Legislation Prioritizes Prostate Cancer Care for Veterans

Half a century after the Vietnam War's end, U.S. veterans continue to suffer the sometimes lethal consequences of Agent Orange exposure, including prostate cancer.

A study conducted in 2013 by the Portland VA Medical Center and the Oregon Health and Science University suggested Agent Orange exposure was associated with a 52 percent increase in the overall risk of being diagnosed with prostate cancer.

It's not just veterans who served in Vietnam, though, who are more susceptible to prostate cancer (and other cancers). Male veterans in general are diagnosed with prostate cancer at a higher rate than their nonveteran counterparts.

Part of that has to do with the fact that the veteran population is older, and prostate cancer is more prevalent in people ages 65 and older—60 percent of cases. Part of it has to do with veterans of all eras having been exposed to herbicides and chemicals other than Agent Orange. Research into the various reasons is ongoing.

Roughly 20 percent of male veterans will be diagnosed with prostate cancer, compared with about 13 percent—1 in 8—of their civilian peers. For Black male veterans and veterans with a family history of prostate cancer, the risk increases. Overall, the American Cancer Society (ACS) estimates some 288,000 men will be diagnosed with prostate cancer, and 34,700 men will die from the illness in 2023.

Something needed to be done.

After years of talk on Capitol Hill, the Veterans' Prostate Cancer Treatment and Research Act (HR 4880/S 2720) passed Congress in December 2022. The new legislation, to be implemented in 2023, aims to streamline a path of treatment for American soldiers and veterans diagnosed with prostate cancer—when time is of the essence.

Before the end of this year, according to the text of the bill, "the Secretary of Veterans Affairs shall establish an interdisciplinary clinical pathway for all stages of prostate cancer, from early detection to end-of-life care."

Capitol Hill

The Veterans' Prostate Cancer Treatment and Research Act aims to reduce the amount of time veterans wait to receive a diagnosis and treatment plan.

The nonprofit organization Zero Prostate Cancer was instrumental in advocating for the bill's passage.

"The veterans who have served our country deserve nothing less than the best prostate cancer care we have to offer them," Zero President and CEO Jamie Bearse said in a news release. "The implementation of a prostate cancer clinical pathway will ensure that veterans have access to the same high-quality care whether they live in Los Angeles or Lubbock, Texas."

More research is needed to fully understand what causes prostate cancer in veterans.

"There are factors that are perhaps correlated with a lifestyle lived in service to our country that certainly relate to prostate cancer, but we don't understand all of it other than to know there is a very clear relationship to Agent Orange," said Alison Manson, Zero's vice president of advocacy and government relations.

"I think the most important thing for anyone to know is that there are no symptoms in the early stages and that screening for prostate cancer is an important part of valid preventative care for men, especially men over 40," Manson said.

The organization launched a program called Zero360 to help any prostate cancer patient, veteran or not, with 360-degree support.

"That could be help navigating insurance, maybe it's help figuring out which support programs they're eligible for, or debt relief while they go through their cancer journey," she said. "It is comprehensive, there isn't any problem they can't at least help someone solve."

To learn more about the Zero360 program, call 844-244-1309 or visit zero360.pafcareline.org.

Symptoms of prostate cancer

When prostate cancer begins to show signs and symptoms in a patient's body, it's often already past the early stages, which is why screening is key. Still, men should know what signs, symptoms and risk factors increase their chances of developing prostate cancer.

Men also need to know their personal, familial risk for the disease.

"The prostate cancer, usually in early stages, has no symptoms at all," said Wei Phin Tan, M.D., an assistant professor of urology and a urologic oncologist at New York University Langone Health Tisch Hospital in New York City. "In more advanced cases, prostate cancer can certainly cause symptoms such as trouble with urination, blood in the urine and semen, bone pain—in particular, if it has metastasized to the bone—and unintentional weight loss. Those are the usual symptoms with advanced prostate cancer."

Other common symptoms include the following:

• Weak urine stream
• Erectile dysfunction (ED)
• Rectal pain or pressure
• Painful ejaculation
• Persistent pelvis, back or hip pain

Patients should talk to their relatives to assess their own risk level for the disease, Tan said. In addition, patients may want to get genetic testing to determine if they have a genetic mutation capable of raising their risk of prostate cancer.

Among the genetic mutations that are linked to increased chances of prostate cancer are a couple that will be familiar to many people. BRCA1 and BRCA2 mutations are associated with a higher rate of breast and ovarian cancers in women, and with prostate cancer.

"A lot of times, we have genetic counselors discuss this with patients to determine if they're at risk of prostate cancer before their screening," he said.

To treat or not to treat

Prostate cancer can be slow-moving cancer, which makes the watch-and-wait approach known as active surveillance one type of "treatment." As such, Tan generally tells his patients that the key is not necessarily to rid the patient of cancer but to ensure they do not die from the cancer.

When treatment is necessary, options include the following:

• External beam radiation
• Prostatectomy, the surgical removal of the prostate
• Brachytherapy, or internal radiation therapy
• Focal therapies—such as cryotherapy, laser ablation, photodynamic therapy and high-intensity focused ultrasound—that treat only the cancerous area of the prostate
• Hormone therapy
• Chemotherapy
• Immunotherapy
• Targeted drug therapy

"So it's actually OK to die with prostate cancer, but what we're trying to do is to prevent patients from dying of prostate cancer," Tan said.

Almost 80 percent of 80-year-old men have prostate cancer, but most of it is "clinically insignificant," meaning it will not cause harm to the patient's life, according to John Sfakianos, M.D., an assistant professor of urology and urologic oncology at the Icahn School of Medicine at Mount Sinai in New York City.

Sfakianos said early screenings are one of the best ways patients can protect themselves against prostate cancer.

"The best thing to do is actually to make sure that you get screened so it doesn't progress into an aggressive cancer," he said. "You want to make sure you catch it early enough."