Prostate Cancer 2008: The Year's Top Stories

Prostate cancer remains the most common form of cancer in men and ranks as the third most common cause of all cancer deaths in males.

The past year was relatively quiet as far as new developments in the diagnosis and treatment of prostate cancer were concerned, with studies finding that dietary content was not a significant factor in the prevention or treatment of the disease and that there was not enough data to indicate that routine prostate cancer screening offered a "quality of life" benefit to those over 75 years of age leading the list of newsworthy items for the year.

Prostate Cancer Risk and Diet

There was more evidence this year that diet, or the use of dietary supplements, has no significant role in the prevention or treatment of prostate.

The year concluded with not one but two studies that were considered of sufficient importance that they were released simultaneously in the online edition of the Journal of the American Medical Association on December 9, 2008.

The first study,"Vitamins E and C in the Prevention of Prostate and Total Cancer in Men," evaluated the protective effects of supplements of 400 IU of vitaminE every other day and 500 mg of vitamin C daily in 14,641male physicians in the United States initially aged 50 yearsor older, including 1,307 with a history of prior cancer. After a median follow-up period of 8 years, statistical analysis demonstrated no decreased incidence of prostate cancer or cancer involving another organ.

In the "Effect of Selenium and Vitamin E on Risk of Prostate Cancer and Other Cancers" study, participants from two previous studies were re-evaluated to determine if selenium or vitamin C, alone or together, had any effect on the number cancers later detected. Again, there was no statistical difference in the results.

In an accompanying editorial, "Randomized Trials of Antioxidant Supplementation for Cancer Prevention: First Bias, Now Chance-Next Cause," Peter H. Gann, MD, of the University of Illinois at Chicago School of Medicine, reviewed the history of claims that dietary factors were a significant factor in the subsequent development (or non-development) of cancer. After reviewing the relevant data he concluded that (as I paraphrase) if you eat a sensible, "heart-healthy diet," your chances of living long enough to develop prostate cancer will improve significantly.

Screening for Prostate Cancer

In the August 5, 2008 issue of the Annals of Internal Medicine the U.S. Preventative Services Task Force (PSTF) revised its 2002 "insufficient evidence for or against" opinion regarding the value of routine prostate cancer screening in those 75 years of age and older to a "not recommended" position. This revision is in line with the February, 2008 statement of the American College of Preventive Medicine which concluded that there was "... insufficient [clinical or scientific] evidence to recommend routine population screening..." as a strategy to reduce the number of deaths due to prostate cancer.

The argument behind these statements is that, at the age of 75, the "natural" median life expectancy is actually no different if a prostate cancer is detected and treated than if the condition was either absent or detected and not treated. These recommendations merely reaffirm the validity of the old pearl of medical wisdom that "more men die with prostate cancer than from it."

Treatment

The first trial to show an overall survival advantage for radiation therapy as the primary treatment of prostate cancer was published online December 16 by the respected British medical journal Lancet. Even more importantly this same study demonstrated that for older men with advanced prostate cancer, adding radiation to androgen-deprivation therapy reduced their risk of dying from the disease by 50%.

Androgens are the general name of the male sex hormones. Androgen-deprivation, or androgen-blockade therapy, relies on medications the 1) increase the levels of female sex hormones that are normally present in small amounts and by 2) blocking the normal metabolism of androgens in the testes and the prostate gland.

In the Lancet study, both radiation and androgen-blockade treatment was associated with side effects such as nausea, impotence, and urinary incontinence. However, the study's authors report that these side effects were easily managed with changes in medication or radiation schedule.

As noted above, 2008 was a quiet year as far as developments related to the diagnosis and treatment of prostate cancer were concerned. Maybe next year the news will be better and I'll have something really positive to say on this subject.

Until then, eat healthy, and save all that money you've been shelling out for diet supplements that don't work.