High prostrate cancer rate still unexplained

Colorado remains one of the top states in the country for high incidents of prostate cancer, although medical experts say there’s no reasonable explanation for the high rate here.

More than 210,000 men in the United States and 4,000 in Colorado will be diagnosed with prostate cancer this year. One in five men will develop the disease in his lifetime. African-American men are 66 percent more likely to get the disease than Caucasian men.

The state has the fifth highest rate for prostate cancer incidents in the country. Screenings are offered in the fall to promote testing but available throughout the year by private physicians.

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Ed DeAntoni, assistant professor of urology at the University of Colorado Health Sciences Center in Denver, said the high rate of prostate cancer incidents in Colorado is a phenomenon.

“There is no reasonable explanation,” he said.

Since screening for the disease became popular in the early 1990s, there has been an

increase in incident rates because of testing, he said.

New tools employed in detection include an ultrasound and a blood test for prostate-specific antigen, he said.

Until the early 1990s, most prostate cancer that was detected already had moved into the

advanced stage, he said. Symptoms include lower back pain and urinary problems.

Many urologists believed that the best way to treat prostate cancer was to test at an early

stage before there were symptoms.

Incidents for prostate cancer rose steadily in the 1980s, then increased in the early 1990s

and now have tapered off some because many men are not being tested anymore, he said.

Managed care, however, has had a direct influence on testing results. For example, Kaiser Permanente, a health maintenance organization, is one of the strongest advocates against screening for prostate cancer when there are no symptoms, he said.

DeAntoni said opponents like Kaiser believe that many men who are screened

and found to have prostate cancer actually would die from other causes and not be affected that much by prostate cancer in their lifetimes.

Some physicians believe that many prostate cancers are fairly harmless although others

would go on to an advanced disease state, he said.

Rather than subject men to uncomfortable treatments through radiation or surgery, these

doctors claim that the prostate cancer wouldn’t have an impact on their normal lives, he said.

Boulder Community Hospital generally conducts prostate cancer screenings in the fall each year, said hospital spokeswoman Carolyn Terman. During the rest of the year, patients are referred to private physicians for testing.

According to the CU Health Sciences Center, prostate cancer testing consists of a digital

rectal exam and a prostate specific antigen blood test. Each test takes about a minute to perform. The combination of these two methods is the most effective procedure for detecting

prostate cancer at an early and potentially curable stage, the hospital said.

The Health Sciences Center recommends that men between the ages of 50 and 70 be

screened for prostate cancer annually, while high-risk men should be screened annually starting at age 40.

From 1992 to 1996, studies found that more than 60 percent of the prostate cancers

detected through screenings were found in the first year that men were screened. Most of the

remaining cancers were detected in the second year of screening, and detection rates decreased

with each consecutive annual screening that followed.

“Annual screening may not be necessary for men who have had two or three negative

examination results and normal PSA (prostate-specific antigen) levels,´ said Dr. E. David

Crawford, associate director of clinical activities for the University of Colorado Cancer Center.

However, it is important for men to get a baseline PSA test at age 35 if they are at high risk — African Americans and those with a family history of the disease.

Crawford said men should get a baseline PSA test at age 45 if they are at normal risk for

the disease.