Prostate Cancer - Three Observations

September 13, 2010

by Christian McEvoy, MPH

Director, Connecticut Challenge Survivorship Center

September is prostate cancer awareness month. I have a particular interest in prostate cancer. When I studied at the Johns Hopkins Bloomberg School of Public Health, I worked under one the worldwide leaders in prostate cancer research.

I often use prostate cancer as an example when I’m discussing survivorship because it clearly illustrates the complicated nature of survivorship. For example, one might assume that smoking is a risk factor for developing prostate cancer; however, this isn’t true. On average, a man who smokes is no more likely to develop prostate cancer than a man who does not smoke. But that is not the end of the story. After diagnosis of prostate cancer, a man who continues to smoke is far more likely to die of prostate cancer than a man who does not smoke. Researchers don’t understand it yet, but there seems to be something in the biology of prostate cancer that is strongly influenced by smoking. In case you missed it, this is one of the first issues of survivorship after a diagnosis of prostate cancer. As in all other cases, stop smoking!

Another thing I find very interesting is the concept of biochemical recurrence (BCR). The National Cancer Institute defines BCR as “A rise in the blood level of PSA (prostate-specific antigen) in prostate cancer patients after treatment with surgery or radiation. Biochemical recurrence may occur in patients who do not have symptoms. It may mean that the cancer has come back. Also called biochemical relapse and PSA failure.” The key thing that I glean from this definition is that BCR “may mean” that the original prostate cancer has recurred. How does this happen if prostate was surgically removed? The less-than-obvious truth is that despite the best efforts of a surgical team, microscopic cancerous cells can be left behind during surgery. Those cells can rapidly divide just like the cells that originally caused the tumor to grow in the prostate. A survivors’ doctor can suggest a regular screening for prostate cancer survivors.

A recent study of prostate cancer survivors caught my attention. The study was conducted in the Netherlands, but it suggests something I have suspected for quite some time. The study suggests that long-term prostate cancer survivors who are categorized in low socioeconomic status (e.g., low education, low income, low access to health care) experience a higher risk of mental health-related quality of life problems. Here’s why I suspected this might be the case: prostate cancer survivors regularly experience urinary and sexual dysfunction. I’m a man, and I intuitively understand how difficult that must be. Many doctors are proactive in treating these side effects, but if a man has low access to care (e.g., if he sees his physicians less often), the man might not be treated for such issues. Bottom line, prostate cancer survivors should be proactive in discussing the side effects of treatment with their doctor, and that discussion can and should start at the point of diagnosis.

Site Map