While the rate of prostate-cancer diagnoses in active-duty servicemen has increased over time, higher rates of screening may be responsible, not a greater incidence of disease, according to a new study.¹

 “We started annual health screening for all Air Force personnel in the early 2000-2001 personnel, so, across the board, we went from having an every five-years physical exam to an annual physical exam required of everyone in the Air Force,” said study researcher Air Force Col. Marc V. Goldhagen, MD, director of the of the Occupational Medicine Residency Program at the U.S. Air Force School of Aerospace Medicine in San Antonio, Texas. “So we think with the increased opportunity for seeing the doctor and getting an evaluation came an increased opportunity for [prostate] screening.”

To study prostate cancer incidence rates, disease risk category and treatments, researchers queried DoD’s Automated Central Tumor Registry for prostate-cancer diagnoses in Air Force servicemen between 1991 and 2008. The study included 106,418 male-officer records.

The researchers found that, between 2005 and 2008, the rate of prostate cancer among white active-duty Air Force servicemen was three times higher than between 1991 and 1994, and that it was 11 times higher for African Americans during the same time period.

For white Air Force men between the ages 35 to 64, there were 26 prostate cancer diagnoses for every 100,000 airmen, while, for African American Air Force troops, there were 39 cases for every 100,000 airmen. Both of these rates were higher than for their nonmilitary counterparts in the same age range.

A significantly greater proportion of active duty servicemen than retirees (62% versus 40%) presented with low-risk disease in the study. Of those with low-risk disease, significantly more active duty servicemen elected curative surgery than retirees (93% versus 53%).

Goldhagen said it may be that more of the active duty servicemen were choosing surgery than the retirees because they wanted “to get on with their life and with their career” and put the disease behind them.

“It may also depend on who the physician is and how they present the data and information as to which way to lean, surgery versus waiting and watching versus radiation versus other types of treatment,” he said.

Screening is beneficial, he said, but more research is needed to determine who needs definitive prostate cancer treatment versus those who may not.

 “Aggressive treatment has long-term life risks like impotence, incontinence and things like that which is more devastating in the younger male population. Some of those risks can be avoided if we can pick out who can be watched and observed versus who should get immediate definitive treatment.” Page 2

1. Del Junco DJ, Fox EE, Cooper S, Goldhagen M, Koda E, Rogers D, Canby-Hagino E, Kim J,Pettaway C, Boyd DD. Increasing low risk prostate cancer incidence in United States air force servicemen and selection of treatments. J Urol. 2011