Discussion: Prostate cancer

Recently several aging orienteers we all know have been told that their PSA levels are rising. Rising prostate-specific antigen (PSA) levels are an indication that cancer cells are multiplying in a man's prostate gland. Indeed more than half of all men over 60 will have prostate cancer, and many will die of it.

The incidence rate of Prostate Cancer is 2.25 times the incidence rate of
Breast Cancer, yet Federal research funding for Prostate cancer is less than half of what Breast Cancer research gets.

To call attention to this inequity, a petition is now circulating that urges higher federal funding levels for prostate cancer research.

We'd like to invite all A/Pers to sign this petition...men and women alike.
Then PLEASE forward this message to all the people in your address book asking them to do the same.

A paper version with 10 signature lines is also available for getting
signatures at meetings or any gatherings. Not everyone is geared to the
Internet. To get the PDF for printing the paper petition, just
mail to: info@pcaawareness.net and ask for paper petitions to be mailed to you.

Washington thinks in terms of millions -- the National Breast Cancer
Coalition submitted a funding petition in 1992 with 2.6 million signatures,
and look at the funding picture now. Unfortunately, so far we have obtained only 2700 signatures for our petition.

I'm not sure that there's a correlation between orienteering and PC. However a link between a limited sex life and PC has been established. So I wonder: are we orienteers more, or less likely to become PC candidates as we get older?

This belongs in Off-Course, not here.

I'm not sure I see the inequity myself - correct me if I'm wrong but breast cancer tends to strike younger people than does testicular cancer. Going by the number of people afflicted AND the number of years, on average, their lives might be extended by successful treatment, breast cancer may well deserve more funding than prostate cancer.

Also, feet is right.

(recategorized)

Thanks ken. I'm still getting used to these discussion catagories. Perhaps we need a catagory entitled "Injuries and treatments."

...breast cancer tends to strike younger people than does testicular cancer..... [so] breast cancer may well deserve more funding than prostate cancer....

Well, see, testicular and prostate cancer affect two different glands; they're completely different cancers. And testicular cancer does affect principally younger men, although its incidence is low. But the incidence of PC is high...and increasing.

The prostate is a gland stuck to the bottom of the bladder, through which the urethra passes. It produces men's seminal fluids. The testes produce only the active sperm that ride in this fluid...and I hope I don't have to point out where the testes are located.

Most urologists now recommend that guys get their first PSA test at age 45; and guys with a family history of cancer should begin at 40. PC is extremely important to catch at these young ages, because it tends to be much more aggressive, and difficult to cure. So catching it early is extremely important.

Since these are similar ages as those that breast cancer develops, I'm not sure that the age-related argument is valid...if appropriate at all. : < )

Sorry, my slip of the mind, possibly caused by my doctor insisting I get an ultrasound to make sure I didn't have testicular cancer some years ago. I didn't mean to bring anything other than prostate and breast cancer into the discussion.

I'm not disputing that catching PC early when it occurs early in life is important but my understanding (which may not, I'll concede, be up to the minute) is that medical researchers are divided as to whether treating PC late in life always makes sense since the side effects of treatment during a patient's remaining years before something other than PC does them in may often be worse than the effects of PC over that same time period.

That aside, I'd argue in general that an argument that one disease deserves more research funding than another ought to be based on more than simply the number of people affected. Some account ought to be taken of the severity of the effects, the adequacy of existing diagnostic tools and treatments, how promising various possible lines of research seem to be, etc. Maybe all that exists and justifies a higher funding level for prostate cancer research than for breast cancer research but it wasn't in the post starting the thread.

I'm not sure that there's a correlation between orienteering and PC. However a link between a limited sex life and PC has been established.

So, maybe a Star Trek fanboy convention would be an even better place to look for petition-signers than among orienteers?

