Proton therapy cancer treatment significantly lowers the risk of second cancer compared to IMRT and 3DCRT

Proton Therapy significantly lowers your risk of second cancer

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X-ray (also called photon) therapy has long been known to cause the development of potentially deadly new cancers in patients who undergo radiation therapy to treat their cancer. However, research shows that patients who choose proton therapy for cancer treatment have a significantly lower risk of developing a second cancer later in life. In a  comprehensive study published last month in Cancer, the prestigious, peer-reviewed journal of the American Cancer Society, researchers at Stanford University found that patients who were treated with x-ray therapy developed more than three times as many new cancers as patients treated with proton therapy.1

ABOUT THE STUDY

The study was conducted by Stanford University physicians Michael Xiang, MD, PhD; Daniel T. Chang, MD; and Erqi L. Pollom, MD, MS. Their research team conducted a retrospective cohort study using the National Cancer Database (NDCB), the most comprehensive cancer registry in the United States.

The study included over 450,000 patients of all ages with a variety of cancers, such as:

  • Prostate
  • Head and neck
  • Breast
  • Gastrointestinal
  • Gynecologic
  • Lymphoma
  • Lung (non-small cell)
  • Bone/soft tissue
  • Brain/central nervous system

Patients included in the study were treated with intensity-modulated radiation therapy (IMRT), 3-dimensional conformal radiation therapy (3DCRT), or proton therapy between 2004 and 2015. They were followed for a minimum of 2 years and an average of 5 years after receiving radiation therapy.

RESULTS HEAVILY FAVOR PROTON THERAPY

Compared to proton therapy, the incidence of second cancers was 3.5 times higher after IMRT and 3.6 times higher after 3DCRT, the two most common forms of x-ray radiation therapy. These differences were found to be highly significant. Proton therapy decreased the overall risk of developing a second cancer by over two-thirds (69%) compared to IMRT. In fact, proton therapy reduced the occurrence of second cancer for eight of the nine types of cancer most commonly treated with radiation therapy.

Compared to IMRT, proton therapy substantially reduced the risk of developing a second cancer for most disease sites, including:

  • 82% reduction among prostate cancer patients
  • 58% reduction among head and neck cancer patients
  • 38% reduction among breast cancer patients with at least five years of follow-up
  • 69% reduction among all cancer patients

“These findings show the extraordinary benefits of proton therapy when it comes to reducing the risk of second cancers, confirming the results of prior modeling studies,” says Mike Sommi, President of Provision CARES Proton Therapy Knoxville. “The data powerfully bears out the theories regarding the benefits of proton therapy in terms of reducing the risk of second cancers.”

The dramatic reduction in risk of second cancers is likely due to to the fact that protons concentrate their radiation delivery within the cancer much better than x-rays. Patients treated with x-rays absorb 2-3 times more radiation in their bodies than patients treated with protons.4-6 The excess radiation from x-rays can severely damage and mutate healthy cells, resulting in serious toxicities, including causing a new cancer.

Proton therapy cancer treatment reduces your risk of developing a second cancer, compared to x-ray/IMRT.

STUDY CONFIRMS PRIOR RESEARCH

The Stanford study confirms the findings of a previously published study from Harvard using the other main American cancer registry, the Surveillance, Epidemiology, and End Results (SEER) Program. The Harvard study found the second cancer rate to be 48% lower after proton therapy, compared to x-ray treatment. The average follow-up period in the Harvard study was 6 years after radiation therapy. 18

The Harvard study noted that while proton therapy reduced second cancers in all age groups, protons may be particularly beneficial for young patients, who have decades to accumulate radiation-induced cancers. In children, for example, x-ray therapy is estimated to increase second cancers by 600-1,000%.19-21

“As time passes and the follow-up period for these patients lengthens, the benefits of proton therapy will become even more pronounced,” Sommi agrees. “This is especially important for patients who expect to survive 10 years or more.”

OTHER BENEFITS OF PROTON THERAPY FOR CANCER TREATMENT

The results of this study highlight yet another clinically-proven benefit of proton therapy for cancer treatment. Because proton therapy precisely targets the tumor and avoids unnecessary radiation to nearby healthy tissue and organs, patients have a lower risk of short-term and long-term side effects.

