MONDAY, July 27 (HealthDay News) -- A major study has good news for men who have prostate cancer surgery but leaves unanswered the complicated question of whether a man should have that operation, another treatment or just watchful waiting.

The study of almost 13,000 American men who had a radical prostatectomy -- surgical removal of a cancerous prostate gland -- between 1987 and 2005 found that only 12 percent of them died of the cancer, according to the report in the July 27 issue of the Journal of Clinical Oncology.

"Patients with what we thought of as high-risk prostate cancer had a much lower risk of dying of their cancers than we ever thought," said Dr. Peter T. Scardino, chairman of the department of surgery at Memorial Sloan-Kettering Cancer Center, and a member of the research team. "Patients with more favorable prostate cancers did remarkably well, so well that you have to begin to question whether they should have been treated."

The choice of surgery, radiation therapy or watchful waiting must be made each year for more than 190,000 American men, most middle-aged or older, who are diagnosed with prostate cancer. Most choose some kind of treatment, said Dr. Andrew Stephenson, head of urological oncology at the Cleveland Clinic's Glickman Urological and Kidney Institute, and another member of the research team. From 40 percent to 50 percent choose surgery, about 10 percent choose watchful waiting, and the rest choose some form of radiation therapy, Stephenson said.

For men who have surgery, the new research has produced a tool that can allow them to predict their chance of survival for at least 15 years, Scardino said. Survival is measured by essentially three elements: the clinical stage of the cancer when it is detected, determined in great part by how large it is; the Gleason score, a measure of how much of its normal structure the prostate gland has lost; and blood levels of prostate-specific antigen, a protein produced by the gland.

The study found that the score had an accuracy of 82 percent in predicting 15-year survival, Scardino said. "If you could predict what would happen in the stock market in the next 15 years with 82 percent accuracy, you would be a genius," he said.

Overall, there was a greater chance that a man in the study would die of a cause other than prostate cancer. The rate of death from other causes was 38 percent, compared to 12 percent attributed to prostate cancer.

The new predictive method will be made public soon, after medical review, so that physicians and men can learn about their anticipated survival after surgery, Scardino said.

"Any person can look at it and put in the numbers," he said.

The new predictive tool is an improvement over the existing method, which relies essentially on readings of prostate-specific antigen levels, Stephenson said.

But no such predictive method exists for newly diagnosed men who must chose between treatment and watchful waiting, and so the study presents a predicament for those men and their physicians, he said.

"It questions the lethality of prostate cancer," Stephenson said. "Perhaps a similarly low risk might have been seen if the men did not have prostatectomy. We can't say whether a cancer poses enough of a threat to the patient so that therapy is needed."

Prostate cancer surgery is not free of problems, Stephenson said. Its major side effects are incontinence and loss of sexual function.

Many prostate cancers grow slowly -- so slowly that an old medical byword is that "more men die with their prostate cancer than of it." No existing method can single out the cancers that will be fatal if left untreated.

"We really need better tools for really identifying prostate cancers that pose a threat to longevity," Stephenson said. "Many have been proposed. All are being investigated, and hopefully in the future we will have better tools that accurately predict the risk of dying from prostate cancer."

Until those tools are available, the question is often "a balance between quantity and quality of life," he added. "That is a very complicated decision that must take many factors into consideration."

More information

Basic facts about prostate cancer are provided by the U.S. National Cancer Institute.

THURSDAY, July 2 (HealthDay News) -- A second gene linked to inherited testicular germ-cell cancer has been identified by scientists at the U.S. National Institutes of Health.

"This study contributes to our understanding of why testicular germ-cell cancer appears to run in families," Dr. Raynard Kington, acting NIH director, said in an agency news release. "The findings may also lead to new ways to identify men at high risk, as well as more effective ways to prevent and treat testicular germ-call cancer."

The U.S. National Cancer Institute estimates that 8,400 men will be diagnosed with testicular cancer this year, and that about 90 percent of the cases will be germ-cell cancers.

For the study, the scientists analyzed DNA from 95 familial testicular cancer patients and found seven different mutations in a gene called PDE11A. Healthy men did not have the mutations.

"The mutations don't cause cancer directly, but instead appear to increase an individual's susceptibility to developing a tumor," the study's senior author, Dr. Constantine Stratakis, chief of the endocrinology and genetics section at the National Institute of Child Health and Human Development, said in the news release.

The PDE11A gene is located in a key biochemical pathway in testicular germ-cell cancer, the cyclic AMP pathway, which regulates how cells respond to such signals as hormones. Drugs that affect the AMP pathway are widely available and, in theory, may help slow progression of testicular cancer.

Learning more about how mutations in PDE11A affect testicular cancer risk could help scientists identify other proteins that also play a role in the disease, Stratakis said.

The study is in the July issue of Cancer Research.

