This paper will investigate several different academic journal articles and some popular media articles that are about prostate cancer. These articles discuss prostate cancer causes, (hypothetical and known), detection methods, and treatment options. A couple of the articles also focus on the cost of treatment for patients, as well as the risks involved with the differing methods of treatment. Several treatment options for prostate cancer are still being studied. This essay will critically analyze and compare prostate cancer detection methods, (such as Prostate-specific antigen or (PSA) tests) treatment options, and the differing success or failure of each method, as well as focusing on the increasing cost of treatment that patients are forced to pay. Some of the articles also suggest that more resources and more education are needed to help lower the mortality rate from prostate cancer. This paper will explore what is being done to help lower the mortality rate as well as what is being done to help increase the rate of early detection of prostate cancer.
Keywords: Prostate-specific antigen
Prostate Cancer: Causes and Treatment Options Available in Today’s Scientifically Advanced Society
According to the Prostate Cancer Foundation, prostate cancer occurs when cells within the prostate grow uncontrollably, creating small tumors. The term “cancer” refers to a condition in which the regulation of cell growth is lost and cells grow uncontrollably. Prostate cancer is a disease of epidemic proportions. 1 in 6 American men will be diagnosed with prostate cancer and new cases are diagnosed every 2.7 minutes (Charles 2009). As prostate cancer poses such a threat to men worldwide, more time and money should be spent to improve upon the existing methods and technology as well as invested towards education and awareness programs. The fact that these statistics are real is why prostate cancer awareness and education is so essential because many deaths could have been prevented if the cases had been detected at earlier stages of the cancer. Prostate cancer’s specific cause is still unknown, however scientists hypothesize that genes play a role, because the risk factor for getting prostate cancer is substantially higher if you have a family history of it. The two main methods used for prostate cancer screening are rectal examinations and prostate-specific antigen (PSA) blood testing. Rathus, Nevid, and Rathus (2008) remind men 50 years and older that the American Cancer Society recommends that men receive annual rectal examinations and PSA blood tests. Treatment methods for prostate cancer are limited, but new technology has allowed for a higher survival rate because of early detection.
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The first point of interest is that the costs of prostate cancer treatment have gone up substantially in the last 20 years according to USA Today reporter Lisa Szabo. In her article entitled “Patients bear brunt as cancer spending hits $90 billion” she discusses how “these rising costs have been driven by forces such as new drugs, robotic surgeries, and radiation techniques” (2010). In her findings she discovered that from 1991 to 2002 the cost of treatment for cancer doubled. “These increases are unsustainable” claims John Seffrin, CEO of the American Cancer Society. Because of the increasing costs of treatment the American Cancer society can only help 1 out of 6 patients as opposed to in the past when they were able to help 1 in 5. When one takes into account how many cancer patients are in the United States, then they can realize how many people are forgoing treatment because they are uninsured and cannot afford treatment. It is tragic that the rising costs are resulting in preventable deaths. In another article reviewed, Krahn, Zagorski, Laporte, Alibhai, Bremner, Tomlinson, Warde, and Naglie, (2009) set out to discover healthcare costs in relation to prostate cancer. They researched direct medical costs for around 42,000 men over the progression of the disease. The costs they found were between $2,000 to around $16,000 dependent on where the individual patient was in the treatment process and how advanced their cancer was. The resulting conclusion was that prostate cancer costs “are highest around two events, cancer diagnosis and cancer death” (Krahn et al’s. 2009).
The second point of interest is that drug company Roche’s “Avastin” a prostate cancer drug recently hit headlines and not in a good way. According to the Wall Street Journal, Roche Holdings released a statement that said that Avastin had failed in late stage prostate cancer trials. This news was not good for stockholders who are estimated to have lost projected sales of 7.48 billion dollars. The other bad news is that people who have been using Avastin an antibody for treatment of cancer, are also paying for something that is not as effective as they have been lead to believe.