Depending on cancer type, other benefits of proton therapy include:

Prostate Cancer

  • 25% lower risk of erectile dysfunction7
  • 35% less radiation to bladder8
  • 59% less radiation to rectum8

Head, Neck and Oral Cancer

  • 27% reduction in overall risk of needing a feeding tube for oropharyngeal cancer9
  • 45% reduction in overall risk of needing a feeding tube for nasopharyngeal cancer10
  • Dramatic reduction of negative impact on taste, nausea and painful changes to the mouth in salivary gland treatment11

Breast Cancer

  • 88% less radiation to the heart for left-sided breast cancer9,10
  • 44% reduction in clinically significant radiation doses to the lung10
  • 90% of partial breast irradiation cases result in good to excellent cosmetic outcomes at 5 years11

Brain and Spine Cancer

  • 31% increase in disease control for aggressive tumors at base of skull (chordomas) at 5 years12
  • 50% less likely to have secondary brain tumor from treatment13
  • 55% reduction in average dose to the hippocampi (memory function) in treatment of meningioma14

Esophageal

  • 26% reduction in lung toxicity compared with IMRT15
  • 21% reduction in the risk of severe, treatment-related lymphopenia, particularly in lower esophagus16
  • 3-4 day reduction in average hospital stay after surgery17

To learn about other cancers that can be treated with proton therapy, and to read about the benefits of proton therapy for those cancers, visit our Cancers We Treat page.


Sources & Studies

  1. Xiang M, Chang DT, Pollom EL. Second cancer risk after primary cancer treatment with three-dimensional conformal, intensity-modulated, or proton beam radiation therapy. Cancer. 2020;0:1-9.
  2. Journy NM, Morton LM< Kleinerman RA, Bekelman JE, Berrington de Gonzalez A. Second primary cancers after intensity-modulated vs 3-dimensional conformal radiation therapy for prostate cancer. JAMA Oncol. 2016;2:1368-1370.
  3. Diallo I, Haddy N, Adjadj E, et al. Frequency distribution of second solid cancer locations in relation to the irradiated volume among 115 patients treated for childhood cancer. Int J Radiat Oncol Biol Phys. 2009;74:876-883.
  4. Eaton BR, MacDonald SM, Yock TI, Tarbell NJ. Secondary malignancy risk following proton radiation therapy. Front Oncol. 2015;5:261.
  5. Chargari C, Goodman KA, Diallo I, et al. Risk of second cancers in the era of modern radiation therapy: does the risk/benefit analysis overcome theoretical models? Cancer Metastasis Rev. 2016;35:277-288.
  6. Hoppe BS, Flampouri S, Su Z, et al. Consolidative involved-node proton therapy for stage IA-IIIB mediastinal Hodgkin lymphoma: preliminary dosimetric outcomes from a phase II study. Int J Radiat Oncol Biol Phys. 2012;83:260-267.
  7. Comparative toxicity and cost of Intensity-Modulated Radiotherapy, Proton Radiation, and Stereotactic Body Radiotherapy Among Younger Men With Prostate Cancer. Read More
  8. Dose–Volume Comparison of Proton Therapy and Intensity-Modulated Radiotherapy for Prostate Cancer. Read More
  9. Gastrostomy Tubes Decrease by Over 50% With Intensity Modulated Proton Therapy (IMPT) During the Treatment of Oropharyngeal Cancer Patients. Read More
  10. Proton therapy reduces treatment-related toxicities for patients with nasopharyngeal cancer: a case-match control study of IMPT and IMRT. Read More
  11. Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation. Read More
  12. Effectiveness and Safety of Spot Scanning Proton Radiation Therapy for Chordomas and Chondrosarcomas of the Skull Base: First Long-Term Report. Read More
  13. A comparison of critical structure dose and toxicity risks in patients with low grade gliomas treated with IMRT versus proton radiation therapy. Read More
  14. Projected second tumor risk and dose to neurocognitive structures after proton versus photon radiotherapy for benign meningioma. Read More
  15. A Multi-Institutional Analysis of Trimodality Therapy for Esophageal Cancer in Elderly Patients. Read More
  16. Lymphocyte-sparing Effect of proton therapy in patients with esophageal cancer treated with definitive chemoradiation. Read More
  17. Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer. Read More
  18. Chung CS, Yock TI, Nelson K, Xu Y, Keating NL, Tarbell NJ. Incidence of second malignancies among patients treated with proton versus photon radiation. Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):46-52. doin: 10.1016/j.ijrobp.2013.04.030. Pub 2013 Jun 15.
  19. Curtis RE, Freedman DM, Roe E, et al. eds. New malignancies among cancer survivors: SEER Cancer Registries, 1973-2000. NIH Publ. No. 05-5302. National Cancer Institute; 2006.
  20. Yock TI, Caruso PA. Risk of second cancers after photon and proton radiotherapy: a review of the data. Health Phys. 2012;103:577.
  21. Taylor C, Correa C, Duane FK, et al. Estimating the risks of breast cancer radiotherapy: evidence from modern radiation doses to the lungs and heart and from previous randomized trials. J Clin Oncol. 2017;35:1641-1649.

