Are PCa death rates down? was..... Nanodiamonds may prove priceless

[Guest guest]

Alan,

Your enthusiasm for science is to be

admired, but……..I am not sure that all your statements can be

demonstrated to be accurate by reference to appropriate scientific studies. I

do not intend to go any further down that line but I do want to respond to just

one of your statements. You say:

<snip> The PSA test has made it

possible to diagnose cancer while it is still treatable. I believe that the

absolute rate of PCa deaths is significantly lower now, not just the rate

relative to the much larger number of men who are diagnosed. This is not just a

change in procedures, it's a scientific development. PSA was unknown in Nixon's

time.<snip>

I certainly don’t want to start yet

another PSA screening discussion but just to seek your views on whether I have

the wrong end of the stick when I look at the World Health Organisation

statistics and say that they do not seem to bear out your views of the rate of

PCa deaths. The stats are here http://tinyurl.com/4tvxzn3

The first available year is 1979, by

chance early on in the War on Cancer and also fortuitously just before the PSA

test was approved. In that year there were 1,044,959 male deaths in the USA. 22,240 of

these deaths were attributed to prostate cancer. So we can say that 2.12% of

male deaths in 1979 were due to prostate cancer.

The latest available year is 2005. In that

year there were 1,207,675 (increase 16%) male deaths in the USA. 28,905

(increase 30%) of these deaths were attributed to prostate cancer. So we can

say that 2.39% of male deaths in 2005 were due to prostate cancer. It seems to

me that this could be expressed as an increase of 13% in the relative number of

men who die from prostate cancer.

Just in passing the number of male deaths from

motor vehicle in USA

in 2005 was 30,332 ( 8,012 (20%) less than in 1979) so there is still a

greater number of deaths from motor vehicle accidents than there are from prostate

cancer. I often wonder how many men worry about that when they start the

engines of the motor vehicle.

Another small thought – the percentage

of male deaths from prostate cancer in Australia

in 1979 was 1.97% but in 2003 (the latest date for Australia) this percentage had shot

up to 4.17%. Whilst prostate cancer does not have the same high profile in Australia as it has in the USA and there is less of a drive

for early PSA screening, the figures seem to contradict the concept that all

the advances in s cience have led to fewer prostate cancer deaths.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer

Sent: Friday, 18 March 2011 1:19

PM

To: ProstateCancerSupport

Subject: Re:

Nanodiamonds may prove priceless in drug delivery

Ø Terry

Herbert

wrote:

>

> Alan,

>

> When you say <snip>. The science really is moving forward. It's

> not as fast as we wish but it is progressing and it's gradually

> building up momentum. <snip> my sense of history tells me you

> may be whistling in the dark. When was The War On Cancer

> declared? That was back in President Nixon’s time, I believe.

> And how many billions of dollars have been spent since then?

> And how many innovative, good, reliable treatments have evolved

> from that process. I don’t think there are any. Surely, some

> have been improved greatly and we probably see less side

> effects now, but then again the median age of diagnosis has

> dropped ten or more years and younger men heal better than

> older men. Same thing goes for success - the earlier you treat,

> the longer it may take for a ‘failure’ to manifest itself. The

> one thing that hasn’t change is the median age for death from

> prostate cancer: it is still a fact that the majority of men

> are over the age of 80 when they die from the disease.

Forgive me, but this is a subject dear to my heart. I'm going to

speak in superlatives for a while and express my reckless

enthusiasm.

I know it's frustrating that we haven't gotten further than we

have, but I think there has been tremendous progress.

We have to look at the whole picture of how cancer diagnosis and

treatment has evolved since Nixon's " war on cancer " in the early

1970's.

Let's consider developments in prostate cancer to start with.

1. The PSA test has made it possible to diagnose cancer while it

is still treatable. I believe that the absolute rate of PCa

deaths is significantly lower now, not just the rate relative to

the much larger number of men who are diagnosed. This is not

just a change in procedures, it's a scientific development. PSA

was unknown in Nixon's time.

2. New surgeries have been developed. Nerve-sparing surgery was

developed after Nixon's time, as well as the still newer robotic

surgeries. Surgeons have a better understanding of what to cut

out, what not to cut out, and how to do it.

3. New radiation modalities have been developed that deliver

significantly more radiation to tumors and significantly less to

surrounding tissue. The cure rate for radiation has gone up

while the side effects have gone down.

4. The first successful chemotherapy (docetaxel) was developed.

It doesn't cure PCa but does extend life and looks like it may

extend life much more if used earlier and in combination with

other therapies.

5. The first ever immunotherapy for any cancer was developed.

I'll say more about it later in answer to your later point.