The third point of interest is that although scientists know what causes cancer, new steps are being made to discovering what specifically causes prostate cancer, and other types of cancer. In an exciting article in Science News, author L. Sanders reviews a new study that suggests probable links between “self-renewing stem cells” and prostate cancer (2010). The study suggests that genes are the culprit. “Think about cancer as a disease of stem cells, Mutations in these cells can cause normal stem cells to lose their regularized behavior and instead turn into an incipient cancer” (Sanders 2010). The researchers also found that prostate tissue cells called “Basal stem cells” are the most likely culprit in laboratory tests done on mice. In all the research they have done, “Basal stem cells are what drives the cancer, regardless of the type of mutation” says Owen Witte, a researcher at the University of California. “A specific gene called Bmi-1 plays a significant role in “Basal stem cells” renewal process, when Bmi-1 activity was reduced, the cells were no longer able to self renew, nor did they form tumors” (Sanders 2010).
The fourth point of interest is that studies show family history of prostate cancer as one of the leading risk factors associated with prostate cancer. As Damber and Aus (2008) discovered while researching prostate cancer, family history is a large factor when assessing ones individual risk factors. They hypothesize that one apparent reason for this is that genes are passed down biologically from father to son. They also believe that the cancer causing genes mutate, but the reason(s) why are still unknown. According to the textbook authors, Rathus, Nevid, and Rathus (2008) consuming high amounts of animal fats has been shown to increase ones risk of getting prostate cancer. They also discuss how the chances are higher in black males than in white males. One thing Damber and Aus (2008) did note in their study was that the number of cases of prostate cancer was higher in men in urbanized nations as opposed to Asian men. The resulting studies showed that lifestyle differences as well as exposure to radiation were the reasons for the different statistics between Asian men and those in more urbanized nations. They also discuss how PSA and other screening methods are still being studied too analyze just how effective they actually are. Once men are suspected of having prostate cancer, the most common method of diagnosis is a biopsy which is surgically removing a small portion of the suspected tumor for testing. Most patients once they are diagnosed with the disease, are concerned with how concentrated the cancer is, because it is this factor more than any other that determines how long they have to live. “In other words, the disease establishes the prognosis more than the choice of treatment.” (Damber and Aus 2008) Treatment methods are varied and all have risks involved, but as the authors pointed out, most treatment plans are based on factors such as the PSA number, (how high or low) the level is, the size and placement of the tumor, as well as the patients individual life expectancy. Treatment plans also vary depending on if the cancer is localized to just the prostate, or if it has advanced (grown) within the prostate, or if the cancerous cells have spread to other parts of the body more serious treatment options will be considered. Damber and Aus (2008) theorize that treatment methods for both localized and advanced prostate cancer will remain the same for the time being.
The fifth point of interest is the actual treatment procedures that are currently used. According to K. Charles in her article about prostate cancer in the Daily News, NY, she discusses the three major ways to treat prostate cancer. Surgery, external beam radiation, and radioactive seed implant therapy. A fourth new and radical treatment option is known as “active survellaince, which is basically doing nothing but constantly monitoring the cancer. She discusses in her article that doctors have not yet been able to decide which treatment option is more effective than another, as they say that the results of each treatment option vary case to case. These variants also depend on how progressed the cancer is and how healthy the patient was before they got cancer.
The sixth point of interest is a possible prostate cancer treatment that is still being researched called Cryotherapy. In an article by A. Gardner, she discusses how several prostate cancer patients had successful cryoblation and their tumors were successfully thwarted. The method is still in research however, and as Dr Debra Monticciolo said, “The concept is good, but we need a bigger study with longer follow up. It takes a while for a couple of tumor cells left behind to gather enough steam to be noticed” (Gardner 2010). One of the most controversial methods of treatment is to do nothing and just check in on the cancer frequently, to ensure that it has not grown or spread. In an article by Johnsun and Treurnicht, they claim that, “The majority of men with low-risk prostate cancer will die of unrelated causes” (2009). They also discuss how this newer method of treatment, officially known as “active surveillance” challenges the old method of radiation, and instead theorizes that attentive non-action, with only minimal treatments is possibly more effective. Johnsun and Treurnicht researched a group of 549 cancer patients who were offered “active surveillance” or surgery. The patients chose the surgery. Over an 8 year time span, it was discovered that the only way to ensure if “active surveillance” is an effective method of treatment is by repeated studies of men who have had biopsies.