 

Lung Cancer Awareness Month

Lung Cancer awareness efforts focus on smoking prevention

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Lung Cancer Awareness Month is dedicated to educating the public about the prevalence of the disease in the United States, and providing resources on prevention, screening and treatment.

According to the American Cancer Society (ACS), lung cancer will kill more than 140,000 people in 2019, making it by far the leading cause of cancer death among both men and women. It is the second most common cancer in both men and women (not counting skin cancer). For men, prostate cancer is the only cancer more common, while in women breast cancer is more common.

Smoking is the leading cause of lung cancer. The ACS reports 80% of lung cancer deaths are caused by smoking.1 However, non-smokers can also develop the disease. This could be caused by exposure to radon, secondhand smoke, air pollution, asbestos, diesel exhaust or other chemicals.

PREVENTION IS KEY

With such a high percentage of lung cancer cases linked to smoking, efforts to reduce the prevalence of the disease are largely focused on kicking the tobacco habit.

“Smoking continues to be the #1 most preventable cause of death and disease in the U.S.,” says Kerri Thompson, Public Health Educator for the Knox County Health Department (KCHD) in Knoxville, Tenn. “It kills so many people and it’s something that can be prevented.”

Thompson spearheads KCHD’s tobacco prevention programs, which focus on three main areas: Youth Prevention, Secondhand Smoke Reduction and Smoking Cessation (quitting). Through educational programs designed to teach children about the dangers of smoking, KCHD hopes to dramatically reduce tobacco product usage in our next generation.

“We’re trying to change the trajectory so, hopefully, we can have an impact on lung cancer,” Thompson notes. “Having (our youth) not use tobacco or not be addicted to nicotine in the first place is really key to addressing the huge impact that smoking has on society.”

Knox County’s programs aimed at youth education actually have a trickle-down effect, impacting its Secondhand Smoke Reduction and Smoking Cessation efforts, as well. Children tend to share resources they receive in school with their parents in hopes they will then try to quit. One of these resources is the Tennessee Tobacco Quitline. This is a free service that offers personalized support from counselors who are trained to help you kick the habit. More resources to help you quit smoking can be found at Smokefree.gov.

When it comes to quitting, Thompson says relapse is common, so persistence is very important. “When someone quits smoking, on average it takes seven to 10 times for someone to quit for good. Many people think since they’ve been smoking for years, the damage is already done, so what’s the point in quitting.” However, if there’s one thing she hopes people take away from Knox County’s education and prevention efforts, it’s this – “It’s never too late to quit.”

LUNG CANCER SCREENING CAN SAVE LIVES

According to the National Cancer Institute (NCI), risk factors for lung cancer include tobacco use, secondhand smoke, family history, HIV infection and environmental risks like exposure to asbestos, radon  or other substances. If you believe you may be at risk for lung cancer, you should start by speaking to your doctor. A general practitioner can perform an assessment, then offer advice for your next step. This could be a referral to a pulmonologist or oncologist, or a prescription for nicotine replacement therapy. Since early detection is so important, at-risk individuals may also benefit from a lung cancer screening.

