➤ Prostate cancer
Prostate cancer is the most common malignancy affecting men in the United States. It is also the most commonly diagnosed solid tumor in VA. In 2016, VA and the Prostate Cancer Foundation established a partnership to promote prevention, screening, and research to find new treatments for prostate cancer in Veterans. They established a network of VA centers to help develop best practices for the treatment of Veterans with advanced prostate cancer. A list of PCF-VA centers of excellence in prostate cancer can be found here. pcf.org/va-partnership/coe/
The VA Precision Oncology Program for Cancer of the Prostate (POPCaP) uses next-generation DNA sequencing to identify specific tumor mutations in Veterans with metastatic prostate cancer. That information can then be used to customize drug treatments for these patients. ncbi.nlm.nih.gov/pmc/articl...
VA early pioneer in prostate cancer pathology—Every year, approximately 15,000 Veterans are diagnosed with prostate cancer. The “Gleason score” is a staging system for prostate cancer developed in the 1960s by Dr. Donald Gleason at the Minneapolis VA Health Care System. Today, it is used almost universally to predict the aggressiveness of prostate cancer. blogs.va.gov/VAntage/80597/...
Surgery risks outweigh potential benefits—In a 2021 study, researchers at the Minneapolis VA Healthcare System and the University of Minnesota found that watchful waiting may be the best approach to treating prostate cancer. "Watchful waiting" involves monitoring a man's prostate specific antigen (PSA) to assess his disease progression without performing more active treatment such as surgery. pubmed.ncbi.nlm.nih.gov/333...
The research team conducted a systematic review of 67 studies to compare the effectiveness of various treatments for prostate cancer. They found watchful waiting may slightly increase the risk of death for men who were clinically diagnosed with prostate cancer. However, it reduced overall harm compared to surgery in this group.
Their results also suggested that surgery for prostate cancer may be necessary only for younger patients (those under age 65) and those with more aggressive forms of the cancer. Surgery, the investigators found, did not reduce death in men 65 or older.
PTSD raises suicide risk in prostate cancer patients—A 2021 study led by researchers at the White River Junction VA Medical Center in Vermont and Dartmouth University found that Veterans with prostate cancer and posttraumatic stress disorder (PTSD) were at greater risk of suicide than prostate cancer patients without PTSD. The results were consistent after adjusting for factors like depression, substance use disorder, and prostate cancer treatment. pubmed.ncbi.nlm.nih.gov/332...
The study looked at 200,000 Veterans with prostate cancer. About 6% of this group had a PTSD diagnosis in the year before their cancer diagnosis. The team found that almost twice as many patients with PTSD died by suicide, while half as many died from circumstances not related to suicide.
The investigators also found that men with prostate cancer and PTSD may be at lower risk of death from non-suicidal causes because of greater health care use and early diagnosis of localized, or low-risk, cancer.
Smoking linked to higher prostate cancer death—A 2020 VA study found that smoking is linked to a higher rate of dying from prostate cancer. Researchers at the San Diego VA Health Care System and the University of California looked at more than 73,000 VA patients diagnosed with prostate cancer. Within 10 years of diagnosis, current smokers had a 5.2% rate of death from prostate cancer. Former smokers had a 4.8% mortality rate, while those who never smoked had a 4.5% mortality rate. According to the researchers, a prostate cancer diagnosis may be an important opportunity to discuss quitting smoking. pubmed.ncbi.nlm.nih.gov/316...
Disparities in prostate cancer outcomes linked to care access—In a 2020 study, researchers at the VA San Diego Health Care system and the University of California found that African American men who received care through VA were not more likely to die of prostate cancer than non-Hispanic white men. In the general U.S. population, African American men are more than twice as likely to die of prostate cancer than non-Hispanic white men. pubmed.ncbi.nlm.nih.gov/319...
The research team followed 18,201 Black men and 41,834 non-Hispanic white men who were diagnosed with prostate cancer between 2000 and 2015. They found Black Veterans had a slightly lower rate of death, and were no more likely to present with advanced disease, than their non-Hispanic white counterparts. The investigators believe that disparities in health care may explain racial differences in prostate cancer mortality in the general population.
Drug could delay prostate cancer spread—In 2018, the Food and Drug Administration approved the use of apalutamide for castration-resistant prostate cancer that has not spread to other parts of the body. The approval followed a 2018 international study—which included a VA Portland researcher—that found patients who took the drug survived longer without cancer spread than those who took a placebo. Patients taking daily apalutamide lived a median of 40.5 months before their cancer spread, compared to a median of 16.2 months in the control group. ncbi.nlm.nih.gov/pubmed/294...
New polygenic hazard score can predict prostate cancer—A large research team including VA researchers has developed and validated a genetic tool to predict the age at which men may develop aggressive prostate cancer. The tool, which is more precise than the existing prostate-specific antigen (PSA) test, may potentially be used to help guide decisions about who to screen for prostate cancer and at what age. A study describing the tool was published in 2018. ncbi.nlm.nih.gov/pubmed/293...
PIVOT trial—The Prostate Cancer Intervention Versus Observation Trial (PIVOT) was a large VA-led clinical trial that lasted nearly 20 years. In a 2017 follow up, researchers found that surgery does not significantly reduce deaths from all causes or prostate cancer in men who are diagnosed with early-stage disease. The cooperative study found no difference in survival between men with early-stage prostate cancer who had surgery and men who underwent observation for disease progression. ncbi.nlm.nih.gov/pubmed/287...
Surgery to remove the prostate was associated with a greater frequency of adverse events, like urinary incontinence. The team concluded that the benefits of surgery were unclear for men with prostate cancer that had no symptoms. The researchers suggested these men could be regularly monitored using a PSA blood test and offered surgery to reduce symptoms if they develop.
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No more hidden paywalled prostate cancer research 
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