6. New hormone therapies have been developed that are safer than

estrogen, are more effective, and don't require irreversible

physical castration. More new hormone therapies like Abiraterone

are about to be approved.

The effect of all this is that more men are being cured, and more

who are not cured are living longer after diagnosis. That is

true even for men who are diagnosed via the old digital rectal

exam technique. That is significant progress.

Ø Post snipped for space reasons

[Guest guest]

Terry Herbert wrote:

> Your enthusiasm for science is to be admired, but ...

Well, maybe it is a reckless enthusiasm

> ... The stats are here http://tinyurl.com/4tvxzn3

Terry,

Thanks for checking all this.

Looking at those statistics it does appear that you're right

[Terry stubbornly insists on keeping me honest ] The absolute

number of cases has gone up between 1979 and 2005. The rate (the

column next to the absolute number) has declined slightly, but

the decline appears to be very slight.

As a cross check, I went to the US National Cancer Institute's

SEER site (Surveillance, Epidemiology and End Results). They

have similar numbers, but they tell a different story. There are

also some interesting facts in the WHO statistics that I'll get

back to at the end.

What the SEER numbers appear to show (assuming I understand them)

is:

From 1975-1987, the annual percentage change (APC) in prostate

cancer mortality in the US went up .9% each year. I have no idea

why this was, maybe reporting got better. Maybe Americans ate

too much or got exposed to more carcinogens.

From 1987-1991, the APC went up 3%! Again, I don't know why.

From 1991-1994, (the years when PSA use started) APC went _down_

0.5%.

From 1994-2005 (the main period during which PSA testing was

instituted), APC went down 4.1%.

From 2005-2007, APC went down 2.6%.

So there appeared to be a big spike in the period from 1975-1991,

then the numbers began to trend downward quite nicely.

Finding these stats is tricky because they come out of a database

and you have to fill in a form. The form is at:

http://seer.cancer.gov/faststats/selections.php?#Output

The statistics are very complicated and I don't have enough

understanding of what NCI or WHO are doing to make a really

informed judgment.

However a complete understanding of the stats also has to take

into account that everybody dies of something. If there are ten

common causes of death and modern medicine eliminates two of

them, then the other eight will see increases, even if our

medical advances have helped us with them too. For example,

decreases in the death rate from heart disease, lung cancer,

pneumonia, etc., might be expected to result in increases in the

death rate from prostate cancer.

Looking at the WHO stats it looks to me like the number of deaths

from PCa went up in older ages and down in younger ones. In 1979

and 2005 age stratified mortality was as follows:

Years

55-64 65-74 75+ years

1979: 2214 7028 12699

2005: 2154 5764 20563

While the total number of deaths went up (in a larger population)

and the death rates stayed roughly the same, the ages of death

from PCa rose. Fewer men absolutely, and still fewer relatively,

died of PCa at younger ages.

It looks like progress to me, though I admit that my enthusiasm

for it may overstate the extent of it.

I know we've got some mathematicians and scientists in our group

so maybe one of them can jump in with more enlightenment.

Alan

[Guest guest]

Alan,

I don’t want to go too much into the

detail, but you have hit on an issue I have tried to clarify for years. WHY

did the mortality rate rise in the same years as the incidence rates rose? We

knw why the latter did – the introduction of PSA testing (in the 80s, not

the 90s as you have said) cause a massive explosive rise in incidence, which

peaked at the same time as the mortality rates. Weird or what? I’ve got

some graphs somewhere that illustrate this phenomenon well but simply don’t

have time to look for them right now. It’s a busy month on the Yan site

with more than 150 updates and/or new entries! Plus a new project –

Paying Forward with Book Donations of which more later.

Oh! Just one thing if you do look into

these issue a little more – can you establish the median age for

diagnosis and the median age for death ‘before and after’ I have

been under the impression until now that the latter has remained in the low 80s

while the former has moved about ten years back from mid 70s to mid 60s.This

means of course that using ten year studies at least half the men will not make

it into the current zone where 90% of the deaths occur – from age 70

onwards – and be even further away from the median. No wonder ten

year studies show such low mortality rates, say IJ

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer

Sent: Sunday, 20 March 2011 9:16

AM

To: ProstateCancerSupport

Subject: Re:

Are PCa death rates down? was..... Nanodiamonds may

prove priceless

Terry Herbert

wrote:

> Your enthusiasm for science is to be admired, but ...

Well, maybe it is a reckless enthusiasm

> ... The stats are here http://tinyurl.com/4tvxzn3

Terry,

Thanks for checking all this.

Looking at those statistics it does appear that you're right

[Terry stubbornly insists on keeping me honest ] The absolute

number of cases has gone up between 1979 and 2005. The rate (the

column next to the absolute number) has declined slightly, but

the decline appears to be very slight.