The NCI says the most effective type of screening is a low-dose spiral Computed Tomography (CT) scan. In its National Lung Screening Trial, the NCI studied people between 55 and 74 years old who had smoked at least one pack of cigarettes a day for 30 years or more. They compared low-dose spiral CT scans with another type of screening, chest x-rays. Researchers observed a 20% lower risk of dying from lung cancer in people who received low-dose spiral CT scan screenings.2

Fortunately, there are resources available to help people get screened. The American Lung Association (ALA) offers an online quiz to help you determine whether you are at risk. The ALA can also help you find information about insurance coverage and screening facilities near you.

In an effort to make lung cancer screenings more accessible, CHI Memorial Hospital in Chattanooga, Tenn. brings low-dose CT scans into the community with its Breathe Easy mobile lung CT coach. The bus serves counties from three different states in the Southeast.

PROTON THERAPY AS A TREATMENT

Given the serious prognosis of lung cancer, it’s important to evaluate all your treatment options before making any decisions. Treatment for lung cancer is based mainly on the type (non-small cell vs. small cell) and the stage of the cancer. Other factors like a person’s health and lung function should also be considered. Treatment options may include surgery, chemotherapy and radiation therapy.

Doctors and scientists have been studying the results of proton therapy in the treatment of non-small cell lung cancer (NSCLC). One study in particular showed that patients with Stage 3 NSCLC who were treated with proton therapy experienced lower rates of lung and esophagus inflammation compared to patients treated with traditional (x-ray/IMRT) radiation.3

Proton therapy for lung cancer treatment is non-invasive and usually painless. Physicians provide doses of radiation to specific areas, controlling the depth of the protons emitted and reducing the impact on the surrounding tissue. Provision CARES Proton Therapy uses a technique known as pencil beam scanning, which provides precise dose of radiation to targeted areas, resulting in a decreased risk of side effects. Proton therapy decreases the risk of damage to healthy tissue and organs surrounding the cancer. This is because the unique physical properties of protons allow the radiation dose to better conform to your cancer, avoiding unnecessary radiation to nearby areas. This is especially important for lung cancer treatment because the tumor may be close to your heart, healthy lung and other critical organs.

Since each cancer diagnosis is unique, we encourage anyone seeking treatment options to speak with one of our Cancer Care Experts to see if proton therapy is right for you.

 

Sources

  1. American Cancer Society. What Causes Lung Cancer? Read More
  2. National Cancer Institute. National Lung Screening Trial. Read More
  3. National Cancer Database Analysis of Proton Versus Photon Radiaion Therapy in NSCLC. Read More
  4. American Cancer Society. Key Statistics for Lung Cancer. Read More
  5. Proton Beam Radiotherapy and Concurrent Chemotherapy for Unresectable Stage III Non–Small Cell Lung Cancer Final Results of a Phase 2 Study. Read More
  6. High-dose hypofractionated proton beam radiation therapy is safe and effective for central and peripheral early-stage non-small cell lung cancer: results of a 12-year experience at Loma Linda University Medical Center. Fractionation 10 for PBT vs 6-8 weeks for IMRT. Read More

 

how to reduce radiation-induced heart disease

The Heart of the Matter: Proton Therapy Can Prevent Radiation-Induced Heart Disease

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Content and information provided by Rebecca Bergeron, RN, BSN, OCN Director of Clinical Services for Provision CARES Proton Therapy Knoxville

February is American Heart Month, and it is the perfect time to talk about preventing unnecessary radiation dose to the heart, often times causing radiation-induced heart disease. When people begin their fight against cancer, they are most likely not thinking about reducing their future risk of heart disease; however, this is certainly something we are thinking about at Provision CARES Proton Therapy.  (more…)

Mediterranean Diet to Reduce Lung Cancer

Reduce the risk of lung cancer with Mediterranean diet

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Replacing saturated fat with polyunsaturated fat impacts reduce risk of lung cancer

By Casey Coffey MS, RD, LDN

According to recent studies, benefits of polyunsaturated fats have been widely reviewed by looking at the relationship between dietary components of the Mediterranean diet and cancer risk, diabetes, cardiovascular events, and Alzheimer’s disease. Within these studies, the primary conclusion shows correlation between fat intake and risk associated with lung cancer.

