The Prostate Cancer Epidemic

a tremendous turnout and both of us part of the prostate cancer mission are so grateful that all of you are here my name is michael putney and it is my pleasure to be the moderator of the session this morning this is a conversation that i think in our community is long overdue this open conversation about prostate cancer one important reason for me about why I am part of the prostate cancer mission and why I here this morning is I had prostate cancer nine years ago and thanks to some excellent physicians a loving and supporting family and perhaps even some answered prayers I am alive and well and thriving but i’m here in large part on the board that can’t prostate cancer mission because thousands of men in our community and millions of men in the world will not have the same success that i did they will not be diagnosed in time they will not be cured and their families as a result will suffer as they suffer from the disease which will take their lives and I think that only goes to underscore the message on the logo if you will notice of the prostate cancer mission it says no man should die a prostate cancer amen we all believe that and we are here with that in mind to discuss the scientific and the human aspects of this disease and we have an outstanding panel of people to talk about it and we have an outstanding audience so many of you are here from the business civic medical communities you bring so much knowledge and in the course of the discussion you will have questions and you will find that on your chairs there are notepads and pencils or pens and if you have a question for one of the panelists I would urge you to write it down those questions will be collected and then dr Conrad is going to go through and we will select as many as possible to pose to the panelists I’m also glad to see so many business leaders here this morning because as you well know beyond the human cost of this disease there is a huge financial cost I see managing partners of law firms here this morning and you certainly know that when lawyers who are critical to your success for example are diagnosed and perhaps diagnosed late with prostate cancer you lose their skills their their abilities and also you may lose them as friends so this cuts across the whole spectrum and I’m glad that the spectrum is represented well there are there’s a lot to talk about this morning and it’s going to be good Frank open talk and we are going to begin with one of the renowned experts on this in the world he is flown here from lyon france which he told me when i said well gee you can get a really good meal there and he said yes but it’s a little bit small 500,000 people as opposed to mow on where he used to live and work when you hear him speak you will understand he’s from neither Lyon or Milan he is from Scotland and he’s got a great Scottish accent dr. Peter Boyle is the director of the International Agency for research on cancer he has many real and honorary awards and titles he is an honorary professor of cancer prevention and control at oxford university honorary professor of cancer epidemic epidemiology at birmingham university and the visiting professor at glasgow university so let’s begin if you would please welcome dr. Peter Boyle thank you very much mr. chairman it’s a great pleasure to be here I really like to congratulate a good friend and cron garden getting together this initiative

and working to increase the visibility locally nationally and hopefully globally about prostate cancer there are two unique things about this meeting for me anyway one is the the life of sponsorship from anyone filter the sponsors in the back page there is no medical device mental pharmaceutical industry has no edge they are not supporting I’m delighted that this is this is the case because allows us to do things without any external pressure going in that direction and the second thing is that for the first time in my life someone can optionally I don’t come up to me just the ten minutes it was it he said could you speak for 30 minutes instead of 15 everyone wants to cut down so he’s asked me to speak a bit longer than usual for bird on board I’ve gotta talk which is divided into two parts the first part I just want to let you know that as a huge change in the distribution of cancer of all forums around the world and run the middle of the big parcel in the middle of the development of a huge epidemic of cancer cases around the world of all types also one two three the prostate cancer as a potential problem as a particular growing problem not only in florida united states that is going to be one of the major problems worldwide and I’m a hundred percent in things that the more thought that that men shouldn’t die prostate cancer it certainly okay exceptin with something that we can all sign up to mr. all what type of me to do something about the current situation model drivers that will go this year this is ignoring all the little skin cancer to include melanoma but not the basal and squamous cell cancers as this year in a bottle to be 11 million people diagnosed with cancer for the first time there were seven million people who died from cancer others will die with the cancer that that would be the cause of death and has 25 million people alive and living with the diagnosis of cancer 100 years ago plainly carcinoma of the lung lung cancer was recognized with one of the rarest swimmers plates that was ever seen but today one cancer in every eat diagnosed worldwide is a lung cancer these are all mine made ninety-five percent of one cancer is caused by cigarette smoking one cancer in 