Veterans: Managing and surviving prostate cancer | Veterans - Citrus County Chronicle

The American Cancer Society estimates 191,930 men in 2020 will be told they have prostate cancer. Currently there are nearly 3.1 million American men living with the disease — roughly equal to the population of Chicago. It was also disclosed that 1 in 9 men will be diagnosed with prostate cancer in his lifetime and a startling statistic finds the incidence rate for this disease in military personnel increases to 1 in 5. Let me tell you about this disease and its’ impact upon our military veterans.

A 2013 study conducted at the Portland VA Medical Center and Oregon Health and Science University found veterans of the Vietnam War, and other locations where exposure to Agent Orange (AO) occurred, are not only at higher risk for prostate cancer but they are more likely to have very aggressive forms of the disease.

TCDD (tetrachlorodibenzo-P-dioxin), a dioxin chemical compound, was the most toxic portion of the AO mixture and this herbicide was used between 1962 and 1971 in the Vietnam War with about 20 million gallons sprayed over millions of our veterans to destroy vegetation in order for them to see the enemy in forests and jungles. Exposure to military personnel also occurred while loading barrels of this poison onto vehicles and trains at supply depots back in the United States. Plus, some aircraft spraying this poison in the Vietnam War later returned to the United States and until 1986, used by our military, or sold to civilian companies. Their aircrews, some being veterans, reported serious health conditions from exposure by contaminated airframes. Unfortunately, AO exposure to our military was also found in Thailand, Korea, while serving ships at sea off the coast of Vietnam, and at many other locations. Some areas are still being identified while veterans suffer from unbelievable health problems, including thousands and thousands from prostate cancer.

Prostate cancer is often first detected with a PSA (prostate-specific antigen) blood test or digital rectal exam and those having AO exposure may be diagnosed with an aggressive prostate cancer. One large study found there may be a 75% increase in the risk of developing life-threatening prostate cancer for men with AO exposure and, on average, they are being diagnosed at younger ages than their non-exposed counterparts. It is a presumptive condition by VA for veterans exposed to AO. There are more than 200,000 cancer survivors in our veterans, while 1 in 3 of cancer occurrences is in their prostrate. There are about 12,000 new diagnoses annually of prostate cancer in our veterans.

If prostate cancer is suspected as a result of a PSA test, digital rectal exam, or other factors, a biopsy is usually performed. Genomic testing will more than likely be added to examine the makeup of the cancer to provide information about how the cancer may behave and the estimation of risk of spread.

Once prostate cancer is confirmed, additional tests are done to learn the location (stage) and Gleason score (grade) of the tumor. Staging is the process used to find out if the cancer has spread within the prostate or to other parts of the body such as bones and lymph glands.

The specific treatment for prostate cancer depends on many factors including age, Gleason score (grade) of the tumor, stage of prostate cancer, symptoms, and general health. That treatment possibly being implemented could be hormone therapy, chemotherapy, immunotherapy, close monitoring, radical prostatectomy, radiation for bone metastases, high intensity focused ultrasound, cryotherapy, or radiation therapy.

U.S. Medicine, The Voice of Federal Medicine, has reported that in order to put precision medicine within reach of all veterans with prostate cancer the VA has implemented a multi-tiered structure. There is a network of prostate cancer centers of excellence serving as the foundation of that structure. Currently, the VA has 10 of these centers located in Ann Arbor, Michigan; Bronx, New York; Chicago; Durham, North Carolina; Los Angeles; Manhattan, New York; Philadelphia; Puget Sound, Washington; Tampa Bay/Bay Pines, Florida and Washington, DC. More are planned in order to bring advanced care to every part of America for veterans suffering with prostate cancer. Added to this program is VA’s telemedicine initiatives that has potential to transform the national efficiency and effectiveness of cancer specialty care.

It has been found that because the incidence of prostate cancer increases with age, nearly half of diagnosed veterans are at least 65 years old. Fortunately, over 80% of these men will have only local disease with 5-year cancer-specific survivals of 98%. For those whose disease returns after treatment statistics find that 1 in 5 will die of prostate cancer within 10 years. However, for “distant” prostate cancer, or cancer that has spread to bones, organs, or distant lymph nodes, the 5-year survival rate drops to 30%. “Distant” prostate cancer is more commonly known as advanced prostate cancer.

It appears most veterans will survive prostate cancer but this disease can lead to reduced quality of life and there is a desperate need for VA medical support for problems caused by the cancer. These include frequent urination, incontinence, erectile dysfunction, pain, depression, and other health issues with about 70% having persistent symptoms for as long as 15 years after treatment. The aforementioned VA cancer centers and telemedicine efforts are critical to optimum treatment of these side effects.

Prostate cancer is a presumptive condition for veterans exposed to AO. “Presumptive” means that veterans do not have to provide a nexus (a link between their condition and service) to prove service connection for disability compensation and healthcare. It is also being reported that veterans who were exposed to burn pits in the Southwest theater of operations after Sept. 11, 2001 (i.e., Iraq and Afghanistan) could develop prostate cancer due to exposure to hazardous smoke and byproducts. Unfortunately, the VA has not accepted disabilities as presumptive when caused by the burn pits of recent conflicts, but veterans of those conflicts can provide a nexus opinion from a medical professional to argue for service connection for their prostate cancer.

In 2014, the VA established a Burn Pit Registry allowing eligible veterans and service members to self-report their exposures and health concerns in an online questionnaire that can be used to initiate discussions of health concerns with a provider. In addition to completing a questionnaire, registry participation involves an in-person exam by a healthcare provider. To date, 200,000 personnel have registered from the following authorized military areas of service:

•Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn;

•Djibouti, Africa on or after Sept. 11, 2001;

•Operations Desert Shield or Desert Storm;

•Southwest Asia theater of operations on or after Aug. 2, 1990.

Early detection and advances in treatment are saving lives. Finding prostate cancer when it is still at an early stage offers the best hope for living cancer free for a long time and I highly encourage you to have regular checkups with your family physicians. I hope this information will be valuable for you but please understand I am not a physician or medical expert. I simply try to gather information to help those who served our country with such great honor while in uniform.

There was a personal reason why I chose this particular subject for my article because I was exposed to AO in the Vietnam War and suffer from a number of serious health issues. One of those being prostate cancer and I am currently in treatment. It is not enjoyable after most recently having nine consecutive weeks, five days a week, radiation treatment with terrible side effects. Sadly, at the fifth week of my treatment, my wife was diagnosed with breast cancer and required immediate surgery. She will shortly have to also undergo radiation treatment. After dealing with my health issues and that of my loving wife, I wanted to pass along some information, most of which I did not know at the outset of the diagnose of my disease. Hopefully, should you be diagnosed with prostate cancer, you will be prepared. It causes many life changing decisions to be made that must be faced, fought and treated.

As a final comment I would like to thank the Chronicle and specifically their Editor, Mike Arnold, who over the past number of years have allowed me to provide articles in support of our veterans and family members. With their continued support and your readership, I hope we continue to do so and perhaps know that, together, we have helped someone who so bravely served America in uniform.

May God Bless you and our freedoms in the greatest country of the world, America.

John Stewart is a retired Air Force Chief Master Sergeant, disabled Vietnam War veteran and has been a veterans advocate for nearly three decades. In 2016 he was inducted into the Florida Veterans Hall of Fame for his volunteer service. You can learn more about him at https://ift.tt/2LBxfrR.