December 27, 2022
Prostate cancer is a common health problem among older men, but it is being seen in a larger numbers among U.S veterans.
Though 1 in 8 men in the general population will be diagnosed prostate cancer as they age, that ratio is 1 in 5 among U.S. veterans. The Veteran's Health Administration system includes nearly 489,000 prostate cancer patients, including 16,000 who have metastatic prostate cancer.
Congress shed light on this disparity last week when it passed the Veteran's Prostate Cancer Treatment and Research Act as part of its end-of-year-spending package. The law, signed by President Joe Biden, establishes a new VHA program aimed at providing more comprehensive care for veterans with prostate cancer.
There is no clear cause of prostate cancer. Men with a family history of the disease are more likely to get it. But among military veterans, exposure to herbicides like Agent Orange also is known to increase risk.
The link to Agent Orange, which was used by the U.S. military during the Korean and Vietnam wars, was detailed in a 1996 report published by the National Academy of Sciences, Engineering and Medicine. A 2013 study later found that veterans exposed to Agent Orange not only have increased risk of prostate cancer, but they also are more likely to develop more aggressive forms of the disease.
Under the new law, the VHA must create guidelines to ensure veterans have equal access to prostate cancer care across the U.S., from screening to treatment to survivorship. It also creates a registry and research program specific to veterans receiving care through the VHA.
"As prostate cancer continues to be a growing problem amongst our veteran population, it is our hope that the VHA will be well-positioned to develop these clinical pathway models and improve research and evidence-based treatments for veterans across America," said Dr. Robert Bass, chair of the American Urological Association's Legislative Affairs Committee.
Prostate cancer is the second most common cancer among U.S. men, following skin cancer. The majority of men diagnosed with prostate cancer are over age 65, but the risk for prostate cancer increases rapidly after a man turns 50.
Studies have shown that Black men are 1.7 times more likely to be diagnosed with prostate cancer and 2.1 times more likely to die from it than white men.
When caught early – before the cancer spreads from the prostate – the 5-year survival rate is 99%. Regular screening is important because many men won't experience physical symptoms until it has metastasized, health experts say. For men of average risk, screening should start at 50. For those at higher risk, it should begin at 45.
When the prostate cancer is localized and at low-risk of spreading, patients usually enter an active surveillance program in which they are monitored every 3 to 6 months. For patients at risk of a more aggressive cancer, the most common treatments are surgery and radiation, but there are more advanced options also available, including proton therapy, high dose rate brachytherapy, immunotherapy and next-generation hormone therapy.
Researchers are developing a test that can detect five types of bacteria in a patient's prostate tissue or urine sample to better determine which prostate cancer cases are most likely to turn aggressive. The test will be similar to those developed to detect bacteria related to stomach and cervical cancers.