10 is a breast cancer one in eleventh colorectal one in 11 stomach cancer prostate cancer six percent of the global counter problem and leather counter is about six percent to the least six forms of cancer account for half of all the global counterpart but you can see here that the African figure out which one is this ebook the lung cancer in the trauma mere acquaintance lung cancer on the troll the orange are the number of cases the green are the number of deaths and one cancers by far the Communist cancer in mainly the present thing but globally all over the world prostate cancer as now the second columns for transit diagnosed in Maine we reckon with over six hundred thousand cases diagnosed only did this compendium 2002 when the process of doing again and the numbers good derived too much closer to a million new cases across their cancer diagnosed around the bottom each year in women to get here just an idea breast cancer despite father cognis cause of kinds of women that’s 1.2 million cases of breast cancer and women every year and something which is extremely rare in the United States and North America celebrates cancers the second congress borough council women and has essentially a major problem in the wall and regions or countries if you can just move a slide down a little bit it’s not we’ve lost it a lot here it’s just we need one of the interesting important things that are transferred is it counts of shifting the council faulty usable cancer was a disease but a huge majority was in the developed countries in the Western industrialized countries here with recurring the warranties are data from the African region of the world health organization and the short here is on Rajee located on the left hand side here you see that kaposi sarcoma is the chromeless form of cancer in men in Africa so it’s all related to the

hiv/aids epidemic there but even in Africa you can see the prostate cancer is the salt commonest form of cancer in men in Africa celebrate cancer in women dominates the pattern here we look at the Americas north and south the North America prostate cancer is the commonest form of cancer in manga the bottom of cancer in North America is dominated here by prostate cancer here at the top tells the number of cases but thankfully because of a lot of determined what I outstanding urologists and other scientists the death from prostate cancer and much less a case fatality as much less than for example for lung cancer but if not much difference in the number of pieces diagnose and Daniel number of deaths and even in Latin America and the Caribbean prostate cancers the colonists cancer men but here you can see that the ratio of numbers of cases to get there’s a little bit different the case fatality as a lot of a pioneer situation wellness dominated by breasts and service cancer in this is the Southeast Asian region is dominated by the patent in India see prostate cancer is still relatively rare in that part of the world in China in the Middle East these are the Arab countries here at the aim-listed Mediterranean region again you can see the prostate cancer is in bladder cancers the Communist cancer in men in the Middle East does not much mentioned prostate down here at the very bottom and the western Pacific that is dominated by China but one-fifth of the world’s population logo here you can see stomach long lever at the dominant person domaine was relatively few prostate cancers we don’t know we’d like to know we’d like it if we all want to become Chinese and 11 China that maybe sunday in European region us from green 10 to Siberia and maximum man dominated by longer prostate cancer is now the second finalist form of cancer there for look at the just the Eastern Europe that from Russia and all the whole Russian republics of a feast here you can see stomach their prostate cancer is much rarer than there is in Western Europe exists the river but has killed huge geographical variation in it across their cans of all forms of cancer as we know the rest becomes greater with increasing age this is not because aging is the risk factor this is just because over time accumulate exposure to the relevant breast cancer and prostate cancer is particularly common gets much much more common and in the eating a eating man and one of the situations are starting to see you develop as the were living in a completely new era broken through an experience that I’ve never seen before according to the estimate is between 80 billion and a hundred billion people ever lived on this planet and the intriguing fact deserve every for those degrees the age of 65 few thoughts of them are alive today so we’re in a completely new game we’ve never experienced this before it’s a completely new situation for humanity but a throw many such a large proportion of the population of seniors who are alive today this is but living I don’t like the word geriatric I don’t think it means anything anymore but we’ve got to be able to realize the one living with a unique situation with an aging population you can see the impact of Aging this is the population of the United States from 1950 and find the intervals up to 2015 these are zero justice men and women these are the number of people in its five-year age 30 to 45 29 up to 85 plants when we go back to the situation in 1950 you can see Sorel to the young population that not so many elderly what’s happened is the population is growing outwards and it’s growing our words there’s more people and on average the getting older we know that we know all about the greening of the United States population but what we will say offers the factorial of mobile as the same things happening in China this is the population pyramid for China it goes up to a hundred plus men and

