Like Xmas in July: Prostate Cancer Awareness Month comes seven months early
See Dr. Loeb's column. Also, Gen. Austin on hot seat in Prostate-gate
By Howard Wolinsky
It’s only February but you’d think it was September—Prostate Cancer Awareness Month.
Prostate cancer has been getting a lot of attention because of the diagnoses of high-profile people such as U.S. Defense Secretary Lloyd Austin, Chicago Cubs Hall of Famer Ryan Sandberg and acquitted murderer and sports legend O.J. Simpson plus the deaths of Dexter Scott King, son of civil rights leader Martin Luther King, and radio talker Joe “The Black Eagle” Madison.
King Charles III brought some inadvertent attention to prostate cancer, too, even though he was been diagnosed with some other unannounced cancer, which was discovered while he was being treated for an enlarged prostate,
So the American Medical Association (AMA) did an explainer—”What doctors wish patients knew about prostate cancer”— even though it was only February: https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-prostate-cancer
The AMA spoke with William L. Dahut, MD, chief scientific officer for the American Cancer Society.
“Prostate cancer clearly increases the older you are. That’s the greatest risk factor,” said Dahut, a hematologist-oncologist who treats patients in the prostate cancer clinic at Walter Reed National Military Medical Center. “Other things to worry about is family history. If your first-degree relative—such as your brother or your father—has prostate cancer, your risk goes up. If you have two first-degree relatives, that goes up significantly”
“If you have certain inherited genetic mutations—the most common is the BRCA2 gene, which is called the breast cancer gene—then your risk is about five times greater than it would have been without that inherited gene.”
Black men, meanwhile, are 70% likelier than other men to be diagnosed with prostate cancer and between two and four times more likely to die of the disease.
“In some randomized clinical trials where everyone receives the same treatment, sometimes Black men actually do better than white men,” Dahut said.
Early diagnosis is supposed to be the key. If found early, 99% of men are alive and cancer-free five years later, said Dahut, adding that if this cancer spreads to the bones, it’s not curable and life expectancy is only three to five years.
I knew that prostate-specific antigen (PSA) screening has been in decline, but I was shocked by the latest numbers from Dahut:
“Screening rates have gone down significantly since their peak about 20 years ago and we’ve seen increased incidences of men presenting with more advanced disease over the last decade or so,” Dahut said. “Only about 25% of men between 50 and 64 last year actually had a PSA test. Men, because of this fear of the treatment for cancer or fear of cancer, are not being screened at all. And thus, when they have a diagnosis of prostate cancer, once it has spread out to the bone, that’s not a curable cancer.
The American Urological Association recommends that physicians offer prostate cancer screening beginning at 40 to 45 years old for men at increased risk of developing prostate cancer based on Black ancestry, germline mutations, and strong family history of prostate cancer. Physicians may use a digital rectal exam alongside a PSA-based screening to establish risk of clinically significant prostate cancer, says the American Urological Association.
Dahut makes an important point often missed in the media: Prostate cancer typically has NO symptoms. Over and over again, apparently, well-meaning media reports state that frequent urination and the like are the result of prostate cancer. Not true. It’s BPH virtually always. Check out my story: https://undark.org/2022/11/24/what-public-health-messaging-gets-wrong-about-prostate-cancer/
Dr. Loeb:
Something I have always wondered about is sleep continuity.
I know that getting up say five times is a problem, but what about twice?
What I really wondered is: In the 20 years from treatment (brachy) I am now getting up twice but I am now 20 years older and would I be if I had not been treated? In other words, has the PCa and treatment caused more discontinuous sleep or is it just a feature of getting older?
Sleepless in Toronto
Dr. Loeb answers:
Waking up at night to urinate ("nocturia") is very common in the population and increasingly so with age. Among individuals over age 65, about half get up at least once per night to urinate and approximately 1/4 wake up 2 or more times per night.
Nocturia can be multifactorial with many different possible contributing factors. Some of these factors may be easily modifiable, such as consuming fluids in the evening. Others are medical conditions that require evaluation and treatment. One such condition is prostatic enlargement, for which there are many available medical and surgical management options.
Another condition that may cause nocturia is obstructive sleep apnea (OSA). Risk factors for OSA include males over age 50, neck size larger than 40 cm, high blood pressure, and snoring. In a survey that we published last year of patients with prostate cancer, 37% were at high risk for sleep apnea. If you have any of these risk factors, it is worth getting checked out since treatment of OSA can reduce nocturia and its other downstream consequences.
In summary, nocturia is very common irrespective of prostate cancer treatment and it is unclear whether that had anything to do with it in this case. If you have already tried reducing nighttime fluid intake but the problem persists, it is worth getting checked by a physician to identify other potential contributory causes.
Dr. Stacy Loeb is a Professor of Urology and Population Health at NYU Langone Health and the Manhattan Veterans Affairs, specializing in prostate cancer. Dr. Loeb completed her urology residency training at Johns Hopkins and subsequently received a Master of Science in Comparative Effectiveness Research at NYU School of Medicine.
