incontinence —may want to consider watchful waiting.

The following are other factors that can indicate whether watchful waiting is a viable treatment method for a prostate cancer patient:

Early stage diagnosis. The earlier the stage at diagnosis, the more time a prostate cancer patient may have in determining what treatment plan is best.
Short life expectancy. If a man has a life expectancy of less than five years for other medical reasons he may opt for watchful waiting.
Having another serious health condition. If a patient is struggling with another disease or health condition, they may not want to proceed with surgery or radiation for prostate cancer at the same time.
Gleason score. When the cancer is not aggressive and is slow to progress, a man may have a low Gleason score. This patient may consider watchful waiting as an option.