Veterans Prostate Cancer 101 Brochure

DURING THEIR IN VETERANS 1 5 PROSTATE CANCER

WILL GET

LIFETIME.

VETERANS EDITION

EDUCATION SCREENING ARE VITAL PROSTATE CANCER. AND DEFEATING TO

PROSTATE CANCER 101 WHAT IS PROSTATE CANCER?

Prostate cancer is cancer that begins in the prostate. The prostate is a walnut-shaped gland in the male reproductive system located below the bladder and in front of the rectum. It surrounds the urethra and makes the fluid to nourish and protect sperm cells. Cancer is defined as the uncontrolled growth of cells into tumors. Tumors can be benign (not cancerous), or malignant (cancerous). Most prostate cancer grows slowly and stays in the prostate. While most prostate cancer is slow growing, others will be aggressive and can spread quickly.

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WHO IS AT RISK? Every 15 minutes an American man dies from prostate cancer. That is a little more than 75 deaths per day. A man’s risk of prostate cancer increases with age, and most prostate cancer is found in men over 50 years. The greatest risk factors are family history, African-American ancestry, Veteran status, and increasing age. Veterans are nearly twice as likely to be diagnosed with prostate cancer, with nearly 1 in 5 Veterans being diagnosed*.

RISK FACTORS

AGE

FAMILY HISTORY RACE DIET

GENES CHEMICAL EXPOSURE

RISK QUIZ

3 3 3 3

Are you African-American?

Are you a Veteran? Did your father or brother have prostate cancer? Are you over the age of 65?

*Cancer Facts and Figures 2022, American Cancer Society

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BENEFITS OF EARLY DETECTION All men are at risk of prostate cancer. Finding the disease early means the best chance of curing it. When found early, 99% of men will be alive five years later. Prostate cancer generally shows no symptoms until it is at an advanced stage. The earlier prostate cancer is detected, the more treatment options are available. The only way to detect it early is with the following tests. There are two early detection tests for prostate cancer: • Prostate Specific Antigen (PSA) Test – Determines the level of PSA in the blood. Levels of PSA can be higher in men with prostate cancer. • Digital Rectal Exam (DRE) – A test done when a physician inserts a finger into the rectum to feel the prostate. GUIDELINES FOR EARLY DETECTION The National Comprehensive Cancer Network ® (NCCN ® ) and ZERO recommend a man should be educated about prostate cancer and understand his options for early detection. Talk with your doctor about your personal risk and the guidelines to make a plan for testing.

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WHY ARE VETERANS AT HIGHER RISK?

Those exposed to toxic chemicals and herbicides while in the military are at a higher risk for developing prostate cancer. Exposures such as Agent Orange, burn pits, and PFAS and PFOA chemicals have all been shown to have higher rates for prostate cancer, among other types. There may be other service- connected factors that increase the risk of prostate cancer, but they are not yet well understood. It is because of that higher risk of prostate cancer that every Veteran needs to be aware of the risks and treatment options, whether it be through the Veterans Health Administration, the Community Care Network, or a separate treatment facility.

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WILL THE VA HELP ME WITH MY TREATMENT? If you qualify for benefits with the U.S. Department of Veterans Affairs (VA), you have a couple of options available to you when it comes to your prostate cancer journey - the Veterans Health Administration and the Community Care Network. The Veterans Health Administration (VHA) Many Veterans are eligible to receive healthcare through the VA. If you are eligible, you can file for VA benefits and/or disability through the VA directly, through your state Veterans Affairs offices, or through a Veteran Service Organization. If you have Medicare or private insurance, you can use VA health care benefits alongside those plans. To learn more, visit www.va.gov or call 1-800-827-1000. The VHA also runs a number of precision oncology centers of excellence that specialize in the treatment of advanced prostate cancer. At these centers of excellence, VA physicians perform cutting-edge research and treatment for patients with advanced prostate cancer.

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The Community Care Network (CCN) With the passage of the Mission Act in 2018, the Community Care Network was established to give Veterans a broader network of medical care outside of the VA. Through the CCN, Veterans can receive care through community providers when the VA cannot provide the care needed. For prostate cancer patients, this means expanded access to treatment and medical care that may be closer to home and easier to access. For more information on the Community Care Network and how eligibility works, please visit our CCN fact page at zerocancer.org/get-support/ zero-prostate-cancer-veterans/the-va-community- care-network/ . Do I have to get my prostate cancer treatment through the VA? Where to receive treatment and how to pay for it is an individualized decision. Some Veterans receive prostate cancer care through the VHA, while others utilize VA benefits through the community care network. Veterans may have access to private health insurance, Medicare, or Medicaid. For assistance navigating insurance benefits, Veterans can contact ZERO360 by calling 1-844-244-1309 Toll-Free.

