Prostate cancer is the number one diagnosed solid tumor cancer in the Veteran’s Health Administration (VHA) system. There are over 489,000 Veterans in the VHA system presently being treated for prostate cancer, with approximately 13,000 to 15,000 new cases annually. The majority of VHA patients are men over the age of 40, in the prime age for diagnosis of the disease, and many believe that prostate cancer education and awareness should be more prevalent in the VHA.
Today, there are several disparities we as Veteran prostate cancer patients experience that significantly affect our treatment, and our quality of daily life, because of the disease. I am personally familiar with a number of these issues as I am once again dealing with a recurrence of my own prostate cancer.
Advanced Diagnostic / Screening / Risk Assessment Testing
Only a small number of VHA facilities and physicians offer these procedures, such as Serum Prostate Health Index or IsoPSA, and almost none promote early screening. Early screening saves lives and it would save billions of dollars in advanced cancer care costs within the VHA system.
PET/CT imaging for initial staging and recurrence
Tests such as PyL prostate specific membrane antigen (PSMA) should be available at every VHA facility in the country. It would save billions on cancer-care decisions and increase the quality of life of patients. Many veterans, including myself, are forced to fly at their own cost to Los Angeles to have the test conducted because it is the only VHA center in the country that offers this technology.
Somatic and germline DNA sequencing
I’ve been lucky enough to have this done multiple times; however, I speak with veterans from other hospitals every day who do not have access to or knowledge of these programs. A comprehensive Prostate Cancer Clinical Pathway and better physician education resources would help to standardize and implement programs such as the DNA Sequencing of all prostate cancer patients.
Checkpoint inhibitors and the immunotherapy drug Provenge is now recommended by the National Comprehensive Cancer Network as a first line treatment for metastatic prostate cancer patients. The use of Mission Act Community Care Network funds should be promoted and encouraged for this type of procedure and medication across all VHA centers.
Radiotherapies and advanced techniques
There are less than 50 radiation treatment sites within the VHA System. It’s a shame that we are not putting the Mission Act funds towards new advancements such as SBRT, HDR Brachytherapy, and Fusion Laser Ablation techniques. These treatments not only save lives, but they are readily available in the private industry and should be offered to Veteran cancer patients as well.
Full spectrum anti-androgen therapy
The law now states that Veterans should receive the same care as any other American; however, this simply is not happening. Veterans are being treated with only drugs in the VHA Pharmacy that have gone through the acquisition process. This process needs to be reformed to adequately address the rapidly changing technologies and needs of the cancer treatment industry.
Clinical Trials for new agents and therapies
There is limited access, funding, and education available for Veterans on clinical trials and new agents available to cancer patients. No organization in the VHA is charged with advertising, educating, or raising awareness on the benefits of clinical trials to patients and fellow Veterans. Nor has there been for the need to participate and facilitate clinical trials.
This list is by no means exhaustive, but it highlights a majority of the significant prostate cancer treatment issues that Veterans face. It’s critical to raise awareness of these disparities and educate leaders in the VHA, Congress, and private industry on these topics to develop comprehensive solutions for all of the 500,000 patients dealing with this disease. I am committed to this important challenge to raise awareness about prostate cancer in the Veteran population, and I am requesting your support and input to our campaigns. Please go to https://zerocancer.org/veterans to learn more.