Essay on Prostate Cancer

Today, prostate cancer is the second most common form of cancer. And because it is generally a disease of older men, prostate cancer is not in the top five in terms of years of life lost. The American Cancer Society projects that in 2002, 189,000 new cases of prostate cancer will be diagnosed (American Cancer Society, 2006). In 2000, there were 32,000 deaths attributable to prostate cancer. Approximately 70 percent of all cases are diagnosed in men age 65 years and older. Prostate cancer is about twice as common in African-American men as in white men.
Prostate cancer is a common form of cancer. In fact, more men will be diagnosed with prostate cancer than any other form of cancer, excluding only skin cancer. And about 3 percent of men will die from the disease.

Help with Essay on Prostate Cancer
Help with Essay on Prostate Cancer

Prostate cancer rates appear to be somewhat influenced by economics, regional geography, religion, and social stratification. For example, the highest rates of Prostate cancer in the United States occur in the Northeast, and lower rates are seen in the South. Rates are higher in urban areas than in rural areas. One suggested explanation of this urban-rural difference is that rural people have more exposure to the sun, with subsequent increases in vitamin D production and calcium absorption. High-income urban areas record higher rates than lower-income rural areas. In the United States, Caucasians and blacks have higher rates of prostate cancer than do Hispanic Americans or Native Americans (American College of Physicians 1997).

Most patients with prostate cancer have no symptoms. “Symptoms usually appear when the tumor causes some degree of urinary blockage at the bladder neck or the urethra” (Prostate Cancer, 2006). Also, symptoms include difficulty in starting and stopping the urinary stream, or even after urination, there is a sense of bladder fullness because the bladder has not been fully emptied” (Prostate Cancer, 2006). The risks increase with age and high fat diet (Coley 1997).

Prostate cancer is common for men age 70 years and older. Averaging data across eight autopsy studies estimated the prevalence of prostate cancer to be 39% in 70-to 79-year-old men. The treatment of this disease varies dramatically from country to country and within regions of the United States. For example, radical prostectomy is done nearly twice as often in the Pacific Northwest as it is in New England, yet survival rates and deaths from prostate cancer are no different in the two regions. PSA screening finds many cases. However, in the great majority of cases, the men would have died of another cause long before developing their first symptom of prostate cancer. When the disease is found, it is often “fixed” with surgical treatment. However, the fix has consequences, often leaving the man incontinent and/or impotent. The outcome model considers the benefits of screening and treatment from the patient’s perspective. Often, using information provided by patients, it is concluded that quality-adjusted life expectancy is optimized without screening and treatment (Coley 1997).

Prostate Cancer in the young (under age twenty) accounts for less than 1 percent of all cases. In this age group, the incidence rate is far higher in blacks than in whites (the opposite of what occurs in adults). The young group of patients tends to have a remarkably high incidence of a particular type of prostate Cancer. Evidence suggests that the main environmental factor is diet. Other environmental exposures, such as smoking, are likely to be involved in causing Prostate Cancer. In further support of the connection of diet to Prostate Cancer are a number of “migrant studies” which have examined the incidence of the disease in ethnic groups who have emigrated to other countries which have a contrasting rate of prostate cancer occurrence. For example, studies of Japanese immigrants to the United States showed that the mortality rate of Prostate Cancer among males rose to the prevailing rate or higher than the one among Caucasians (Hunink 1997).

Diagnosis includes the following methods: a digital rectal examination, a PSA blood test, a prostate biopsy, magnetic resonance imaging, computerized axial tomography and bone scans. Somewhere between a quarter and a third of these men were found to have prostate cancer making the false positive rate about 7 percent. Others have reported false positive rates in the range of 7 to 11 percent. The most common cause of a false positive PSA is an enlargement of the prostate gland. Because the prostate tends to enlarge with age, PSAs tend to rise with age. Therefore, false positives are less common in younger men and more common in older men. The false positive rate for subsequent PSA testing depends on whether the initial result was normal or not. If the men with abnormal PSAs are excluded, the false positive rate for a repeat test drops to around 2 percent. In other words, if a test was normal in the past, practitioners are much less likely to have a falsely abnormal test in the future (which in turn means that an abnormal result in subsequent testing is more likely to represent a cancer). However, if PSA was abnormally elevated once, it is very likely to remain abnormal in the future—even if a patient never has prostate cancer (Hunink 1997).