In another article I reviewed, author R. Lane and C. Metcalfe looked into a study that is being conducted in the UK. The study is a “randomized controlled trial evaluating different prostate cancer treatments” (2008). In the article, they claim that repeat PSA testing is one of the most effective methods for deciding if one needs surgery. According to the article, men whose PSA levels are between 3.0 and 19.99 ng/mL are all candidates for treatment and most likely, a biopsy. Also according to Lane and Metcalfe, in the trial referred to in the article, the participants were between 50 and 70 years old. The conclusions of the authors was that “repeat PSA blood testing, particularly in men aged <60 years, may help identify those with high risk cancer who would benefit from aggressive treatment, as well as preventing over-diagnosing men with clinically insignificant disease and avoiding biopsy in those with no cancer" (2008).
The seventh point of interest in regards to Prostate Cancer detection methods is the conflict over PSA testing and its accurate results, or is it as accurate as one would hope? Nogueira, Corradi, and Eastham (2009) explore other biomarkers besides PSA tests. They believe that “although PSA is the best cancer biomarker available, it is not perfect. It lacks both the sensitivity and specificity to accurately detect the presence of prostate cancer” (Nogueira et al., 2009). In their article, they evaluate the progress that is being made towards being able to use newly discovered biomarkers to help screen for prostate cancer. The studies that they review show that Human Kallikrein 2 or (hK2) is a serine protease that is closely related to PSA in sequence. The studies have revealed however, that (hK2) is not ready to be used yet as it can indicate that there are cancer cells active in the blood, but not accurately enough. This is similar to the problem that researchers run into with PSA testing. Several other membrane antigens and antibodies are also being studied, but none of them are yet ready to be used as further research and testing is still needed. In the textbook, Rathus, Nevid, and Rathus (2008) agree with this article that PSA testing is the best method available. This should not be seen as though no progress has been made however, because as Dr. Richard Stock said, “The past 40 years have seen a revolution in prostate cancer treatment. Not only are 90% of cases caught before they metastasize, but doctors have vastly improved technology for fighting cancer in the other 10% of patients” (Charles 2009).
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The eighth point of interest is the recent news that the American Cancer Society has released new guidelines on prostate cancer screenings. In the article by A. Gardner, it discusses how the American Cancer Society is now putting less emphasis on routine PSA testing and more emphasis on doctor-patient conversations and decisions. These new guidelines are issued as a result of research and the ongoing conflict over how accurate PSA testing really is. According to a statement issued by the American Cancer Society, “men with no symptoms of prostate cancer who are in relatively good health and can expect to live another 10 years should make an informed decision with their doctor about prostate cancer screening after learning the uncertainties, risks, and potential benefits associated with such screening” (Gardner 2010). These new statements disagree with with what Rathus, Nevid, and Rathus (2008), state in the textbook, “The American Cancer Society recommends that men receive annual digital rectal examinations beginning at the same age as PSA tests” (Rathus et al. 2008). They are now suggesting that PSA testing should not be a requirement for all men over 50.
The ninth point of interest, however, is that many agree that PSA testing is still not a very reliable or effective method of detection. In an article in Practical Nurse, urologist Professor Roger Kirby, director of the Prostate Centre in London, states that, “PSA testing is hugely controversial because the number of false positives and missed diagnoses of prostate cancer generated by the test raises questions about its usefulness” (2009). In the article Kirby also points out that although PSA testing is so sketchy, that unfortunately men do not have many other options for detection. He calls for more research into alternative testing methods for the presence of cancerous cells in ones blood. He also calls for more education among men, to make them aware of their risk of contracting prostate cancer. Personal education and personal awareness are key elements in fighting the mortality rate of prostate cancer.
The tenth point of interest is the progress being made towards educating the public on prostate cancer. In the European Journal of Cancer Care, contributing author S. Bowen, discusses a public health program in Ireland called the National Cancer Information Service. It was developed because of the National Cancer Forum’s, “concern that high quality, accurate information and resources should be available to the public” (Bowen 2010). The majority of people who called in to the service concerned about prostate cancer were men in their 50’s to mid 60’s. The service also found that most men were calling to find out how and where to get screened for prostate cancer. Bowen thinks this is due to not enough public awareness of prostate cancer, he believes that, “as the public becomes increasingly aware of cancer, it is important that they have access to clear unbiased information from a responsible quality service informed by ongoing evaluation” (2010).
