Agent Orange Raises Vietnam Vets' Risk of Recurrent Prostate Cancer -

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currentprostatecancer

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Bev

Agent Orange Raises Vietnam Vets' Risk of Recurrent Prostate Cancer By E.J.
Mundell
HealthDay Reporter
29 minutes ago

SUNDAY, May 20 (HealthDay News) -- Exposure four decades ago to Agent Orange
in the Vietnam War appears to boost veterans' risk for a recurrence of
prostate cancer even after the organ is surgically removed, a new study
shows.

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And if the cancer does return, it tends to be more aggressive among veterans
exposed to Agent Orange than in those not exposed to the chemical defoliant,
the researchers found.

Black veterans are especially vulnerable to these tough-to-treat
recurrences, the researchers said.

"This means that we need to make sure that these patients are not lost to
follow-up, that their PSAs [prostate specific antigen levels] are checked
regularly and that Vietnam veterans are screened aggressively for prostate
cancer," said lead researcher Dr. Sagar Shah, a urology resident physician
at the Medical College of Georgia. "The quicker that we catch [a
recurrence], the more treatment options we have."

Shah's team was to present its findings Sunday at the annual meeting of the
American Urological Association, in Anaheim, Calif.

Agent Orange was used to clear dense jungle cover during the Vietnam War. It
contains dioxin, which, Shah said, "isn't really a tumor mutagen -- it
doesn't cause cancer -- but it is a tumor-promoter. So, if the cancer is
there, it makes it more prominent."

Exposure to dioxin and Agent Orange has long been linked to increased risks
for a variety of malignancies, including leukemias, lymphomas, prostate
cancer and lung tumors, according to Phil Kraft, program director for the
National Veterans Services Fund, which lobbies on behalf of U.S. veterans.

"Agent Orange -- and its bad-guy ingredient, dioxin -- affects everyone who
is exposed genetically," he said.

In the new study, Shah's team sought to determine if there were any
differences in the rate or type of prostate cancer recurrences seen among a
group of 1,653 black and white Vietnam veterans -- 199 of whom had been
exposed to Agent Orange. All of the veterans were treated after first being
diagnosed with prostate cancer between 1990 and 2006. Their treatment
included surgical removal of the prostate gland.

Examination of biopsy samples under a microscope showed no pathological
differences between the tumors of men exposed to Agent Orange and those who
were not exposed, Shah said.

Differences did emerge, however, when the researchers compared rates of
"biochemical recurrence."

Biochemical recurrence means that blood levels of the marker
prostate-specific antigen -- produced by prostate cancer cells -- rose
sharply and steadily in the months after surgery. Doctors routinely test men
for their blood levels of PSA to help spot prostate cancer.

In this study, the shorter the time it took for a man's PSA level to double,
the more aggressive his cancer appeared to be, Shah explained.

Veterans exposed to Agent Orange "had a higher relative risk of having a
biochemical recurrence" than unexposed veterans, Shah said.

The rate of post-surgical prostate cancer recurrence among white veterans
rose by 42 percent if they had been exposed to Agent Orange, compared to
non-exposed veterans, the researchers found. Black veterans exposed to the
herbicide fared even less well, with a recurrence rate that was 75 percent
higher than their non-exposed peers.

And when prostate cancer did recur among veterans exposed to Agent Orange,
"it seemed that they had a much shorter PSA doubling time, a surrogate for
aggressiveness," Shah said.

Among black men with a cancer recurrence, PSA levels doubled in just nine
months for those exposed to Agent Orange, compared to 16 months for those
unexposed to the toxin.

Why might black Vietnam veterans be most vulnerable? Numerous studies
conducted among the general population have already suggested that genetics
or other factors put black American men at higher prostate cancer risk
compared to whites.

In addition, black troops serving in Vietnam "were also more likely to have
higher levels of exposure than whites," Shah noted. "They were more likely
to be ground troops and less likely to be officers away from Agent Orange
exposure," he said.

What does it all mean in terms of veteran's health? "When you are counseling
patients on their treatment options, this is something that you can make
them aware of -- that this puts you at higher risk for a recurrence," Shah
said.

Shah stressed that the study did not look at recurrence rates for prostate
cancer patients treated with methods other than surgery -- for example, with
radiation. "We just don't know about those outcomes," he said.

"However, if he has surgery, the patient and I need to be on the same page,
and I need to say, 'You have to make sure that you come in for your regular
PSA test,' " Shah said. "We really have to be aware of this."

Kraft agreed that veterans' health deserves closer scrutiny, and he said
that the experiences of the men and women who served in Vietnam have much to
teach today's physicians and policymakers.

"We are the guys who are learning the lessons," said Kraft, himself a
Vietnam veteran. "We hope we're passing that knowledge on to the Persian
Gulf, Iraqi Freedom and        Afghanistan veterans."

More information

Find out more about Agent Orange and its effects at the U.S. Department of
Veterans Affairs.