As a physician but not a urologist, I have some perspective on the subject, although not solid numbers to back up my impressions. Prostate cancer is indeed a very common malignancy with a prevalence comparable to breast cancer (and probably a greater likelihood of occurence in men compared to breast cancer in women of a similar age as women make up a greater percentage of the elderly population). The incidence rate discrepancy quoted by chitownclark may indeed be valid, but one must always bear in mind that the incidence rate over a relatively small time period may reflect more aggressive diagnostic measures rather than a true discrepancy in prevalence. Like breast cancer, prostate cancer is increasingly likely to occur with advancing age. I believe the age of incidence curves are fairly similar. However, by my recollection, prostate cancer patients have a significantly higher survival rate than breast cancer patients (perhaps a 5-10 fold advantage over 5 years, which seems to be the standard by which these statistics are currently measured). Finally, the benefits of early detection and treatment are not so clear cut as they are for breast cancer, as the interventions are generally associated with greater morbidity (although this probably discounts body-image issues related to mastectomy) and with a lower percentage change in the outcome of death. This is not to say that I disagree with the suggestion that prostate cancer research is a valid use of healthcare resources. However, it does suggest that the current favored status of breast cancer research as compared to prostate cancer research may have some validity based on the natural history of the two diseases.

well, my impression is that prostate cancer seems to be a real and significant "bad thang" that happens to humans a fair lot (eg dad-in-law is getting biopsies etc), so I'm ready to be signing a petition. I'll look around up here in Canada and sign one or do an equivalent action for ya, Chitown (and "other aging orienteers" :) it's a small thing so it's certainly not hard for me to do, and when added to the efforts of others, it can be significant... cheers!

However a link between a limited sex life and PC has been established....So, maybe a Star Trek fanboy convention would be an even better place to look for petition-signers...?

Seems to me that quite a number of orienteers pass up that morning "eye opener," to instead arise and go out running. Their A/P logs may be well-tended, but how happy are their prostates?

Well, all we're asking is that you guys sign a petition, that may one day directly affect you, or a loved one. Isn't that a pretty good use for federal dollars?

...Some account ought to be taken of the severity of the effects, the adequacy of existing diagnostic tools and treatments, how promising various possible lines of research seem to be...

Well as ParkSchool pointed out, treating PC sometimes results in significant "morbidities": ie, often you cannot pee, or you cannot stop, after PC treatment. This is because the various known treatments (surgery, radiation, microwaves, freezing) unavoidably impact the lower urinary tract.

And if the PC is not removed entirely, it begins a slow progression: first to the lymph system and bladder, then to bones and the upper organs. But it takes years to actually kill. Meanwhile bones break, vertebrae collapse, and pain levels mount.

I don't know how much more severe the effects would have to be to justify a higher level of research funding.

just had my prostrate exam 2 days ago, waiting for the PSA results to get back. Can't wait to tell my wife about the link between limited sex and PC!!

OK, I've had enough. Once again, using this forum to push your favorite causes - good or bad - is in poor taste. Asking the intelligent readers here to send around a chain letter is just criminal. There are an infinite number of worthy causes in this screwed-up world that people could advocate, but personally I come here to chat with friends about orienteering. Its one of the few escapes I can find from everything out there that can kill me or make life miserable. I can (and have) read about PC in places more appropriate to do so. Please, please stop using attackpoint to push your basically non-orienteering causes. Being preached at in my favorite recreational forum just increases my blood pressure. This is not your mailing list to hijack.

just increases my blood pressure

And that can't be good for one's health, either.

Eddie, you need to lay off those satanic cookies :)

Awww, but they're so yummy. And vegan too!

Vegan cookies that Eddie can't resist? It might violate his principles to say here what they are but, if so, I hope he'll feel free to identify them for me by private email.

I'll, temporarily at least, resist the urge to continue the discussion in deference to Eddie's sensibilities but I would like to register my opinion that the Off Course discussion category, consistently and appropriately used, ought to be an adequate way of dealing with off-topic discussions short of actual commercial solicitations.

Sorry Jon, they're both just joking references to older threads. I'm not sure if Nabisco makes anything vegan (or satanic). I still like those maple cookies from Bulk Barn (tm).

Sad to say, Bulk Barn has switched to a non-vegan maple creme sandwich cookie maker :( Though there are other suppliers for my fix so it's not the end of the world.

'OK, I've had enough. Once again'...Eddie is right, no solicitations....

Eat your spinach.......

OK, I'm new round here and don't really want to start a flame war (especially with any vegan satanic cookie munchers), but is there a rule I'm not aware of that all users HAVE to read EVERY discussion thread, regardless of whether they're interested in the topic or not?