Overall, the popular media articles that I reviewed did seem to agree with the academic journal articles. In regards to the cost of prostate cancer treatment, the textbook did not really go into depth on the topic, but the two articles that I reviewed did seem to agree with the consensus that prostate cancer treatment is expensive, and that the cost of treatment is rising. Another issue that I reviewed was also not really covered by the textbook, but the article that I reviewed was convincing in that it shows that more research is needed for prostate cancer drugs. Another issue that I reviewed was also not covered by the textbook, but I found it fascinating that scientists are coming so close to finding a way to cure cancer. Another issue I reviewed was agreed upon in my textbook, the academic article and the popular media that risk factors for prostate cancer are pretty consistent. Another issue that I reviewed was the actual procedures which did agree with my textbook. Another issue I reviewed was Cryotherapy, which is an experimental method, not covered in the textbook. Another issue was conflict over PSA testing, and I found that the academic and popular media did agree mainly when it came to this issue. I do not feel that anything was left out in these articles or the textbook. I did feel that the academic studies were and are legitimate.
I believe that future studies should focus on prostate cancer detection and treatment. The articles that I reviewed were very promising as they show that a lot of progress has already been made in reference to prostate cancer treatment and detection. I think that scientists and researchers should continue what they are doing, especially with the research on stem cells and their direct connections to cancer. I think that finding the cause of prostate cancer should be the number one priority of researchers. I also feel that finding the future cure to cancer can only be done if much more extensive stem cell and gene research is conducted. Until that cure is found howver, I believe it is important to focus today’s research on finding more accurate methods of testing, as PSA blood testing has been shown time and time again to not be as reliable as medical professionals would like it to be. The new findings that I discussed are quite exciting though, and the possibility of finding a 100% accurate test for cancerous cells in the bloodstream is most likely soon to be a reality. The discovery of a new and more accurate testing method for prostate cancer would help increase the number of survivors as well as decrease the number of false readings and wrong diagnoses.
I feel that the important message throughout the articles and research that I conducted is that men need to be more educated and more aware of prostate cancer and its symptoms and that doctors need to spend more time with their patients who are diagnosed with prostate cancer. I think that families with a history of prostate cancer need to have father-to-son discussions about prostate cancer and that they might want to cut down on their intake of animal fats and their exposure to radiation as that raises their risk. Black men who consume a lot of red meat with a family history of prostate cancer should be especially concerned. The other important thing is that men who are diagnosed with prostate cancer need to be informed of all their options, not just the options that benefit and are profitable to the medical institution providing the treatment, or the drug company providing the drugs for treatment. The new “active surveillance” prostate cancer treatment method is still under scrutiny as to whether it is as effective as medical professionals are hoping it will be. I also think that reform is needed in regards to the outrageous cost of treatment, which for the average person, is very hard to afford.
The general public needs to be more aware and educated; more societies such as the American Cancer Society are needed to help raise awareness and to provide valuable information, resources, and support to those who are affected. The financial burden on those with prostate cancer is also something that needs to be addressed. The future of prostate cancer is one that is hard to predict however, because cancerous cells and genes are constantly mutating and changing generation from generation. The sheer amount of time, money, and resources that have been put into cancer research and treatments is incredible. I think that the future of prostate cancer will hopefully be cut short by the discovery of a way to prevent the cancerous cells from mutating, whether it is from radiation, antibodies, or removal of the cancerous cells.
I also feel that the important message to anyone reading this is personal responsibility and personal awareness and education. It is not groups such as the American Cancer Society’s responsibility to educate and help those who are fighting prostate and other forms of cancer, it is the individual’s responsibility to do all that they can, within reason, to prevent and detect cancer early, before it is too late. Fear, procrastination, ignorance, and lack of health care and coverage are big issues when it comes down to the truth. The fact of the matter is that many people who are dying and have died from prostate cancer could have been saved if they had detected it earlier. The importance of getting routine screenings for men over 50 years old is crucial. The testing methods may not be 100% accurate, but it is better to be informed than to just take a chance with your life.
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