Running head: PROSTATE CANCER 1

Prostate Cancer

Evelyn Mathis

Chamberlain University

NR 503: Population Health Epidemiology and Statistical Principles

May 2020
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Prostate Cancer

The development of prostate cancer is one of the most common among man, however;

because of its insidious signs and symptoms during phase one it presents great challenges for

both the person developing it and the healthcare provider. As we have learned in this class

primary preventive care would absolutely improve early stage diagnosing and treatment

interventions choices for this very common cancer among man. The problem is that many times

its development is insidious and as so many man delay seeking medical care until the cancer has

already metastasized making the course of treatment more aggressive and the prognosis a poorer

one. However, adhering to the national preventive diagnostic test guidelines for the detection of

prostate cancer has proven effective (American Cancer Society | Cancer facts & statistics, 2020).

It is critical to realized that the incidence of prostate cancer is more prevalent in some

races than others. In the Unites States Black American man comprise the highest group for

developing prostate cancer ( 4 Things African American men should Know about prostate

cancer, 2020).

The main concern regarding prostate cancer, is that it occupies the second level of

mortality among the cancers afflicting man, it is imperative that we aim primarily toward

educating the general public and using secondary prevention through early diagnostic tools such

as prostate specific antigen screening and following close active surveillance.

For year 2020 the estimated number of cases nationally is projected at 191, 930 out of

which 33.330 are expected to die. While research and treatment options are ever changing in the

urologic community the decision to how aggressive the eradication of the cancer should be
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remains both a patient –healthcare provider decision (American Cancer Society | Cancer facts &

statistics, 2020).

Background and Significance of the Health Problem

The development and background for developing prostate cancer has been directly

associated with factors such as hereditary, age, race and environmental aspects Heredity plays a

highly significant role in the incidence of prostate cancer in man. If genetic predisposing such as

having a father or blood related sibling has been identified, then the likelihood of developing the

disease increase two folds. Age is also significant to the development of prostate cancer,

however; 65 years of age and above has been directly connected to the greatest incident of the

disease in that group. While many of the risks associated with developing prostate cancer are

many times unavoidable, healthcare providers who know this make it their priority to implement

preventive diagnostic measures. In the year 2020, the incidence of new prostate cancer incidence

is projected to be 13,950 with an estimated mortality of 2,800. Nationally, the figure is 191,930

with 33,330 deaths projection. The incidence rate based on 100,000 man was 104.2 and deaths

rates per 100,000 were 19.1 %. In Florida the prevalence of prostate cancer is higher in Non-

Hispanic Blacks followed by American Indians.

Table 1.

Analysis National Prostate Cancer Florida Prostate Cancer Race

Incidence 191,930 13.950

Mortality 33,330 2,800
Non-Hispanic Blacks 38.7
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Current Surveillance and Reporting Methods

In the case of patients who have been diagnoses with low level risk type of prostate

cancer which comprises around 30% of all prostate cancers and wish not to proceed with more

radical methods to eradicate the disease they opt for a less invasive option which is known as

active surveillance, this is a method often used as an option to radiation or radical surgery.

Active surveillance offers patients the freedom to be treated only when absolutely needed and

based on active surveillance results.

Interestedly enough is the fact that while prostate cancer is numbered among the ten

most common cancers, it is considered the one cancer having the most slow growing types of

tumors, and this makes prostate cancer a good candidate for active surveillance in lieu of more

aggressive treatment options (Active Surveillance and Prostate Cancer, 2020).

Florida incidence of cancer compared to the national average has decreased in general for

the last ten years this data has been collected by The Florida Cancer Plan initiative one of the

state of Florida surveillance programs dedicated to collecting active data on new and existing

cases of prostate cancer goal number 2 of the 2020-2025 is to centralize a data center to all

statewide number of cases whether from private, public and outpatient’s centers. This data

collecting initiative will better reflect Florida’s latest data of current cases (Site Search | Florida

Department of Health", 2020). Under the Florida Statute 385.202 healthcare providers are

required to report prostate cancer among other conditions in the state of Florida, the information

is significant to the data collected by the Florida Department of Health and is part of a national

reporting initiative that id then reported to the Center for Disease Control data collection and not
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complying with this mandate can result in license suspension or revocation (The Florida Cancer

Data System - Laws and Rules, 2020).