Diagnosis of cancer often leads to a radical prostectomy (surgical removal of the prostate gland). The success of the surgery would be confirmed by eradication of the tumor, reduced prostate -specific antigen (PSA), and patient survival. In contrast to the traditional biomedical model, an outcomes perspective embraces public health notions of benefit. Instead of focusing on disease process, benefit is defined in terms of life duration and quality of life. Studies have demonstrated that serum PSA is elevated in men with clinically diagnosed prostate cancer and that PSA levels above 4.0ng/mL have positive predictive value for prostate cancer. Despite the promise of PSA screening, there are also significant controversies (Fleming 1993).

Based on the available literature (Fleming 1993), the preponderance of evidence suggests that after adjustment for the extent of disease, when treatment is comparable, there are no differences in survival from early stage prostate cancer that can be attributed to race. For more advanced disease, it is likely that the survival differences reflect differences in the distribution of disease at the time of diagnoses that are not accounted for in the staging system used. Since many of the patients treated for prostate cancer are staged clinically and not pathologically, accurately determining the true extent of disease in prostate cancer patients is more difficult than for breast cancer.

The volume of the typical prostate is 30,000 cubic millimeters. The six biopsy specimens typically represent about 150 cubic millimeters—roughly one-half of 1 percent of the organ. And because only part of each specimen is sliced and placed on a glass slide, the volume of tissue actually examined by the pathologist is about 3 cubic millimeters (or 1/10,000 of the gland). The examination of the slide then proceeds in stages: first the slides are assessed with the naked eye; then the entire slide is viewed using low-power magnification (20 times larger than life). Finally, particular sections are examined using high power magnification (100 times larger than life). Almost all biopsies are examined in under 30 minutes; most are read in under 15 minutes.

One example of the differences between the traditional biomedical and the outcomes models concerns screening and treatment for prostate cancer. The war on cancer followed a traditional find it–fix it biomedical model. The identification of prostate cancer dictates treatment, which in turn is evaluated by changes in biological process or disease activity. In the case of prostate cancer, a digital rectal exam may identify an asymmetric prostate, leading to a biopsy and the identification of prostate. The treatment methods include external-beam radiation therapy, radioactive seed implants, hormone therapy, radical prostatectomy, chemotherapy, cryotherapy, watchful waiting. For instance, “radioactive seeds implanted into the prostate have gained popularity in recent years as a treatment for prostate cancer. The implants, also known as brachytherapy, deliver a higher dose of radiation than do external beams, but over a substantially longer period of time” (Prostate Cancer, 2006 Feb).

Transurethral resection of the prostate was quite popular in the late 1970s and 1980s and was performed frequently enough that the reported cases of prostate cancer began to rise. Then, in the late 1980s, a new way to find prostate cancer was developed: a blood test that measured prostate specific antigen (PSA). This test caused the number of cancer cases to skyrocket (Curtis, Juhnke 2003).

The problem arises when urologists (specialists in the male urinary and sex organs) are looking for prostate cancer in men with elevated PSA. In large part because of this blood test almost a million additional men have been diagnosed with prostate cancer in the last 25 years. Consider a typical scenario. A patient has an elevated PSA level, but the doctor cannot feel a lump on the prostate. Because there is no obvious place to biopsy, the urologist takes six biopsies, each one involving a separate insertion of a needle, to search for cancer in various parts of the prostate. The goal is to sample throughout the prostate, with three biopsies on each side: one at the top, one at the mid portion, and one at the base. But no matter how systematic the approach, it still boils down to extracting six samples, each the size of a wood splinter, from an organ the size of a small ball (Coley et al 1997).