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Protons offer promise for reirradiation

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For those with cancer who have already an initial course of radiation therapy, a recurrence of their disease can be an understandable cause for concern.

With conventional (X-ray) based radiation, we generally can only safely give one round of treatment to the primary site of disease. But with proton therapy, because of its ability to zero in on the cancer and spare healthy surrounding tissue, a second course of treatment could offer hope to patients with recurrent tumors. (more…)

Conventional radiation for lung cancer damages heart

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Note: This is the first in a monthly series of blogs that will be authored by Dr. Ben Wilkinson, radiation oncologist and medical director for Provision Center for Proton Therapy. Dr. Wilkinson will cover a variety of topics related to proton therapy treatment and cancer care.

For some years now, the damage conventional radiation can do to the hearts of breast cancer patients has been documented in the medical literature.

Now, we’re seeing the same effects in lung cancer patients. (more…)

Dosimetrists focus on finding perfect proton path

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Not too long ago, radiation prescribed for cancer treatment was calculated by physical measurement and mathematic formulas worked out by hand.

Now computers do much of that detail work, but the job of a dosimetrist is as important as ever in making sure patients receive the right dose of radiation in exactly the right place. And thanks to advancements in the field—the development of proton therapy and advanced application technologies such as pencil-beam scanning, sophisticated software modeling platforms and high tech imaging capabilities—patients receive precise, customized therapy that’s the best in the world.

Kevin Kirby is one of six dosimetrists who work at Provision Center for Proton Therapy. These experts in the delivery of radiation for treatment of cancer work with radiation oncologist and physicists to determine the best treatment plan and then ensure its successful delivery, says Kirby, who spoke recently at a patient chat, held each Wednesday at the proton therapy center. The talks provide information on a variety of topics of interest to patients and their families.

“Our job is to create (proton therapy) dosage that focuses just in the tumor,” Kirby says. “We figure out the best way to position the patient so we can minimize any radiation to excess tissue.”

With the pencil beam application ability, calculations must be made to determine the direction and length of path for the protons being channeled to the tumor. In some cases, treatment can be made challenging by the location of the tumor, on the lung, for instance, in which radiation must be administered while the patient is breathing.

“We are able to predict the motion of the lungs by using four-dimensional CT scans to develop the treatment plans,” he says.

A laundry list of equipment and programs are involved in coming up with the unique plan for each patient. In the case of the lung cancer patient, for example, a respiratory device helps plan for treatment between breaths. Medcam marries patient x-rays with CT scans to aid dosimetrists, physicians and physicists in creating the treatment protocol. A software package called “Matrix” serves as quality assurance for treatment before it starts, even sending protons into the nozzle through which they’ll be delivered to the patient. Treatment planning software serves as a “flight simulator, which also allows for changes in the treatment plan based on shifts inside a patients body during the course of therapy. Another program, Mosaiq, records the treatment itself, creating a unique therapy chart for every patient.

Among the team of caregivers, physicians prescribe and monitor treatment, physicists manage the entire process on both the equipment and treatment delivery side and therapists interact directly with patients who are receiving therapy. Dosimetrists, says Kirby, focus specifically on the way radiation—in this case, proton therapy—targets the cancer in the patient’s body.

“We take the prescription the doctor gives and determine how to deliver it,” he says.

Sarcoma rare but responsive to proton therapy

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Sarcoma represents just 1 percent of cancer cases. Bob Sisson is among the 1 percent.

“There isn’t a buddy check for sarcoma,” he says. “I don’t know how you give yourself any self-exams. It’s just bad luck.”