Descriptive Epidemiological Analysis of Health Problem

In describing prostate cancer as a health problem the what aspect would referred to the

occurrence of prostate cancer and lack of education on the topic, and where the disease is mostly

distributed in this case prostate cancer is a health problem exclusive to man, this complete the

who aspect of the disease, the who aspect also deals the age of the population affected

epidemiology studies point to man over 65 years of age as being the most affected and this age

determinant is even stronger when there is familial genetic connection which in that case

diagnostic tests are encouraged to be performed at a younger age 45 years old. The when and

why closely related to the client family history and other determinants such as obesity and higher

exposure to a carcinogenic environment

The incidence of prostate cancer is more prevalent in developed countries such as the

United States (where). In the last decade the increment of prostate cancer both nationally and at

the state level has reach its highest levels. Depending on the geographical and how aggressive

the preventive guidelines are implemented it would make a difference in the number of new

cases discovered through these testing tools. When comparing the aggressiveness of prostate

cancer between African- American man (who) to White man in the United States it was

discovered the African American suffered the most aggressive type. It is critical that we as future

healthcare providers keep in mind that both the social injustice seen in low socioeconomic areas

and the all familiar health disparities seen in aggregates where the majority is actually minority

gets the preventive opportunities to be tested early to decreased mortality rates and as much as
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possible to lessen the aggressiveness of prostate cancer and as a result star building better quality

of life and increased survival rates for the most afflicted group of patients which a s the literature

and research has proven are African American man and their families. According to Cancer

Facts & Figures American Cancer Society (2020) lack of compliance with treatment has add to

poor outcomes and an increment in mortality rates of prostate cancer patients, this otherwise

preventable increased has lend to the frustration felt by healthcare providers as well creating a

negative impact to the health insurance sector.

Screening, Diagnosis, Guidelines

The preferred screening method for detecting prostate cancer in its earlier stages is the

prostate specific antigen (PSA) followed by digital rectal examination (DRE) even though the

literature expressed that there is insufficient proof to say that early detection of the disease leads

to decreased mortality, having this early diagnostic tool has improved the early detection of the

disease. The has not been sufficient proof between the disease history and the relationship

between early detection, the natural course of the disease and best outcomes for man who did go

through early testing has not fully been proof. Since the introduction of (PSA) as a diagnostic

tool in the 1990’s worldwide incidence of prostate cancer has doubled. There are countries were

the incidence of the mortality related to prostate cancer has decreased but the relationship

between this decreased in mortality and early detection through using (PSA) has not been

demonstrated (Recommendation: Prostate Cancer: Screening | United States Preventive Services

Taskforce, 2020).

The reliability of using PSA as a diagnostic tool has proven not reliable in determining

whether a cancer is a slow growing or a more aggressive type. The lack of reliability from using
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(PSA) testing then translate to applying more invasive procedures such as biopsies to man that

might no need to exposed themselves to unnecessary treatments and subsequent side effects such

as impotence and other gastrointestinal or genitourinary dysfunctions. The main goal of early

diagnostic methods such as (PSA) is to improve outcomes of disease, but in the case of (PSA)

the risks many time are far more critical and damaging than the benefits.

A more reliable test is virtually new and is called the Parsortix this test is also uses blood

levels to detect the presence of prostate cancer markers, but the great difference between this test

and ( PSA) is the Parsortix test actually more accurate cell that are particular to tumors in its

earlier stages these are called circulating tumor cells ( CTCs), this is so empowering to both

patients and healthcare professionals alike because of the accuracy of the test on measuring

living tumor cells that had just detached from the tumor and this provides earlier accurate

treatment to patients (Queen Mary University of London, 2019.

The predictive value of (PSA) testing has decreased in the last few years mainly due to

the performance of its sensitivity and specificity of prostate cancer which has led to many

unnecessary and more aggressive invasive procedures to determine the correct presence of a

cancerous prostate gland or perhaps a benign prostatic hypertrophy, because ( PSA) is mostly

sensitivity and presence of tumor and not specifically the prostate as an organ/gland the results

can be applied to prostate cancer on 100 percent of the time ( Recommendation: Prostate Cancer:

Screening | United States Preventive Services Taskforce, 2020).

Plan of Action

Knowing that while primary care is critical to detecting disease early in its course, as a

new nurse practitioner one would consider both educating the public on diagnostic testing
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benefits and seeking estate and governmental assistance to bring such benefits as early testing

when working with groups of the population that are knows to have disparities in their

aggregates. As a nurse practitioner who is planning on working with African American

communities and other minority groups, one will create initiatives to empower these

communities through education and policy advocacy.