women and it’s the same as the United States from 1950 up until 2050 it can see from the gabbai it’s in 1950 with no elderly people in the population of China but the last century terminated population grew by words but also grew up words and as you look ahead we’re going to see a distinct eating of the Chinese population china population of China is one-fifth of the world’s population and as going to have a huge Empire by the global cancer bomber and here’s what’s going to happen in China this is the percentage of elderly now might information of the order which changes every year but nine teachers never this is the percentage of people over the age of 65 in Chinese population from 1952 2015 here is five percent up until the nineteen ninety suddenly is going to increase the quarter so we’re going to go from eight percent of the Chinese population inst over 65 today twenty-four percent is over 65 n in 25 years time as a rapid aging of the population of China and this is something which is very technical of what’s happening and what used to be the developing countries the emerging countries because we see the same in India we see the same in Indonesia with see the same all over Asia and Central and South America and this aging of the population is going to give us a huge problem for the global cancel button this is the population of the world and 2005 according to the United Nations steps and a half billion people and this is at age distribution from 0 to 4 up to 85 plus i’m going to deflect to the next way that i couldn’t get it to automate itself and and we’re going to look at 2013 this will be the increase in the population by the flick to the next slide watch the growth awards and the growth outwards here of the population so you see what’s going to happen to the world population is going to increase from six my heart billion to 8.1 billion of the next 25 years and it’s going to be significant and older the consequence is that we’re going to go from this situation today the situation we expect in 2013 the 11 million cases that were going to have this year will increase the 27 million around one the number of deaths will increase from 7 million per annum to 17 million there are not and will be 75 million people alive with cancer the reasons are best escorted to emphasize this is something which is not just going to thank the developed countries it’s going to be a two and a half fold increase in Africa and powerful potato in southern Watson and medic and the Caribbean please growing a huge increase in the numbers of cases of cancer each year and the India Southeast Asia the Middle East the western Pacific is a chain and all the countries around there and even in Europe’s are going to be everywhere in the world would see tremendously rapid increases in the global cancer partners cancer of all forums and particular among them there’s going to be a huge increase in prostate cancer although overall for three reasons the growth of the world’s population the aging of the world’s population and then one of the greatest bez mistake successes of the last 40 years in terms of cancer as a successful exploitation of cancer risk factor such a cigarette smoking from a higher source countries to the loaders of countries were absolutely building up an epidemic of tobacco-related disease in those countries the calculated essentially this is something we’ve published with a great deal of comments there’s going to be 1 billion people in the world visit the century who died because the smoke cigarettes and all of that all of that is completely avoidable so here you see the era that were in these are the Barton of cancer walk around the world a doubled between 1975 in two thousand and never looks at all is going to rise exponentially as a huge problem with Ganter worldwide is a global problem but we can begin to cope with it if we put a big investment and logistics and training and infrastructure in our own communities but the places which are going to be harvested by down the are good to be those low-income and middle-income countries at the present time and just to digress for two manages

to show you the problems of a facing we know that radiotherapy we note the counselors of all radiotherapy is a key component one of the basic components of cancer care half of patients in Western society get one course of radiotherapy and a quarter ahava a second course of radiotherapy the real drama today is at the step two countries in the world that don’t have a single radiotherapy machine there is huge and Africa has got twenty percent of his needs in radiotherapy those are trying psilocin radiotherapy received short in the law as those countries this means that there’s a whole huge proportion of patients with cancer but totally excluded from any foreign receiving any form of conventional therapy thankfully something being done about this the International Atomic Energy Agency you’re working with them the 150 million people go to the cancer and horizonte’s between 2000 and 2020 of which a hundred million are suitable for Eva therapy and yet we wanna go radiotherapy to meet twenty percent of those needs this is a shocking situation but we’re really working we are very closely with the other authorities and other United Nations agencies to try and rectify the present time and well around the world when we hear everything here huge wonderful work and resources and financing and lobbying for tuberculosis for AIDS and malaria these are wonderful these of focus points of the