Yes.

i'll NEVER get old.

Well, there's one easy way to not get old, but I don't recommend it.

Dear birdman,

Well done. It took me a year to figure out that every discussion thread must be read.

PS It sure can't hurt Clark's petition.

I think that the original post is valid. There is increasing evidence that many years of endurance training/racing may cause cancer. Look at the rates among ultrarunners these days. Same thing with atrial fibrillation.

Anything we can learn and share about prevention is a good thing I think. Meanwhile, forget about petitions and do what we already know we should be doing... take your antioxidants/ free-radical scavengers, nap, eat less animal food, ...you know.

"There is increasing evidence that many years of endurance training/racing may cause cancer. "

This would be news to me. Mind pointing us to some of that evidence since I'm not getting anything in the way of studies on this topic with the first few searches I've tried online.

it might have something to do with the idea that exercise in general causes an increase in free radicals in the body... any way eat your veggies and fruits to keep up the anti oxidant levels

just curious, how does napping reduce cancer risk? I need a good excuse to nap, now that I have a good excuse for lots of sex!

here's some info on exercise and generation of free radicals
http://www.rice.edu/~jenky/sports/antiox.html

I think "Ultrarunner" mag had an article in the past 2 years looking at the apparent high incidence of cancer among long-time ultrarunners.
There is a Finnish study on veteran orienteerers and atrial fib (statistically higher rates there)
Sorry I don't have the time right now to dig those sources up (end of the semester grading-crunch!)
Isn't it rather common knowledge though that hard training produces free rads which may result in tumor growth?
Naps: "Athletes are a sleepy lot." -some forgotten Brit
I don't need an excuse for a nap; they just feel damn good! And sometimes segue into that other prostate-healthy activity you mentioned.

Common knowledge, yes, but speculating that there might be such an effect and having firm evidence in hand of at least correlation if not causation are far different things. The link jingo6390 gave, after all, also mentioned a study or studies indicating endurance athletes are better at mopping up the free radicals they produce than are sedentary people.

In any case, thanks - that may be enough additional detail already with which to find some information. It never occurred to me that the atrial fibrillation might have been specific to orienteers so I was looking for studies on that and ultrarunning. Though I find it hard to imagine why either group would be more likely to suffer from any cardiovascular problem than non-exercisers - a much bigger leap there, given that endurance exercise is generally acknowledged to be good for that system, than imagining the stress of heavy training over a long time might somehow promote cancer.

The literature of distance running (and I suppose other endurance sports) is replete with quotations like..."I don't do this because it's GOOD for me...but rather because I'm damn good at it." Hard marathon training, common sense tells me, is not really a healthful pursuit. Easy/varied pace running for about an hour a day probably is.
The orienteering study, by the way, doesn't claim that orienteering is particularly causal in A Fibrillation, but it just happens to be the group of endurance athletes that they studied in Finland. I think that all endurance athletes are in the same boat. I got it after 35 years of marathoning, exactly as the study suggested.

http://www.pubmedcentral.nih.gov/articlerender.fcg...

Lone atrial fibrillation in vigorously exercising middle aged men: case-control study
Jouko Karjalainen, internist, Urho M Kujala, chief physician, Jaakko Kaprio, senior researcher, Seppo Sarna, associate professor, and Matti Viitasalo, cardiologist

Introduction

Regular physical exercise reduces cardiovascular morbidity.1,2 However, our clinical impression is that atrial fibrillation is quite common in otherwise healthy middle aged men engaged in long term vigorous endurance sports. We therefore compared the prevalence of atrial fibrillation in middle aged men doing intense endurance training and men from the general population.