One would take advantage of the internet accessibility and the fact that most people have

a cellular phone so that increase communication could be maintaining through that venue with

patients, according to Sajani Patel (2020) using technology as a tool to improve patient- provider

communication of health related topics in minority aggregates has proven to be effective in

improving patient outcomes and early diagnosing of disease.

A second intervention would be aimed towards having local universities that are involve

in educating future health care professionals create mobile clinics that attend specifically to

patients that have been identified as both being vulnerable in the aspect of ethnicity, but also in

the age and socioeconomic factor, these efforts would have to be collaborative in nature , where

the city council, healthcare official and local churches would work together to identify the

patients who are for any reason not able to fill their medication prescriptions, be complaint with

follow up visits or simply got lost in the system ("Better Medicare Alliance Statement on Racial

Disparities and Violence | BMA", 2020).

A third intervention would actually start with me and the place where one would work,

assessing the needs for change and researching facts to prove to the organization that the

community is in need of best change and improvement on health care delivery practices (Better

Medicare Alliance Statement on Racial Disparities and Violence | BMA, 2020).

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Conclusion

Prostate cancer is an afflicting disease affecting man in general. Determinants of prostate

cancer such as age, ethnicity and heredity are not modifiable, however, environmental, early

detection testing and best health practices are excellent factor that would improve both morbidity

and mortality rates. Healthcare providers and community leaders have the ability to improve the

lives of those diagnoses with prostate cancer through purposeful education of their patients and

to create meaningful change that improves the quality of life and outcome of this devastating

disease.

Nationally there are organizations and alliances in place that would assist the healthcare

provider who is truly passionate about disintegrating disparities and reducing both the

unnecessary exposure to invasive treatment pain associated poor diagnosing of true prostate

cancer and not benign prostatic hypertrophy. Research on best diagnostic tool that are more

specific and sensitive to prostate cancer are being developed, but the responsibility of choosing

wisely remains on the healthcare provider, this is a cancer that needs our best determination in

preventing, diagnosing and treating.

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Recommendation: Prostate Cancer: Screening | United States Preventive Services Taskforce

(2020).

References

Active Surveillance and Prostate Cancer | Prostate Cancer Foundation. (2020). Retrieved 13 June
2020, from https://www.pcf.org/about-prostate-cancer/prostate-cancer-treatment/active-
surveillance/

American Cancer Society | Cancer Facts & Statistics. (2020). Retrieved 10 June 2020, from
https://cancerstatisticscenter.cancer.org/?_ga=2.28799994.795081071.1591813116-
755193253.1590353382#!/

Better Medicare Alliance Statement on Racial Disparities and Violence | BMA. (2020).
Retrieved 15 June 2020, from https://www.bettermedicarealliance.org/newsroom/press-
releases/better-medicare-alliance-statement-racial-disparities-violence

Cancer Facts & Figures 2019 | American Cancer Society. (2020). Retrieved 14 June 2020, from
https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-
figures-2019.html

Pentyala, S. N., Lee, J., Hsieh, K., Waltzer, W. C., Trocchia, A., Musacchia, L., Rebecchi, M. J.,
& Khan, S. A. (2015). Prostate cancer: a comprehensive review. Medical oncology (Northwood,
London, England), 17(2), 85–105. https://doi.org/10.1007/BF02796203
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Recommendation: Prostate Cancer: Screening | United States Preventive Services Taskforce.
(2020). Retrieved 13 June 2020, from
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening

Site Search | Florida Department of Health. (2020). Retrieved 12 June 2020, from
http://www.floridahealth.gov/search/search.cgi?
zoom_query=prostate+cancer+reporting+&zoom_cat%5B%5D=0

Sajani Patel, M. (2020). Activating Racial and Ethnic Minorities to Engage in Preventive Health:
Patient Preferences for Health Reminders. Retrieved 15 June 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736376/

Site Search | Florida Department of Health. (2020). Retrieved 12 June 2020, from
http://www.floridahealth.gov/search/search.cgi?
zoom_query=prostate+cancer+reporting+&zoom_cat%5B%5D=0

Things African American men should know about prostate cancer. (2020). Retrieved 10 June
2020, from https://www.mskcc.org/blog/4-things-african-american-men-should-know-about-
prostate

The Florida Cancer Data System - Laws and Rules. (2020). Retrieved 12 June 2020, from
https://fcds.med.miami.edu/inc/lawsrules.shtml

Queen Mary University of London. (2019, September 10). New blood test for prostate cancer is
highly-accurate and avoids invasive biopsies. Science Daily. Retrieved June 13, 2020 from
www.sciencedaily.com/releases/2019/09/190910114245.htm