Millennium Development Goals which is a wonderful wonderful initiative but we’ll forgotten not but how to mention cancer at all and the millennium development goal we don’t have a very organized international cancer control community and yet when no other does more deaths each year in the world from cancer there from TV is a malaria combined so that’s a global picture whatever a unique situation which is in terms of the global cancer partner is going to get worse it’s going to be a huge increase in the numbers of cases of cancer weatherize worldwide as we go forward over the next 10 or 20 years this is not a theoretical exercise this is going to happen because these people are already alive and on the process of aging of life expectancy it’s increasing and the demographics of the world particular load of those countries are changing dramatically so we go back here to the runaway frequency of trans remain and here you can see prostate cancer is the second corners form of cancer like a pointed out to you gallery around will underplay urology when we look around the world the proportion of urological Kansas vault hunters men thirty percent today thirty percent of all cancers worldwide get the percent are urological cancers and this is resin from twenty percent in 1916 the reason for the increase years blogger cancelling out from 19 75 80 85 90 2000 2002 blog accounts of testers head neck but a huge increase which has been taking place now for 30 years as in prostate cancer worldwide and you can see that was bad and if that keeps on going Ida’s on top of the growth and aging of the population we’re going to reach a very dramatic situation as we look around the world of every five years my agency produces compendium of cancer incidence statistics from all over the world this it would know the ninth volume with cancer incidence inside quantum’s and we never cover about three hundred different populations of cancer incidence around the world and this are the twenty highest and the 20 lowest rates of prostate cancer all over the world and this is a disconcerting message this is the ratio knocked about 200 per hundred thousand per annum the highest rate in the world is among the black community in the United States and Australia Canada New Zealand the bikes in the white community in the United States canna Canadian registries up here Australia Switzerland result I resort countries over here the good news the exciting news and the news that we’ve got to develop a strategy to investigate why is that you can get places such as Korean member Hong Kong sale via Singapore Japan excellent central southern Italy regular in Siracusa in region is huge in southern Italy and Spain check Denmark dark parts of the world we can get very very low instant rate we don’t know fine but

theoretically with if we got all these incidence rates here telling to this level here then we could eliminate the three quarter of all prospects of olive oil as a challenge challenge for epidemiology were not making much progress but they certainly something that we need to make a lot more effort to do to type this problem on a global scale but some places in the world that we don’t have them really high quality these are pure quality and cancer registration data but when you start to look at places like central Africa completely the huge rates in Zambia huge ratings involved with huge raging Uganda huge very high incidence rates of prostate cancer and Central Africa and also in populations living in the Caribbean some places that we don’t have mortality in incidence data for and were forced to look at Maternity and here you can see the deed is done various countries like Kuwait Armenia Japan down here Hoodie time achieved variable mortality rate because you’ve got variable incidence rates and a lot of these countries like Norway Sweden Denmark come from these are areas where the mortality is very high and the incidence is very high to the trains question is the incidence rising declining work but a number of countries which is looking at country level as a number of countries are very few of them was a population-based coverage of cancer incidence and cancer mortality for a long period of time this allows us to see how things that conference are evolving Norway Finland Denmark Sweden Scotland name is Emil slovenia Slovakia Singapore and the Syrian areas that the sixteen percent of the u.s. population cobra bite banks of registry these have existed her requirement and look at trends these are the trends time trends from 1950 502 2005 in the incidence of prostate cancer you can see even in the lorry area here went in Singapore this is the seer area of the United States this is sweetened you can see somatic increases their place in the incidence of prostate cancer prostate cancer is becoming much more frequent very rapidly in a large number of western star equations around the world the only good news have got is that this is the mortality this is the death rate from prostate cancer you can see that it remains increased here a little bit pine logs known as good signs here that the whole pack of them is starting to beginning to come and some doubt as great news entenmanns ganar mortality coming down or catching the disease yellow or treating the greater the outcome for the individual mine is better that’s great but or still got a long long way to go and of course the best thing that with influences thought people getting the disease in first place because the very famous Scotsman road and 200 years ago and prevention avoid the labor of being said when you look at other countries are 30 your Austria where we don’t