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Today there are over 22,000 men living in Israel who have ever had prostate cancer * a collection of studies

This is according to recent data from the National Cancer Registry at the Ministry of Health. This is the most common cancer among men. Yesterday was Prostate Cancer Day

The urinary tract in the male body on an x-ray. Illustration: shutterstock
The urinary tract in the male body on an x-ray. Illustration: shutterstock

New and updated findings
Dr. Little Kinan Booker - Deputy Director of the Center for Disease Control at the Ministry of Health: presented recent data from the Ministry of Health's National Cancer Registry, regarding prostate cancer: Prostate cancer is the most common cancer in men in Israel (the first in frequency in Jewish men, and the second in frequency, after cancer the lung, in Arab men).

Today there are over 22,000 men living in Israel who have ever had prostate cancer.

Incidence rates:
In 2010, 2,557 new patients with invasive prostate cancer were diagnosed, of which 2,314 were Jews (90%), 123 Arabs (5%) and 120 others (non-Arab Christians and those without religious classification).
The age-adjusted incidence rates of invasive prostate cancer have been on the rise since the early 90s, peaked in 2007, have decreased in recent years and are stabilizing. The rate in Jewish men was 52.3 per 2000 in 60.4 and 2010 per XNUMX in XNUMX.

Incidence rates of invasive prostate cancer increased mainly in the late 80s and early 90s, a time when the PSA test became common and available in Israel.

Morbidity rates by age:
Incidence rates of invasive prostate cancer increase starting at age 50 in all population groups. In 2010, most of the morbidity was observed in people 65 years and older. The peak of morbidity among Jews is in the 70-74 age group, and among Arabs 75 and older.

Morbidity rates by place of birth:
In 2010, there were no substantial differences in the age-adjusted incidence rates of invasive prostate cancer, between the different ethnic groups among Jews. The highest rate was observed in European-Americans (64.8 per 57.9) and the lowest rate, in Asians (XNUMX per XNUMX).

Survival rates:
There is a trend towards an increase in the relative survival rate from prostate cancer, and today the relative survival rate for 5 years is over 90%.

Mortality rates:
Prostate cancer is the fourth most common cancer as a cause of death in men in Israel, after lung cancer, colon and rectal cancer, and pancreatic cancer.
In 2010, 380 men died in Israel from invasive prostate cancer, of which 348 (91.6%) were Jewish.
Age-adjusted mortality rates for invasive prostate cancer have been on a downward trend in recent years among Jewish men: in 2000 the mortality rate was 8.53 per 2010, compared to 6.56, when the mortality rate was XNUMX per XNUMX. Arab men also show a downward trend, with stabilization, in the last year.

International comparison:
According to the International Agency for Research on Cancer (IARC) data for 2008, which compares the incidence rates and death rates from prostate cancer adjusted for age in Israel, compared to 20 countries with the highest rates in Europe, it appears that the rates in Israel are relatively low, and are similar to those reported from Italy and Spain.

What to tell the patient about a prostate cancer screening test?

Guidance for doctors from the clinical guidelines of the American College of Physicians (ACP)
Prostate cancer is the fourth most common cancer as a cause of death among men in Israel. In the US, 1 in 6 men will be diagnosed with prostate cancer during their lifetime - 2.9% will die from the disease.
It is difficult to estimate the percentage of men who were diagnosed with prostate cancer but never developed clinical symptoms. It is estimated that the percentage ranges from 23% to 66%. The prevailing approach in the world is that screening for prostate cancer has more disadvantages than advantages, therefore in Israel, as well as in most countries of the Western world, there is no blanket recommendation to perform a screening test.
The goal of the ten formulated rules is to help doctors to allow patients to make an informed decision regarding the dilemma of whether to perform a test to diagnose prostate cancer:
1. The ACP recommends that doctors inform men between the ages of 50 and 69 about the limited benefit and the possible harm inherent in prostate cancer screening. ACP recommends that physicians base the decision to refer for prostate cancer screening on the benefits and harms of the test, the patient's general medical condition and expected life expectancy, and the patient's preferences. ACP recommends that doctors do not refer patients for prostate cancer screening who do not specifically state that they wish to have the test performed.
2. ACP recommends that physicians not refer prostate cancer screening to men, at no risk, under the age of 50, men over the age of 69, or men whose estimated life expectancy is less than 10-15 years.

Although the instruction to doctors is not to refer men who are not interested in the test to the screening test, there are still men who would prefer to perform the test.
In these circumstances, the recommendation is for joint decision-making by the doctor and the patient.