As a cross check, I went to the US National Cancer Institute's

SEER site (Surveillance, Epidemiology and End Results). They

have similar numbers, but they tell a different story. There are

also some interesting facts in the WHO statistics that I'll get

back to at the end.

What the SEER numbers appear to show (assuming I understand them)

is:

From 1975-1987, the annual percentage change (APC) in prostate

cancer mortality in the US

went up .9% each year. I have no idea

why this was, maybe reporting got better. Maybe Americans ate

too much or got exposed to more carcinogens.

From 1987-1991, the APC went up 3%! Again, I don't know why.

From 1991-1994, (the years when PSA use started) APC went _down_

0.5%.

From 1994-2005 (the main period during which PSA testing was

instituted), APC went down 4.1%.

From 2005-2007, APC went down 2.6%.

So there appeared to be a big spike in the period from 1975-1991,

then the numbers began to trend downward quite nicely.

Finding these stats is tricky because they come out of a database

and you have to fill in a form. The form is at:

http://seer.cancer.gov/faststats/selections.php?#Output

The statistics are very complicated and I don't have enough

understanding of what NCI or WHO are doing to make a really

informed judgment.

However a complete understanding of the stats also has to take

into account that everybody dies of something. If there are ten

common causes of death and modern medicine eliminates two of

them, then the other eight will see increases, even if our

medical advances have helped us with them too. For example,

decreases in the death rate from heart disease, lung cancer,

pneumonia, etc., might be expected to result in increases in the

death rate from prostate cancer.

Looking at the WHO stats it looks to me like the number of deaths

from PCa went up in older ages and down in younger ones. In 1979

and 2005 age stratified mortality was as follows:

Years

55-64 65-74 75+ years

1979: 2214 7028 12699

2005: 2154 5764 20563

While the total number of deaths went up (in a larger population)

and the death rates stayed roughly the same, the ages of death

from PCa rose. Fewer men absolutely, and still fewer relatively,

died of PCa at younger ages.

It looks like progress to me, though I admit that my enthusiasm

for it may overstate the extent of it.

I know we've got some mathematicians and scientists in our group

so maybe one of them can jump in with more enlightenment.

Alan

[Guest guest]

Terry Herbert wrote:

> I don’t want to go too much into the detail, but you have hit

> on an issue I have tried to clarify for years. WHY did the

> mortality rate rise in the same years as the incidence rates

> rose? We knw why the latter did - the introduction of PSA

> testing (in the 80s, not the 90s as you have said) cause a

> massive explosive rise in incidence, which peaked at the same

> time as the mortality rates. Weird or what? ...

Terry,

I don't know the answers to your questions. I looked up the

article on Prostate Specific Antigen on the Wikipedia and it said

that the first commercial PSA test was released in February,

1986. I haven't been able to find out when it was approved by

the FDA or by what date a significant number of men had been

screened. I presume that if the first test came out in 1986, it

would take some years before many men had been screened. But I

don't have details.

The Wikipedia article on Prostate Cancer Screening said that in

the year 2000, 34.1% of US men had been screened with a PSA test

in the last year and 56.8% had been screened ever.

....

> Oh! Just one thing if you do look into these issue a little

> more - can you establish the median age for diagnosis and the

> median age for death ‘before and after’ I have been under the

> impression until now that the latter has remained in the low

> 80s while the former has moved about ten years back from mid

> 70s to mid 60s.This means of course that using ten year studies

> at least half the men will not make it into the current zone

> where 90% of the deaths occur - from age 70 onwards - and be

> even further away from the median. No wonder ten year studies

> show such low mortality rates, say IJ

I found this table in the SEER statistics:

http://seer.cancer.gov/csr/1975_2005/results_merged/sect_23_prostate.pdf

It kinda, sorta gives some of the information you want, in gross

form. It's not real easy to figure out, but my interpretation of

it is that PCa diagnosis went up rapidly in all ages up through

1992, but much more so for " under 65 " age groups. The under 65's

continued to increase in " incidence " to as late as 2002 (or maybe

not since the age group could include rapid increase in the early

part of that period with decline in the later part but still

giving an average increase.) But clearly something was going on

with younger men being diagnosed much more than older ones

relative to the past.

The statistics look like they might support what I said, but they

might also support what you said. They aren't really clear to

me. Part of the problem is that the age ranges and year ranges

are all too coarse. Trends that go up and then down, or down and

then up, get reported in a way that the trend is lost and only

the average is shown.

I'm going to give up at this point. All I can say for sure is

that I do plan to get another PSA test this year, and another one

next year, and so on for the rest of my life.

Alan