have the incidence data gives the pan down here here’s grease down here again when you look at mortality you can see apart from a few more places nice turnarounds and decline in the death date from prostate cancer I think has a great success if it can never get the incidence to come down that would be an even greater success and decline made this the client come much more rapidly just want to show you how you can get things really wrong this wasn’t me though is a publication in the Lancer about five years ago and they said these are the mortality from prostate cancer in the United Kingdom this is mortality from prostate cancer United States and the United States has a tremendous amount of screening since 1990 united kingdom was no screaming at all a tremendous amount of and very radical treatment in the united states as readily from britain and yet they are they argued that the mortality rates were both the comment starting to become so therefore this is nothing at all the decline of the united states that had nothing to do with treatment with diagnosis error detection and radical therapy they really should have waited awhile because when you are doing the yield data from beyond 1999 you can see now the effect in the united states of this huge increase and the prevalence of screening and radical therapy they

stopped the profits that information about here for there was no difference Mazzilli it’s really useful to wait to see what’s good to happen at the long-term because now you can see the dramatic gap between the situation and the united states and the united kingdom of course the guts are all wrong because they were all Oh could you excuse me could you put down on again how God just disappeared off you just it just be the good smart of them see we concentrated on this area here but it doesn’t look too carefully what’s going on here and the question is fine as the maternity men over 50 I have to be constant for so long that it suddenly shootin the answer is do turn out the fact is nothing to worry about it’s just a new bed 1980’s the United States them because a group to deal with all the deaths of replication recording of their certificates introduced the computer program to select the underlying cause of death automatically from death certificate has done before behind by very skilled Buddhists and they called the system from get water we said called a roadrunner professional co di PA system and when you look at the United Kingdom but not when the soonest and well brothers name was the UK could introduce it does a huge increase in prostate cancer mortality in men over the age of 70 I mean you bring that down the banking pieces in it then over 85 84 or 75 79 and what was happening with his program wouldn’t accept assault cause of death in the first car certificate the phone while ago looking for a hard cause of death in a second as soon as they introduced us in Britain as a 25-percent fall and the mortality from pneumonia because they started looking always thousand died of pneumonia so the legality is that you know he’d prostate cancer 20 years ago so prostate cancer even though nothing to do with the underlying cause of death prostate cancer was selected I brothers brother stupid computer program is now beginning to rectify itself but it produced this big appetite of increases so every increase or decrease in you see is not necessarily not necessarily on one of the big big questions today and where we need community action to do something about this there are four randomized trials new run of screening we need randomized trials because we need to know the benefits Emily to note any disadvantage you need to see what the effective cost then they’re not a cost enter the advantage to the downside of these programs are as two studies which have been published the both of poor quality and the show absolutely absolutely no decline of authority whatsoever duty screening either pretty rubbish trials but they exist there are two good trials over does the PLC oh the prostate lung all right form of alien trial started in 1993 a recruited 37,000 man between 55 and 74 and the same number enter parallel control group I studied in been on since 1993 and what good have the resumption this is in the United States and the United in Europe the European randomized study year spc started in 1991 it’s the 84th a little man and a ninety-nine thousands in a control hook again it hasn’t published that is always the result of fifty a bit longer to go on because of some of the controlled refraction went and got screamed and then waiting for the sufficient statistical power that if you much longer to finish than expected however if today we put together those two trials were pooled was data we would have more than adequate statistical power to answer for the was the advantage of disadvantage of screening for prostate cancer and to make strong recommendation to the populations around the world and it pains me that the egos of the scientists involved in scientific community in the scientific groups involved is getting in the way of allowing us to have as important public health measure if I were waiting for the results the message hasn’t been out he made what should do and it’s unfortunate of people are going to die because of this particular situation one of the grade studies which is going on as he studied at I’m helping out run around Ramon professor George batch in