The ten important points that the doctor must mention and clarify to the patient:
1. Screening for prostate cancer, using the controversial PSA test.

2. A screening test using PSA can diagnose prostate cancer, but for most men the chance of causing harm from the test outweighs the benefit of performing it.

3. A small number of prostate cancer cases can cause death. Prostate cancer usually develops slowly and does not cause death.
4. Most men who choose not to perform the PSA test will not be diagnosed with prostate cancer during their lifetime, and will die under other circumstances.
5. Patients who choose to perform the PSA test will have a higher chance of being diagnosed with prostate cancer.
6. The PSA test sometimes does not differentiate between cancer with lethal potential, and non-lethal cancer. At the same time, men with a high PSA level (above 10 mg/L) have a lower chance of dying from prostate cancer, if they are operated on.

7. The small advantage of screening for prostate cancer is in preventing the death of
1,000 person per 11 men, surveyed over XNUMX years of follow-up.

8. There may be many damages as a result of the survey:
• Error in interpreting the results.
• A high PSA level can be obtained due to an enlarged prostate, and not due to the presence of cancer, or the level can be low despite cancer findings.
• If a biopsy is required, it may also have risks. The biopsy requires the use of needles inserted into the prostate under local anesthesia, and there is a risk of infections, bleeding, and hospitalization.
• If cancer is diagnosed, it will usually be treated with surgery, or radiation, which also have their own risks. There is a small risk of death in surgery. In addition, in each of the methods there is an increased risk of impotence (37% excess risk) and loss of urinary control, which necessitates the use of diapers (11% excess risk), compared to the risk without surgery.
9. The PSA test is not a simple blood test, it is a test that may "open the door" to additional tests and treatments that may harm the patient. A person's chance of harm is greater than the chance of benefit from the test. Therefore, each person must receive the information, so that he can decide whether to perform the test.
10. Research is being done all the time, so doctors may learn more about the benefits and harms of screening. Efforts are being made to develop more effective diagnostic tests and treatments, so recommendations may change over time.

Can consuming tomatoes prevent prostate cancer?

In the review of the studies, the researchers present the effect of lycopene and its mode of action on the prevention of cancer in general, and prostate cancer in particular.
There are reports that about 30% of men in the US between the ages of 20-40 carry microscopic prostate cysts, which can develop into prostate cancer. Therefore, it is very important to intervene through nutritional supplements, in order to slow down the growth and progress of these small cells.

Lycopene is a fat-soluble molecule found mainly in red fruits and vegetables, such as: tomatoes, watermelon, apricot, pink guava and papaya. The antioxidant activity of lycopene is based on the ability of this compound to trap free radicals in cell cultures and living models.

In various epidemiological and clinical studies, a relationship between high consumption of tomato products and a reduction in the risk of malignant tumors was demonstrated, and a close relationship was found between the concentration of lycopene in plasma and malignant diseases of the pancreas and bladder.

Several studies have examined the relationship between the consumption of tomato products, the consumption of lycopene in the bloodstream and the risk of getting cancer in general and prostate cancer in particular. The most impressive data regarding the consumption of tomato products and the prevention of malignant tumors were obtained in the context of prostate cancer. An inverse relationship was found between the consumption of lycopene from different tomato products, and the risk of prostate cancer. A reduction in the risk of almost 35% for prostate cancer was observed for a frequency of consumption of 10 servings, or more, of tomato products per week.

The protective effects are even stronger in cases of advanced or aggressive prostate cancer. It was also found that lycopene can reduce the symptoms of prostate cancer, mainly reducing pain and easing urination.

At the same time, the data obtained are not conclusive. There are studies that did not find a connection between lycopene consumption and prostate cancer, and others as mentioned indicate that high lycopene consumption, or high concentrations of lycopene in the blood circulation, reduce the risk of prostate cancer by 30%-40%, especially as mentioned, violent prostate cancer. The hypothesis is that processing and heating the tomato products increases the bioavailability of lycopene, also the presence of fats in food increases the absorption of lycopene. Therefore, processed tomato products such as ketchup are good sources of lycopene.
As mentioned, further research is required to confirm the findings.

From the Medicine volume 152, booklet 8, August 2013. Review of studies on "the relationship between the consumption of lycopene and tomato products and the treatment or prevention of prostate cancer", Tali Zilberstein, Soroka Medical Center, Eldad Zilberstein, Ben Gurion University, and Ushera Sapir, Sami Shimon Academic College .

Is there a connection between drinking coffee and the recurrence of prostate cancer?