A cancer of the body’s connective tissue, there are approximately 14,000 cases of sarcoma diagnosed each year in the United States and represent approximately 15 percent of cancer found in children, according to the Sarcoma Alliance. About 11,300 of those cases soft tissue sarcoma, which can be found in muscles, fat, blood vessels, tendons and other tissues. Just 2,890 cases are bone sarcomas. Sisson was diagnosed with a soft tissue sarcoma known as spindle cell last October.

bob-s-blog-img

“I started feeling a lump on my left hip—the left hip started getting a little larger than the right hip,” he says. That was last summer. By fall, he started to feel pain in his hip bone, and he visited his primary care physician who ordered a CT scan. There was a large tumor that had already metastasized into Sisson’s lungs.

“Maybe if I’d gone in 3 months sooner…,” he wonders.

Because the tumor was so close to key organs including the bowel and kidneys, he was not a candidate for surgery. He started chemotherapy at the recommendation of his oncologist in hopes of shrinking the tumors. But Sisson had also noticed the Provision ads on television featuring ice skating champion Scott Hamilton. He did some research about proton therapy and made a “cold call” to the Knoxville treatment center.

“I thought the proton therapy sounded good for me,” he says. “I have a background in nuclear engineering, so I’m not unfamiliar with the (concept)…. I talked to my doctor, and he said he didn’t think it would be a bad route.”

Sisson and his wife spent three hours at the initial consultation, talking with Dr. Tamara Vern-Gross and her nurse Julie Goodfellow.

“They brought in a lot of their staff people to meet with us and talk with us,” he says. “It was so great to be able to have that interaction, that they would take the time to sit there and talk to you about this.”

Because protons deposit their energy at a specific target, there is less collateral damage to surrounding, healthy tissues and organs, making it a good treatment for many cancers, including sarcoma. Vern-Gross also advised on a shorter regimen of traditional radiation therapy, completed at Provision Radiation Therapy, for the smaller tumors in Sisson’s lungs.

The tumor on Sisson’s hip responded well to the treatment, drastically reducing the size of the sarcoma. He continues chemotherapy treatment for the lung nodules.

“The facility was just first-class. Just walking into the facility you think you’re in a clubhouse. It gives you a healthy perspective, a positive perspective,” Sisson says. “I would give (Provision) the highest marks on care. I would give it the highest marks on medical (expertise) because it’s state of the art. Dr. Tamara is great, absolutely fantastic. The world is a better place to have people like her.”

As for his cancer, Sisson says he has continued to stay active—caring for his wife who suffered from a stroke four years ago, driving himself to chemotherapy, keeping up the house and yard. While he knows the odds for beating stage 4 cancer aren’t in his favor, and although his Blue Cross Blue Shield insurance would not pay for the proton therapy treatments, he does not regret the investment.

“It resolved the issue that it was supposed to,” he says, referring to the tumor on his hip. “It’s your life you’re talking about.”

Men’s health awareness should include cancer screenings

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June is Men’s Health Awareness month—a time to remember that keeping tabs on your health can pay long-term dividends.

Cancer screenings can play an important role in health awareness, particularly for those at risk of certain types of cancer, because catching and treating cancer in its early stages improves the prognosis for remission and long-term survival.

This is particularly true for lung cancer patients.

For example, in lung cancer patients, those who have stage 1 cancer experience a 45-49 percent five-year survival rate—that is, 45-49 percent of patients are still alive five years following treatment. That compares to a 5-14 percent five-year survival rate for stage 3 and a 1 percent five-year survival rate for those with Stage 4 lung cancer. That’s according to statistics from National Cancer Institute.

Lung screenings are now covered by Medicare as well as state and private insurers for those at high risk for lung cancer. Medicare, for example, pays for the test for those between ages 55 and 77 who’ve smoked 30 pack-years—or the number of cigarettes smoked per day divided by 20 (1 pack has 20 cigarettes)—as well as those who currently smoke or quit smoking within the past 15 years.

Provision Diagnostic Imaging offers lung screenings, a low dose CT scan that would cost $300-$500 without health insurance reimbursement. Call (865) 684-2600 to schedule a lung screening.

Unlike lung cancer, prostate cancer has a much higher survivability rate—but it affects a much higher percentage of the population. Prostate cancer is the third most common cancer. In 2015, there will be an estimated 220,800 new cases diagnosed in the U.S., and approximately 14 percent of men will be diagnosed with prostate in their lifetimes, according to the National Cancer Institute.

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