Prostate Cancer Conference Report:
Future Directions for Public Health Practice and Research in Prostate Cancer

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Executive Summary

Prostate cancer is a common cause of cancer-related morbidity and death in the United States (U.S.), and public health agencies and other organizations involved in cancer prevention and control are increasingly asked to play an active role in the effort to reduce the burden of prostate cancer. Yet, there is very little consensus among scientists and public health practitioners on effective prevention and control measures. There are no commonly recognized modifiable risk factors for prostate cancer. In addition, although prostate–specific antigen (PSA) testing and digital rectal exams (DREs) are commonly used to screen for prostate cancer, there is no consensus that screening reduces risk of death or increases quality of life. Since prostate treatments commonly cause serious side effects, there is no consensus that the potential benefits outweigh the harms of screening and treatment.

To help address this situation, the Centers for Disease Control and Prevention (CDC) organized a workshop, "Future Directions for Public Health Practice and Research in Prostate Cancer." The purpose of the meeting was to provide a forum for discussion of issues in prostate cancer prevention and control and to develop suggestions on how public health organizations can engage in research and program activities to address prostate cancer. Eighty-nine researchers, public health and medical practitioners, and representatives of community organizations and volunteer associations from Canada, Europe, and the U.S. attended. The meeting was held in San Diego, California on December 6–8, 2000.

Meeting participants were asked to discuss four major issues in prostate cancer prevention and control: understanding the risk and burden of the disease and its associated interventions, primary prevention, secondary prevention and treatment, and quality of life for survivors. Participants were also asked to suggest future public health activities in four areas: surveillance and monitoring, research, health communications, and other programs and services.

Because a number of controversies surround the issue of prostate cancer prevention and control, the meeting organizers did not anticipate consensus among the meeting participants. The meeting was organized to provide a range of suggestions reflecting the diversity of thought and, where possible, to reflect general or partial agreements among meeting participants on some specific recommendations. Recommendations regarding screening for prostate cancer were not the focus of the meeting. CDC, the meeting organizer, supports the recommendations developed by the U.S. Preventive Services Task Force. The Task Force does not recommend screening because there is insufficient evidence available that screening is effective or that benefits outweigh harms.

Small groups in breakout sessions discussed each of the four prostate cancer control issues and each of the four categories of public health activity. Groups discussed recommendations about what public health organizations should be doing in each area. They also selected a set of suggestions to be highlighted and reported these suggestions back to the meeting as a whole.

Participant recommendations are summarized in the chapter for each session. Highlighted suggestions are listed at the end of the chapter summary. The diversity of the discussions and recommendations cannot be captured in this executive summary. However, several recommendations that emerged repeatedly in discussion and in highlighted suggestions are summarized here. Although prostate cancer screening recommendations were not the focus of discussions, much discussion centered on public health activities related to screening.

A common topic in discussion during many of the sessions was the need for better communication about secondary prevention of prostate cancer. One suggestion from several sessions was that public health agencies, and CDC in particular, should be active in developing both messages and strategies to communicate to the public and to practitioners the uncertainties about the effectiveness of screening and the balance of potential benefits and harms from screening and treatment of screen-detected cancer. This activity should include reviewing scientific evidence on the effectiveness of screening, conducting research on how to summarize and communicate this complex information (e.g. through decision aids) and developing programs to deliver the information to the public and providers. Meeting participants recommended collaboration by public health agencies with other organizations to review evidence, provide better access to information, and address barriers to communication.

For other public health programs and services, participants recommended that public health organizations build infrastructure to facilitate collaborative research in secondary prevention and develop programs to encourage participation in clinical trials of primary and secondary prevention and treatment.

In the area of public health monitoring and surveillance of prostate cancer, participants commonly recommended improved surveillance of prostate cancer screening and of provider and public knowledge about prostate cancer. To complement clinical trials of the effectiveness of screening and treatment and research on risk factors, it was recommended that cancer registries expand the kinds of data collected and link registry information to other data sources to facilitate related analyses. Another recommendation was that public health conduct additional and longer term follow-up studies of men with prostate cancer compared with men without cancer, to provide better information on screening and treatment outcomes and quality of life.

In public health research, in addition to recommendations noted above, a major focus was on research to better understand disparities among U.S. population subgroups in prostate cancer incidence, mortality, and other measures of disease burden. Because of the great variation in risk and burden by race/ethnicity and other demographic characteristics, emphasis was placed on the need for improved understanding of the reasons for these disparities, from risk factors through health services. Another focus of research interest was in development of better information on quality of life of prostate cancer survivors and the development of better measures of quality of life for use in follow-up studies of survivors.

The issue of disparities was also addressed in terms of the need to develop and provide communications that are specific for population subgroups, the need for programs to facilitate access to services and information, and the need for improved surveillance of different demographic subgroups.

Acronyms

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