For localized and regional disease, the most common treatments are radical prostatectomy or radiation therapy, although some physicians may recommend “watchful waiting” depending on patient characteristics (such as age). Once the cancer has metastasized, there is no longer a choice in treatments. At this point, androgen ablation, either with hormone treatment or through orchiectomy, is the recommended treatment. If the androgen ablation ceases to contain the disease, then chemotherapy is used as a treatment of last resort.

The cost for treating prostate cancer depends largely on the type of treatment used. A 2000 study of over 10,000 men treated for early-stage prostate cancer found that the average costs of the initial work up for diagnosis, treatment, and six-month follow up ranged from $12,000 to $30,300, depending on the type of treatment (Brandeis et al, 2000). Treating with radical prostatectomy and adjuvant radiation is the most expensive, with an average cost of $30,300. Radical prostatectomy alone had a mean cost of $18,300, and the adjuvant radiation alone typically had costs of $15,100. The least expensive form of treatment for early-stage prostate cancer was brachytherapy (radiation through radioactive seeds implanted directly in the tumor), at about $12,000 (Brandeis et al, 2000). Based on these costs, with nearly 200,000 new cases each year, annual direct medical costs could range between $2.4 and $6 million. All of the above costs are for treating early-stages of prostate cancer. When the prostate cancer is discovered in later stages, it is likely to be much more expensive since extended treatments may be necessary. For metastatic disease, costs could include extended rounds of hormone treatments, chemotherapy, and palliative care, which could lead to even higher treatment costs. Whether or not a cancer is found is a function, in part, of its size. Big cancers are easier to find than small cancers. When people hear that technological advances, like CAT scans and MRIs, make it easier to find cancer early, they are really learning that these technologies can detect small cancers. Without these technologies, many small cancers would go unnoticed. Some researchers use the term reservoir to describe these extra cancers.

These two conditions are very different in terms of the types of treatment choices and the consequences of those choices on the health and functioning of the patient, as well as the costs to the patient. Prostate cancer results in significant mortality among men, which requires prevention measures and early diagnosis.

Works Cited Page
1. American Cancer Society, 2006. www.cancer.org
2. American College of Physicians. Screening for prostate cancer. Annals of Internal Medicine 126, 1997, 480–484.
3. Brandeis J, Pashos CL, Henning JM, et al. A nationwide charge comparison of the principal treatments for early-stage prostate carcinoma. Cancer 89 (8), 2000, 1792 – 1798.
4. Coley, C. M., Barry, M. J., Fleming, C., et al. Early detection of prostate cancer. Part II: Estimating the risks, benefits, and costs. Annals of Internal Medicine 126, 1997, 468–479.
5. Curtis, R.C., Juhnke, G.A. Counseling the Client with Prostate Cancer. Journal of Counseling and Development, Vol. 81, 2003, 160.
6. Fleming, C., Wasson, J. H., Albertsen, P. C., et al. A decision analysis of alternative treatment strategies for clinically localized prostate cancer. Journal of the American Medical Association 269, 1993, 2650–2658.
7. Hunink, M. G., Goldman, L., Tosteson, A. N., et al. Decisions about prostate cancer screening in managed care. Current Opinion in Oncology 9, 1997, 480–486.
8. Prostate Cancer. 2006. http://www.emedicinehealth.com/prostate_cancer/page5_em.htm.
9. Prostate Cancer. 2006. February http://www.cnn.com/HEALTH/library/DS/00043.html
10. Schover, L.R. Is There Sex after Cancer? Patients Must Focus on the Power of Love and Understanding, Rather Than the Actual Mechanics of Lovemaking to Enjoy a Life of Intimacy Once Again. USA Today (Society for the Advancement of Education), Vol. 132, November 2003, 30.

CustomEssayPapers.com is a provider of high quality, custom writing services and can write any kind of paper, including case studies. CustomEssayPapers.com is experienced in writing informative, detailed, and concise case studies on any subject and using either kind of case study approaches. If you need help with a case study, place your order for a case study and one of our professional writers will happily construct a case study for you or help you with any other writing assignment you may have: Essay, Research Paper, Thesis, Term Paper, etc.

Place your order now to get an excellent custom-written case study!

Comments are closed.