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Patients on certain drugs may reduce risk of death from prostate cancer

By BOB MASSEY

"The main point that I would like to get across is that prostate cancer is the most leading cause of cancer death in men besides skin cancers," said Dr. Eric Coronato of Southwest Florida Urologic Associates.

However, a recent study suggests there may be a way to reduce the risk of death.

As it turns out, men with prostate cancer who take cholesterol-lowering drugs called statins are significantly less likely to die from their cancer than men who don't take such medication, according to the findings of researchers at Fred Hutchinson Cancer Research Center.

Approximately 30 percent of the 1,000 study participants in the Seattle area reported using statin drugs to control their cholesterol. After an average follow-up of almost eight years, the researchers found that the risk of death from prostate cancer among statin users was 1 percent, compared to 5 percent for nonusers.

While this is good news, it's too early to tell if these drugs should be used for preventing prostate cancer, according to study leader Janet L. Stanford, co-director of the Prostate Cancer Research Program and a member of the Hutchinson Center's Public Health Sciences Division.

That can only be determine after a larger, more detailed trial.

The study is unique in that most prior research of the impact of statin use on prostate cancer outcomes has focused on a rising PSA level -- not prostate cancer-specific mortality.

But for Coronato, the proverbial ounce of prevention is most important -- and has come under fire in recent years.

The prostate is a gland that makes up part of the male reproductive system. The test to determine if cancer has developed there is called a PSA test -- an acronym for prostate-specific antigen -- which measures the blood level of, a protein that is produced by the prostate gland.

The higher the PSA level, the more likely it is that cancer is present. However, it is admittedly an imperfect test, as there may be other reasons for having elevated PSA levels -- and some patients with prostate cancer don't display an elevated PSA.

"Even though PSA ... has its flaws, without any other specific screening test, it's the only thing we have," Coronato said. "I see it all the time where patients come in with a preconceived notion that if their PSA is high, it's no big deal. It's our job to explain to patients -- especially those who are younger and healthy -- that aggressive prostate cancer does kill."

He added that there has been a shift in the way both physicians and the public look at prostate cancer over the last few years.

"I think a lot of it is the fault of urologists and some of us who treat prostate cancer," Coronato explained. "For some reason we've let the media and ... some other groups in medicine give the notion to the general public that prostate cancer is not important, that it's a benign disease that patients will typically die of something like a heart attack or lung cancer or some other disease before they die of prostate cancer.

It started when the United States Protective Services Task Force (USPSTF) -- a group composed of primary care physicians (not specialists) that provides guidelines for cancer screening -- announced that prostate cancer screening is probably not beneficial over the age of 75.

"They did recommend against checking it but generally left it up to the physician and the patient if you're under 75," Coronato said. "But last year, they said it should not be checked."

An outcry ensued from the American Urologic Association, and studies showed that the data which the USPSTF used to come to its conclusion was flawed.

"I tell many of my patients that the number of deaths per year from prostate cancer is about 28,000," Coronato said. "The number of patients diagnosed each year with prostate cancer is about 240,000. We feel as urologists that if we stop screening for cancer, then we'll go back to the days when the mortality rate was higher -- in the 40,000 range per year.

"I think is very important is to make known to patients and primary care physicians that there are many types of prostate cancer that are very, very virulent, that will kill patients. The only way to find that out is to screen them."

As it turns out, the real problem wasn't over-screening but over-treating patients who tested positive for prostate cancer.

The focus for urologists now is to try to find out which patients require treatment and which do not. There are many patients with prostate cancer that have low-grade disease and have low-risk disease. Many studies show that these patients don't need treatment -- they need close follow-up -- known as "active surveillance."

"I think most of us practicing urologists will tell you that we have patients that we just follow -- we don't treat," Coronato said. "The reason is we know those patients have low-grade, low-risk disease, and probably will do well by just following them rather than subjecting them to treatment. The majority of those patients would include those in this area because we have an older population in Charlotte County and in southern Florida.

"However, those patients who are much younger -- who are in their 40s and 50s and early 60s -- who are very healthy, that becomes a discussion with the physician and the patient as to whether or not they should have treatment."

The latest recommendations by the American Urologic Association is to start screening at the age of 50 to 69. Men between the ages of 40 to 50 should be screened if they have a family history of prostate cancer or if they're African-American, because they have a higher risk of prostate cancer. After the age of 69 or 70, it's up to the physician and the patient.

"This market, where we have patients who are 70 years and above, a lot of them have life expectancies of at least 10 to 15 years," Coronato said.

"Those patients probably will benefit from screening."

Southwest Florida Urologic Associates has an office in Port Charlotte at 21260 Olean Blvd. Suite 202A. For more information, call 941-625-1550.

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