In a study conducted in the USA by researchers from the Fred Hutchinson Cancer Research Center in the USA, the coffee and tea consumption of 630 men diagnosed with prostate cancer was monitored between 2002-2005 in the state of Washington.
The researchers received data about the coffee and tea consumption of the participants for two years before the diagnosis. The respondents were not asked to report the type of coffee, regular or decaffeinated coffee, nor the type of tea and the researchers assume that it is regular black tea.
In addition to the questionnaire, the researchers examined the health events of the participants for about six and a half years after the diagnosis. In 2011, a follow-up questionnaire was conducted, in which data were reported about the recurrence of the disease, treatments and tests performed during the follow-up, etc. During these years, 140 recurrences of the disease, or its progression, were reported, when the recurrence of the disease was defined as a case of death from prostate cancer, the discovery of metastases, receiving additional treatment for the disease, or an increase in the PSA index.
Data on coffee consumption were divided into 5 categories: less than a cup per week, 2-6 cups per week, a cup per day, 2-3 cups per day and over 4 cups per day.
About 61% of the patients consumed at least one cup of coffee a day, 12% consumed more than 4 cups a day.
It was found that coffee consumption was associated with a decrease in the risk of recurrence of the disease, or its progression. The patients who consumed more than 4 cups a day had a 59% lower risk of disease recurrence, or its progression, than those who were in the lowest category, consumption of a cup per week.
The researchers found that tea consumption had no connection with the risk of the disease returning, or its progression. Also, no connection was found between coffee consumption and mortality from prostate cancer or any other reason.
In light of the fact that previous studies have found that coffee consumption is associated with a decreased risk of several types of cancer, the researchers hypothesize that there are certain components in coffee that are responsible for the anti-cancer effect. Since another study on both regular and decaffeinated coffee consumption indicated a similar relationship with aggressive prostate cancer, the researchers hypothesize that it may be an ingredient other than the caffeine itself. They emphasize the need for larger and more comprehensive studies to confirm these results. At the same time, it is important to emphasize that the results of this study are consistent with the findings of Harvard's (Health Professionals Follow-Up Study Harvard's) which found that men who drink 6 or more cups of coffee per day had a 60% reduction in their risk of metastatic prostate cancer, compared to men who do not drink coffee .
The study was published in the journal Cancer Causes & Control in the August 2013 edition
. (Milan S. Geybels, et al.)

Active surveillance as a treatment option for prostate cancer, in very low-risk patients, with benign prostate enlargement

In a study conducted in the urology department at the Carolinas Medical Center in North Carolina, USA, the researchers followed, using a method called 'active surveillance', patients who were diagnosed with very low-risk prostate cancer, and who were treated with drugs due to a benign enlargement of the prostate gland.
Considering the advanced age of many diagnosed with prostate cancer and the possible side effects that may result from treatment of this disease, active surveillance appears to be a therapeutic option for a certain group of patients. The American National Comprehensive Cancer Network - NCCN recommends active surveillance for those diagnosed with prostate cancer, who have a life expectancy of less than 20 years, who are at a very low risk of the disease spreading. Often these men also suffer from a benign enlargement of the prostate.
The treatment of men with benign enlargement of the prostate, with symptoms of urination problems and with a diagnosis of prostate cancer at a very low risk level, poses a dilemma for doctors, when the fear is that the drug treatment of the benign enlargement of the prostate will worsen the cancer that was diagnosed at a low risk level.
82 men who were diagnosed with prostate cancer with a very low degree of malignancy (Gleason equal to or less than 6) participated in the study. and who were additionally diagnosed with benign prostatic hyperplasia (BPH), and were treated with the drugs Proscar or Avodart for this problem. The treatment aims to affect the volume of the prostate gland and reduce the PSA level. Active follow-up included follow-up of PSA levels every six months, biopsies after one year of diagnosis, and after two years.
The researchers found that during 3 years of active follow-up of men who had very low-risk prostate cancer, and who were treated with drugs against benign prostate enlargement, about 70% of the men were without any progression of the disease, or their biopsies were negative.

Among the 82 patients, 76 of them underwent another biopsy after one year. Of these, in 41 (54%) no cancer was observed at all, 16 (21%) continued to be at very low risk, in 19 (25%) of the patients the disease progressed to 'low risk', or medium. In no patient was a 'high-risk' disease observed, not even among those who underwent a second biopsy, two years later.
Only 22 (about 27%) of the 82 patients were not satisfied with active surveillance, and received treatment for prostate cancer. Their results after the 3 years of follow-up did not differ from those who were in active follow-up only.
The study was published in the journal Urology in the May 2013 edition ((Peter Q. Shelton et al.

Based on materials from the Cancer Society.

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