The Selenium and Vitamin E Prevention Trial

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Jesse Watts
5 years ago
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1 The largest-ever-prostate cancer prevention trial is now underway. The study will include a total of 32,400 men and is sponsored by the National Cancer Institute and a network of researchers known as the Oncology Group. The name of the trial is The Selenium and Vitamin E Prevention Trial. The study will take up to 12 years to complete. The goal is to determine if selenium or vitamin E can protect against prostate cancer. Dr. Linda Goodwin, Reinsurance Medical Director for Transamerica Reinsurance, provides and excellent overview of the impact of functional ability on older clients in an article that was originally published in Broker World: functional_assessment_elderly.asp Click here for an interesting study from the New York University School of Medicine using PET scans to predict patients who would eventually develop Alzheimer s disease based on "brain metabolism:" medlineplus/news/fullstory_3779.html Where exactly is the prostate gland? What are PSA and "Free PSA? How do you read a pathology report? How is insurability impacted? Screening Questions Prostate Cancer Essentials Aside from skin cancer, prostate cancer is the most commonly diagnosed form of cancer among men in the United States. Only lung cancer causes more "cancer-related deaths" than prostate cancer. The American Cancer Society estimates that 198,100 new cases of prostate cancer will be diagnosed in Over 31,000 men died of the disease in % of all men with clinically diagnosed prostate cancer are aged 65 years or older.

2 Fewer than 10% of men with prostate cancer die of the disease within 5 years of the diagnosis. African American men develop prostate cancer at a higher rate than men in any other racial or ethnic group. The reasons are unknown. Many people are unclear about the location of the prostate gland. It is important to know its anatomical location to understand both detection and treatment strategies for prostate cancer. This link provides an anatomical overview of the prostate: Note that an edge of the prostate gland is near the lower wall of the rectum. This is why a Digital Rectal Examination (DRE) has been used for years as a primary screening test for changes in the prostate gland. The DRE, however, has limitations. Tumors form in areas that can not be reached by a DRE. In addition, clinicians have difficulty distinguishing between benign abnormalities and prostate cancer. PSA is an "enzyme" secreted by the prostate gland and is measured in the blood of men. An increase in PSA can be a normal part of aging or an indication of prostate cancer. At age 50 PSA levels are routinely checked in men. The normal range for PSA is: ng/ml The PSA blood test can not distinguish prostate cancer from a benign process. In an attempt to improve the clinical usefulness of the PSA blood test, the components that make up the PSA have been measured individually. The two most important components are "Free PSA" and "Bound PSA." Together they essentially make up the PSA. When you divide the "Free PSA" by the PSA (Free plus Bound) you get a ratio or percent of which portion of the PSA is "Free." The percent of "Free" PSA is high in normal men (i.e. > 25%) The percent of "Free" PSA is low in men with prostate cancer (i.e. < 15%) The percent of "Free" PSA is intermediate in men with benign prostatic hypertrophy (BPH). A "Free" percentage of 8% or less is associated with a high probability of prostate cancer. A "Free" percentage of 20% or more is associated with a high probability of BPH Knowing the "Free" PSA value can help determine who needs a prostate biopsy and does not. However, the "Free PSA" is not a diagnostic test. Only a biopsy of the prostate can diagnose prostate cancer.

