Cardiovascular Risk and Prostate Cancer Management - Episode 2
A broad look at the economic burden of prostate cancer and outlook in regard to survival within the current treatment landscape.
Maria Lopes, MD, MS: Prostate cancer is the most common cancer in men; it’s the second leading cause of death, second only to lung cancer. There were over 191,000 cases and 33,000 deaths in 2020 as a result of prostate cancer, according to the American Cancer Society. Over 60% of men diagnosed with prostate cancer are 65 and older, with an average age of about 66 years. So some of the costs have to do with not just the diagnosis of prostate cancer. Earlier identification is certainly leading to a lot of treatment options, including watchful waiting. But novel procedures, robotic procedures, radiation therapy, including IMRT [intensity-modulated radiation therapy], the cost of the ADT [androgen deprivation therapy], GnRH [gonadotropin-releasing hormone] agonists [and] antagonists, as well as some new and exciting treatment options, are part of the costs of prostate cancer. We have to think about not just the cost of prostate cancer, but the total cost of care, with many of these men having many other comorbidities and dying of potentially other causes outside of prostate cancer.
John L. Fox, MD, MHA: Over the last several decades, there have been a significant number of innovations in screening for prostate cancer and in treatment, and all of this has led to an increase in survival in patients who have prostate cancer. But there are a couple of challenges with that conclusion. First of all, there’s lead-time bias, where we might overestimate survival due to early detection by screening them rather than clinical presentation. Then there is also the challenge of length-time bias, where we overestimate survival because we detect the cases that are slowly progressing. So the real way to look at the impact of increased awareness, detection, and treatment in prostate cancer is to look at prostate cancer mortality. And clearly, mortality due to prostate cancer is decreasing. Even as far back as 1995, cardiovascular disease overtook prostate cancer itself as the leading cause of death in men with prostate cancer. So clearly, we’re having an impact, but we have to be aware though, too, that in these competing causes of mortality, that in men with prostate cancer, cardiovascular disease is now, and has been for over 25 years, the leading cause of death.
Transcript edited for clarity.