PDE11A is also highly expressed in the prostate gland, so Stratakis and colleagues are now studying the frequency of PDE11A mutations in men with prostate cancer.

More information

The American Cancer Society has more about testicular cancer  .

FRIDAY, June 12 (HealthDay News) -- Efforts to help people quit smoking vary from state to state, and despite progress over the years, there is still a long way to go, a new report concludes.

The news appears particularly timely given Thursday's historic Senate vote to put tobacco products under federal control.

The report, Cigarette Smoking Prevalence and Policies in the 50 States: An Era of Change -- the Robert Wood Johnson Foundation ImpacTeen Tobacco Chart Book, is a systematic review of national trends and tobacco-control policy and smoking behaviors in all 50 states.

"There are some areas of progress, and some areas where we are not doing so good," said study author Gary G. Giovino, chair of the Department of Health Behavior at the University of Buffalo School of Public Health and Health Professions. Giovino presented the report Wednesday at the National Conference on Tobacco or Health meeting in Phoenix.

Progress includes more people living in smoke-free homes and more states passing smoke-free air laws, Giovino said. "The country is becoming a smoke-free society," he said.

But at the same time, states are cutting funding for tobacco-control programs, Giovino added. "Over the years, states have taken more money in from excise taxes and the tobacco settlement payments, and yet they have cut back on tobacco-control funding," he said. "That doesn't seem right to me."

According to the report, after 40 years of efforts to get people to stop smoking, one-fifth of American adults still smoke. Smoking among those with lower levels of education and income, Native Americans and people with psychiatric and substance-abuse problems is even more prevalent.

Another group that needs to be targeted is young adults, where smoking rates are increasing, Giovino said.

In addition, disparities in tobacco policies exist among the states.

For example, the prevalence of smoking among those aged 18 to 29 is 2.5 times higher in Kentucky than in California (36.2 percent vs. 14.4 percent). Moreover, by 2007, 66 percent of those 30 and older in New Hampshire had quit smoking, but only 45 percent of West Virginians in the same age group had quit.

The report also says that in states with the fewest smokers, those still smoking are less likely to be dependent on smoking and more likely to want to quit, compared with smokers in states with a high prevalence of smokers.

States need to do more to educate people not to smoke and help smokers quit, Giovino said.

"There is wide variation in cigarette-smoking prevalence across states and a clear relationship between smoking prevalence and the rate of mortality that can be attributed to smoking," Giovino said. "Strong tobacco-control programs save lives."

While outreach programs, legislation, cigarette price increases and coverage for and access to stop-smoking treatment work, most states are not fully implementing these approaches to reduce smoking rates and protect nonsmokers, the report said.

For example, about 27 percent of people receiving Medicaid smoke, which is significantly more than the 17 percent of people with private health insurance who smoke. Yet, 12 states do not provide Medicaid coverage to help people quit.

Making smoking more expensive through excise taxes on cigarettes is a proven way to get people not to start smoking or to quit, the report says. But taxes vary by state -- Rhode Island's tax of $3.46 a pack is the highest; South Carolina's 7-cent tax is lowest.

Combined state and federal cigarette taxes make up a smaller percent of the cost of a cigarette pack in 2009, at 40 percent, than they did in 1970, at 49 percent, the authors noted.

On the bright side, state programs have shown progress in reducing smoking and exposure to secondhand smoke from the early 1990s to 2007.

• The number of smokers has dropped, from 24.5 percent to 18.5 percent.
• The percentage of people living in a home where smoking is not allowed inside increased, from 43 percent to 79.1 percent.
• The percentage of smoke-free workplaces has increased, from 46 percent to 75 percent.

Data in the report came from different sources, including the Tobacco Use Supplement to the Current Population Survey, the Youth Risk Behavior Surveillance System and the ImpacTeen State Legislative database. The ImpacTeen State Level Tobacco Control Policy and Prevalence Database

An earlier study supports the idea that states with strong tobacco-control programs can make a significant dent in smoking. According to a March report from the U.S. Centers for Disease Control and Prevention, differences in tobacco marketing and promotion and tobacco-control programs are among the reasons why adult smoking rates are almost twofold higher in some states than others.

For example, about 28 percent of adults in Kentucky smoke, and 27 percent in West Virginia, compared with 14 percent of adults in California and 12 percent in Utah, the report found.

Dr. Norman H. Edelman, a scientific consultant to the American Lung Association, thinks that while the number of smokers has gone down, attention needs to be paid to young adults and teens.

"Clearly we have made progress in reducing smoking," Edelman said. "But we seem to be coming down to a hardcore smoker -- a young adult or teenager, poorly educated and from a low socioeconomic status -- and that's problematic. We need to focus more on those groups."

More information

For more information on smoking, visit the U.S. National Institutes of Health.