Second cancers are on the rise; 1 in 5 US cases is a repeat

Very predictable, right?

Today we are diagnosing (labeling) men with smaller and smaller amounts of non-lethal prostate cancer...men with 3+3 or 3+4 cases who never would have been diagnosed in the past (or treated) and never would have even known the difference. Then men are leading full lives after treatment (because treatment has no impact on their life longevity) and are dying of something else...heart disease or cancer (which is now a 2nd cancer).

Prostate cancer is the most common and among the least lethal cancer, creating a very large pool of "survivors."

Ravineman430 said... Please explain how these lower grade Gleason tumors were not diagnosed in the past. Sure, that’s easy…     Back in the early days of mass PSA screening, dealing with low-risk cases was different.   I’ll quote Dr Anthony Horan:   “ We didn’t go looking for the incidental cancers that were of no clinical significance.  And if we found them, we did nothing about them .”   Even before the term “active surveillance” was invented, the conventional wisdom of the day was a non-treatment approach for low-risk cases which were incidentally found.   This was based upon the result of an early Mayo Clinic study which showed that most men diagnosed with incidental PC had a survival curve identical to the general population of men…which is a similar (not identical) finding to the PLCO trial findings more than 25 years later.   Today, doctors are “looking harder” in younger and healthier men than ever, and they are therefore finding more and more smaller and smaller amounts of low-grade (air quotes) “prostate cancer.”   (Air quotes because discussion among the medical thought leaders has included the possibility or re-naming low-risk PC so that it does not carry the anxiety-provoking burden of the word “cancer.”)   Six biopsy cores used to be the standard, then it crept up to 12, and today many are looking at 18 cores as the new norm, plus other new additional imaging techniques which did not exist in the past.   Doctors are definitely looking harder than in the past…and why wouldn’t they, treatment for PC is one of the fastest growing and most lucurative specialties in medicine.   The appropriate quote I’ve found to directly address your question is:   “ The likelihood of being diagnosed with prostate cancer is directly related to the rigor with which one looks for it .”   Today, once a patient is “labeled” as a “cancer” patient, our society drives a behavior that introduces us to a cascade of events—a slippery slope—that sends patients to very morbid therapy.   The fact is that today the majority of newly diagnosed men are favorable-risk, organ-confined, yet treatment rates are extraordinarily high.   Interestingly, overtreatment then generates a cycle of positive feedback for even more of the same over time.   As the disease is more widely diagnosed, a larger and larger proportion of the population knows someone, whether a family member, friend or celebrity who "owes their life" to early cancer detection and treatment.   Some have labeled this the popularity paradox of screening :   The more overdiagnosis screening causes, the more people feel they owe it their life and more popular screening becomes.   The problem is compounded by media reports about the dramatic improvement s in survival statistics, which in reality reflects lead and length time bias.   Please, please don’t misinterpret this. I am not saying that the diagnosis of “cancer” is not appropriate when it has a good chance of leading to treatment that benefits the patient.   The difference is that the increased rigor for looking for smaller and smaller minuscule pieces of PC has driven a dramatic overtreatment crisis in this country, causing harms to many men who were never at risk.          

While population-adjusted prostate cancer deaths have declined nearly 50% in 20 years, metastatic prostate cancer mortality is unchanged. Perhaps the difference is earlier detection and treatment leading to the lower incidence of metastatic disease? It seems likely that for many of us treatment has extended longevity and without treatment we would have known the difference. Despite this progress, prostate cancer is second only to lung cancer in the number of cancer-related male deaths each year. Yes, there are 2.9 million men living with diagnosed pCa. Though only about 10% of them will die of that disease, we can not measure the indirect consequences of pCa and it's treatment for their health and longevity. Considering the side effects of surgical, radiation, hormone and chemo therapies, they might be significant.

If they count basal cell skin cancer, then I'm in the second cancer boat. However, these are easily found and removed.

In part the over treatment controversy is exacerbated by the fact that surgery is preferred over brachy, despite higher side effects. So, the problem is somewhat self inflicted.

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Age 63 in 2015
12/02 PSA 2.9 age 51
9/03 BX/DX, Gleason 6, 4 of 12 cores
9/03 Brachytherapy
5/08 PSA nadir 1.1
12/08 PSA 1.8
2/09 BX/DX, Gleason 8, 1 of 12 cores
6/09 Hyperthermic Radiation, Hormone (short term), IMRT (10 fractions) spring 2009
10/09 PSA nadir < 0.1 10/09 through 01/12
4/12 PSA 0.2
3/14 PSA 2.9
5/14 C11 Acetate PT/CT, found 2.0 cm lymph node
5/14 Lupron/Casodex (9 months)
8/14 nadir <0.01
2/15 SBRT to node, at UCSD
3/15 PSA 0.02,T=0
6/15 PSA<0.015,T=105 (yippee!)

These statistics about second cancers make sense. I've had two, including the very common basal skin cancer. We have one member here who reports having had 5 different cancers.

Cicero2K, while I have a lot of general agreement on the “self-inflicted” nature of PC treatment for men (specifically for men with favorable-risk cases), I am not so quick to give a blanket agreement to the notion of any sort of blanket benefit for radiation therapy.

In fact, the key report this article was based on specifically commented that there is “well-established second cancer risks associated with radiotherapy.” It further describes that the risk (for radiation-related second cancers) “persists for decades following exposure” (the fundamental reason that radiation therapy is typically considered better for "older guys" seeking primary treatment for PC)




JNF (and others), the less dangerous non-melanoma skin cancer (both basal and squamous cell) was excluded from the analysis.

I am really happy with this thread. A valid note about something that I also heard this morning, but had not posted.

The responses and counters have not so much as gotten close to any lines in the sand. What? You guys being civil?

I'm proud of you!