3 The pathology report from a prostate biopsy contains the following essential underwriting information: 1. Gleason Score 2. Staging Click on this link to see an actual prostate biopsy report: Referring to the above pathology report note the Gleason score is 5 (2+3). The Gleason score is a measurement of aggressiveness of the prostate cancer. When the pathologist looks at the biopsy he or she grades the cancer (if cancer is present) by comparing the appearance of the cancer cells to the appearance of normal prostate tissue. The grades go from Grade 1 (almost normal) to Grade 5 (very abnormal). Click on this link to see how nearly normal cells change into very abnormal cells and are assigned a higher Gleason score: positi1.gif The pathologist adds the results from the two greatest areas of cancer. The Gleason score is as the sum of the two areas (i.e. 2+3). The range of Gleason scores run from 2 to 10. The higher the Gleason score the more aggressive the cancer and the more likely it will spread outside of the prostate gland. A Gleason score of 2 (1+1) has a good prognosis. A Gleason score of 10 (5+5) has a poor prognosis. The Staging indicates the extent of the cancer at the time of diagnosis. Like the Gleason score, it provides important information regarding treatment and prognosis. The actual Staging is usually not listed in the pathology report. The Staging needs to be assessed based on what the pathology report says about the extent of the tumor. Click on this link that gives an overview of Staging for prostate cancer: Note that Staging is divided into four (4) subsets: A, B, C &D or T1, T2, T3 & T4. The higher the Staging, the more advanced the cancer. In the pathology report above, the cancer is reported as being "confined" to one lobe of the prostate gland. That would make the tumor a Stage A or T 1. Gleason score and Staging are the key elements in determining insurability. The lower the Gleason score and Staging the sooner the client becomes insurable from the end of treatment. Here are some general guidelines: Most clients are postponed in the first year after treatment. There are exceptions for clients with very early tumors (Stage A) and low Gleason scores (2+3=5). Clients with large tumors (>1.5cm) or multiple tumors are generally postponed for two years after treatment. Almost all Stage C and D tumors (ones that spread outside of the prostate gland) are postponed for five years after treatment.

4 When was the client diagnosed with prostate cancer? Underwriting Comment: Prostate cancer can be insurable, in some cases, in less than one year following the end of treatment. The normal period of postponement is two years. The exact date of diagnosis is the starting point for the risk assessment process. How was the prostate cancer treated and when did treatment end? Underwriting Comment: The size of the tumor, the tumor s aggressiveness, the degree of tumor s invasion and the age of the patient will determine the kind of treatment. Small cancers that are well contained in the prostate of older men (i.e. age 70 or older) may require only "Waitful Watching." Advanced cancers that have spread outside the prostate gland may require multiple treatment modalities. There are generally four treatments available for prostate cancer: Watchful Waiting: Usually reserved for older clients (i.e. 70 and older) who have slow growing, well contained tumors (i.e. Stage A or B with a Gleason 5 or less). Surgery: This involves the complete removal of the prostate gland (called a radical prostectomy). At the time of surgery lymph nodes that surround the prostate gland will be removed to see if the cancer has spread outside of the prostate gland. Radiation: This involves either direct beams of radiation to the cancerous areas of the prostate gland or a newer approach that involves a radioactive seed being implanted in the cancerous areas of the prostate Chemotherapy: This involves the use of medications that will turn off the hormonal stimulation of the tumor and hopefully slow down its spread and growth. These are used for advanced cases of prostate cancer where surgery or radiation have failed. REMEMBER: The "waiting period" for clients with a history of cancer before they are insurable for individual coverage begins from the last date of all forms of treatment. What are the current medications that the client is taking? Underwriting Comment: Successful treatment of prostate cancer generally involves no on going medications. If a client is currently taking medications for prostate cancer (i.e. Lupron, Eulexin, Zoladex, Precis, Nilandrone, or Casodex) it either represents a primary tumor that has metastasized (spread) outside of the prostate gland or a tumor that has reoccurred following initial treatment with surgery or radiation. Have all of the PSA blood tests been normal since the end of treatment? Underwriting Comment: The PSA blood test is used to monitor prostate cancer patients following their treatment. It should remain essentially zero (i.e. undetectable) as verification that the prostate cancer is in remission. Any rise in the PSA presumes that the prostate cancer has returned. In the case of a client who has undergone the surgical removal of the prostate, a rise in the PSA blood test suggests a distant spread (called a metastasis) of the disease. Featured Topic in November 2001 Newsletter: Kidney Transplants

What Is Prostate Cancer? Prostate cancer is the development of cancer cells in the prostate gland (a gland that produces fluid for semen).

What Is Prostate Cancer? Prostate cancer is the development of cancer cells in the prostate gland (a gland that produces fluid for semen). It is a very common cancer in men; some cancers grow very slowly,