Dr. Loeb is an internationally recognized expert in prostate cancer with more than 340 peer-reviewed published articles and 11 book chapters. She is on the Editorial Board for the Journal of Clinical Oncology, European Urology, Urology Times, Nature Reviews Urology and Reviews in Urology. Dr Loeb authored the chapter on “Diagnosis and Staging of Prostate Cancer” for Campbell-Walsh Urology, the primary textbook used in the field of urology.
(Send your questions about AS and urology, radiology, pathology, sexual health, and lifestyle via email to mailto:pros8canswers@gmail.com or just cut and paste pros8canswers@gmail.com
Keep questions short and sweet. They should be of general interest. Sign with your real name, or just initials, tell me where you live, how long you‘ve been on AS, are you seeing a private practice or university urologist, tell me how it’s going for you. Share a whimsical signature if you’re so inclined. Like ‘Butch from Idaho” or “Lost in Flossmoor.’)
Getting close: ZERO support group on AS on March 12
By Howard Wolinsky
For the past three years, I have run a special Active Surveillance support group for ZERO.
Sign up now and join us at 11 a.m. Eastern on Tuesday, March 12, 2024. Register:
https://us02web.zoom.us/meeting/register/tZUsfuqgrjIoG9AWf7voMhzT_UjdqbQQbQPA
House Armed Services Committee to grill Secretary Austin on Thursday in Prostate-gate scandal
By Howard Wolinsky
U.S. Defense Secretary Lloyd Austin has apologized to the prostate cancer community for not being open about his diagnosis and not taking a leadership position, especially in informing other Black men about his condition.
All is forgiven here.
But Austin is facing scrutiny from members of the House Armed Services Committee after several members of Congress, especially Replicans, called for his resignation over national security issues.
He was taken to the woodshed for not informing his boss, President Joe Biden, that he had been diagnosed and had undergone a robotic prostatectomy for his cancer. Military Times reports a hearing will be held Thursday.
Austin, 70, was admitted to Walter Reed National Military Medical Center on Jan. 1 after developing a urinary tract infection from complications related to prostate cancer surgery on Dec. 22. He ran operations, such as using drones to attack terrorists in the Red Sea, from an ad hoc command center in his hospital room. Austin did not inform the White House about what was going on until Jan. 5.
Austin copped a mea culpa on Feb. 1 and said his decisions were “more about privacy than secrecy.” He subsequently was rehospitalized and notified Biden and had a deputy take over. He’s back on the job and answering questions.
The Pentagon Inspector General also is investigating Prostate-gate.
Meanwhile, Austin’s staff did a review and let themselves off the hook, according to Associated Press.
An internal review blames privacy restrictions and staff hesitancy for the Pentagon's failure last month to quickly notify the president and other senior leaders about Austin's hospitalization for complications from prostate cancer surgery.
AP said the review, performed by Austin's subordinates, largely absolves anyone of wrongdoing for the secrecy surrounding his hospitalization, which included several days in the intensive care unit. And it says flatly there was “no indication of ill intent or an attempt to obfuscate.”
Instead, after a 30-day review, they blame the system and said procedures must be improved and information shared better about when the defense secretary must transfer decision-making authorities to his deputy.
The review suggests there was no established method for handling such an incident, and the fact that his hospitalization was “unplanned” contributed to the failure to let others know.
Staffers said they were was limited by medical privacy laws that prohibited doctors from providing information and they “were hesitant to pry or share any information they did learn." It adds that since Austin's condition was “in flux" they could not ensure “timely secured communications.”
Major General Pat Ryder, the Pentagon press secretary, told reporters Monday that Austin’s aides found themselves in an “unprecedented situation.” He said that as Austin was being moved into intensive care, his aides recognized that he would not have access to critical communications, and they made the decision to transfer authorities to the deputy.
AP said the fact that staff and not Austin made the decision raised questions about who was in control of the department at that moment, including America’s nuclear arsenal. Ryder said there were “no gaps” in command and control of the department.
Pressed on the lack of blame and whether anyone is being disciplined, Ryder said, “as the secretary has said, the buck stops with him and he’s taking responsibility for not notifying the president and the White House sooner.”
He added that “dedicated public servants were doing what they thought was the right thing.”
Austin told a press conference Feb. 1 that he didn’t tell his staff to not notify the White House. At the same time, he said he took full responsibility for Prostate-gate though he pointed at his staff for doing things they thought were in his best interest.
He also apologized, especially to the Black community, which is hard hit by prostate cancer, for not taking a leadership position and not being more open.
The staff report urged development of better guidelines for the transfer of authorities and better reporting requirements during those incidents.
Prostate-gate prompted the White House to issue new guidelines to ensure it will be informed any time a Cabinet head transfers decision-making authorities when they are unreachable due to medical, travel, or other reasons.