Innsbruck Austria is divided into nine Oscars one country with named federal states one of which is the terror they’ve been very active in an increasingly of staring radical prostatectomy that began unorganized cancer detection 1919 but from 1993 PSA testing was made freely available by the health authorities to every mind age 45 to 75 it was made available free you can have it every year and the thing is the after that test you had direct access high-quality free benefit when you needed the first year they did this study about a third of the population in that age group we’re thing up until two thousand and five has been 107 thousand people who have passed through that interval and eighty six point six percent of men since 1993 have been between the age of 45 and 75 about the PSA measured at least once fifteen thousand haider measured depth 14 times as many more thousands and tens of thousands hundred measure 13 and 12 times has become a routine part of what’s going down the same wasn’t introduced to the other federal states in Austria so we can do this comparison between the mortality from prostate cancer in the turtle hill compared to the rest of Austria rest of our staff often debated the client’s bridge currently with tremendous a healthcare system and the evolution of prostate screening has been practical but has been evolving in the same ways in evolving many other countries it’s just that the husband being so widely prevalent in the community as a husband settlement and here you can see the results in tales of the huge reduction and the more rapid reduction of mortality for prostate cancer zero but the was cleaning compared to the rest of Austria but there was no organized program these are just different mathematical ways of looking at the same thing and dealing stop setting line with the joint point you can see very clearly eschewed adoption commonly by God is a very very very good safety profile of the subject which is important no 30-day mortality Greg Holland Reno since 2000 spoiled 0.1 percent and no uniform injuries very little bleeding constantly very very high in a court in Syria who started it so the very good sir very expert pilot of high quality group of neurologists radiologist they were followed it everyone involved in the multidisciplinary an acrostic answer them you don’t need to remember all these numbers messages says that in 2005 and material based on the East deceptive rates from nineteen eighty six to nineteen ninety before screening star field applied to the population of two thousand crying we expected 65 cases 65 death from prostate cancer natural five rows one modality presented certified death from prostate cancer which was a 55 of same production over for was expected that’s really a very key and a very important result it’s not a randomized trial but there are very very strong things organized screaming in population but as a high of thing for the standing therapy with water they can lead to significant reductions and this very aggressive disease the problem dollar issue is that these would have made up to the age of 79 to voltage and we just spoiling deaths forgot something when we look at the rest of Oscar the worst 730 cases and deaths expected with 517 and this was a deputy percent reduction this is for targeting individuals crafted about 37,000 we got fifty five percent reduction in the colonel this was aged 45 279 and the question is are just the spawning deaths for after the age of 80 and we will look at the deaths over the age of 80 expected 50 and eternal we observed 32 in 2005 but is a thirty-six percent reduction and but I was lonely had a seven percent reduction in the best possible so if not for not responding heads are fighting instead were avoiding significant fractions of the deaths from

frost occurs along this this is just a lot of are safe from the journal Neurology this year from in Thompson and his group it been reported the main guide was the prostate cancer live longer and longer longer than those were self diagnosis and that’s a really cute thing to see because the follicle of crisis look to the VA both of the record from San Antonio a consecutive series of patients discover that seventy-three percent of men following some jelly seventy two percent meant a change of medical regime 61 percent of the change in medication twenty-nine percent received a new significant grateful diagnosis so men who really put might want to see the doctor dude everything appointed once the diner once that end to the system they have a significant change in that health for an advantage here to treat you for the prostate cancer but a life expectancy proves also because of changes of the other diseases high cholesterol high blood pressure whatever and the go signal that is really a nice nice a spin-off of them all frosty area at present so why are we here well here because there’s a global epidemic of cancer but here because there’s a huge epidemic across the transit just now one of it is going to get was that we go forward while which we know are fairly certain we know something about introducing the mcdonald thing but we’re waiting for a few more pieces the waist come along we really can’t wait forever when you’re faced with situation like this but 2005 a man in the United States is seventeen percent chance of having a diagnosed across the account of his wife and he’s got three percent risk of dying from prostate cancer but we were going to do something religious cats around and say well okay what office academic exercise finished in a couple of years and then we’ll see what to do Scott rasta and that’s the advantage of this mission are on set off and all his colleagues and friends and business community the medical community here it really is attained do is one thing to do something about trouble with prostate cancer thank you very much