Subjects, methods, and results

We chose top level veteran orienteers to represent subjects doing long term vigorous exercise. A high position in the veteran ranking list is an indicator of years of intense training. We enrolled the 60 top ranked orienteers in 1984 from the race classes age 35-39 years, 40-44 years, 45-49 years, and 55-59 years, a total of 300 runners. The 495 controls comprised all men aged 35-59 enrolled for an earlier study.2 At 20 years old these subjects had been completely healthy (fully fit for military service). Mean (SD) age at baseline was 47.5 (7.0) years in orienteers and 49.6 (5.3) years in controls. Controls had responded in 1985 to a questionnaire which included items on physical activity and occurrence of various diseases.2

In 1995 we sent a similar questionnaire to the orienteers and controls but which contained an additional question on cardiac arrhythmias: ?Has a doctor ever told you that you have atrial fibrillation or atrial flutter.? Those who answered ?yes? completed another detailed questionnaire on atrial fibrillation, and electrocardiograms and other data were obtained from their medical records to confirm the diagnosis. We excluded all subjects who reported known risk factors for atrial fibrillation.3

Ninety per cent (262) of the orienteers and 83% (373) of the controls responded to the questionnaire (figure). Compared with the general population orienteers had much lower mortality (1.7% (95% confidence interval 0.5 to 3.8%) v 8.5% (6.2% to 11.3%)), lower reported coronary heart disease since 1985 (2.7% (1.1 to 5.4%) v 7.5% (5.1% to 10.7%)), and fewer risk factors for atrial fibrillation (figure). However, in men without known risk factors, lone atrial fibrillation had been diagnosed in 12 of 228 (5.3% (2.8% to 9.0%)) orienteers and in 2 of 212 (0.9% (0.1% to 3.4%)) controls (P=0.012, two tailed Fisher?s exact test), the relative risk being 5.5 (1.3 to 24.4) in orienteers. The two controls with lone atrial fibrillation also took vigorous exercise. The age-specific prevalence of lone atrial fibrillation at the end of 1995 in orienteers was 4.2% (4/95) for those aged 46-54 years, 5.6% (4/72) for those aged 55-62 years, and 6.6% (4/61) for those aged 63-70 years. In subjects with risk factors atrial fibrillation had been diagnosed in 12% (4/34) of orienteers and 9% (15/161) of controls (P>0.05).

The first attack of lone atrial fibrillation in orienteers was at a mean age of 52 years (SD 10, range 34 to 68) after an average training history of 36 years. Three also had documented episodes of atrial flutter.

Comment

Vigorous long term exercise is associated with atrial fibrillation in healthy middle aged men despite protecting against coronary heart disease and premature death. In population studies the average prevalence of atrial fibrillation, persistent or paroxysmal, is 0.5% in subjects aged 45-54 years, about 1% at 55-64 years, and 4% at 65-74 years.4 The prevalences of lone atrial fibrillation in our sportsmen were higher.

The reasons for the increased risk of atrial arrhythmias in middle aged endurance athletes can only be speculated. Enhanced vagal tone, characteristic of endurance athletes, predisposes normal hearts to atrial fibrillation.5 Atrial enlargement and left ventricular hypertrophy, both features of the endurance athlete?s heart, may further increase the tendency to atrial fibrillation. We do not know whether stopping exercise would have prevented recurrence of atrial fibrillation. Most of the orienteers with commonly relapsing cases had responded adequately to antiarrhythmic drugs and continued competing.

References
1.
Morris JN, Everitt MG, Pollard R, Chave SPW. Vigorous exercise in leisure-time: protection against coronary heart disease. Lancet. 1980;ii:1207?1210.
2.
Kujala UM, Kaprio J, Taimela S, Sarna S. Prevalence of diabetes, hypertension and ischemic heart disease in former elite athletes. Metabolism. 1994;43:1255?1260. [PubMed]
3.
Krahn AD, Manfreda J, Tate RB, Mathewson F, Cuddy TE. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med. 1995;98:476?484. [PubMed]
4.
Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution and gender of patients with atrial fibrillation. Arch Intern Med. 1995;155:469?473. [PubMed]
5.
Coumel P. Paroxysmal atrial fibrillation: a disorder of autonomic tone? Eur Heart J. 1994;15(suppl A):9?16.

I think that perhaps the most telling statistics from the article are that "compared with the general population orienteers had much lower mortality (1.7% (95% confidence interval 0.5 to 3.8%) v 8.5% (6.2% to 11.3%)), lower reported coronary heart disease since 1985 (2.7% (1.1 to 5.4%) v 7.5% (5.1% to 10.7%)), and fewer risk factors for atrial fibrillation". Such risk factors for atrial fibrillation include: hypertension, myocardial or valve disease, diabetes, thyroid disorder, and severe obesity.