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PSA Screening Guidelines*

NCCN GUIDELINES ® FOR PROSTATE CANCER EARLY DETECTION

Age 40

Talk to your physician about testing and your personal risk

Have a baseline PSA and DRE if PSA above 1 ng/mL, repeat at 1 – 2 year intervals until 50 if PSA below 1 ng/mL repeat PSA at 50

Age 45 – 49

Age 50 – 70

If PSA is below 3 ng/mL, repeat testing at 1 – 2 year intervals

Talk with physician and assess general health to decide together if routine PSA testing should continue

Age 70 and over

* Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer Early Detection V.1.2014.© 2014 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc. PROSTATE CANCER 101 07 THERE ARE RESOURCES TO HELP YOU FIGHT IT. IF YOU HAVE PROSTATE CANCER,

DIAGNOSING PROSTATE CANCER If cancer is suspected as a result of a PSA test, DRE, or other factors, a biopsy will most likely be performed. A prostate biopsy is the removal of samples of tissue from your prostate with a needle and the help of ultrasound. Exciting research shows that using both MRI and ultrasound can help doctors pinpoint aggressive prostate tumors.

National Cancer Institute

GENOMIC TESTING Genomic testing is done on cancerous tissue taken from the prostate in order to provide information about how your prostate cancer might behave. It can be performed on both biopsy tissue and on tissue from an entire prostate following a prostatectomy. Genomic testing is useful for helping prostate cancer patients and their doctors decide on a treatment, so these tests are most helpful for those who are newly diagnosed with prostate cancer that is still confined to the prostate. However, men who have had surgery and want to understand their risk of recurrence may also find this information helpful. By looking at the genetic makeup of the prostate cancer, genomic tests may help predict whether a person’s prostate cancer will grow slowly or aggressively.

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GRADING AND STAGING 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.

PROSTATE CANCER STAGES The cancer is small and only in the prostate. The cancer is larger and may be in both lobes of the prostate but is still confined to the prostate. The cancer has spread beyond the prostate to nearby lymph glands or seminal vesicles. The cancer has spread to other organs such as the bone and is referred to as metastatic cancer. If prostate cancer spreads, or metastasizes, to the bone, you have prostate cancer cells in the bone, not bone cancer.

Stage I Stage II

Stage III

Stage IV

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Grading, using the Gleason score, indicates how quickly the tumor will grow and spread. The grade is the description of the tumor based on how abnormal the cells look under the microscope. Today most scores range from 6 – 10.

GLEASON SCORES IN CATEGORICAL ORDER The tumor tissue is well differentiated, less aggressive and likely to grow more slowly

Gleason 6

The tumor tissue is moderately differentiated, moderately aggressive, and likely to grow but may not spread quickly

Gleason 7

The tumor tissue is poorly differentiated, or undifferentiated, highly aggressive, and likely to grow faster and spread

Gleason 8 -10

STAGING AND TREATMENT Choosing a healthcare team is an important decision. Take the time to get educated on all available options and potential negative side effects to make the best decision for you. Early stage, also called localized, prostate cancer is cancer that has not moved outside of the prostate, either Stage I or Stage II. Between 15 - 40 percent of men treated with localized prostate cancer will experience a recurrence. Advanced prostate cancer is cancer that has moved outside of the prostate. Stage III prostate cancer has spread to the seminal vesicles or nearby lymph nodes. Stage IV prostate cancer has spread to other organs, such as the bone. This is referred to as metastatic prostate cancer. About 5% of men are diagnosed with metastatic disease.

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The best treatment for one person may not be the best for another. The right treatment for you depends on many factors including: • Age • Gleason score (grade) of the tumor • Stage of prostate cancer • Symptoms • General health Prostate cancer is a disease that can be treated by several different types of medical specialists. And the treatment chosen may mean that the doctor who diagnosed your cancer is not the one doing the majority of your treatment. You may meet with many doctors before you make a final decision about treatment. Consider a multidisciplinary team for the treatment of your prostate cancer. A multidisciplinary team is a group of health care professionals from different specialties that work together to suggest a treatment plan.

CONSIDER A MULTIDISCIPLINARY TEAM

TIP

OF HEALTH CARE PROFESSIONALS

If you cannot work with a multidisciplinary team, meeting with a medical oncologist will help you have a full picture of all treatment options available to you. This is especially important should your cancer return at some point in the future.

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Specialists involved in the treatment of prostate cancer include:

Physicians: • Urologist

• Radiation Oncologist • Medical Oncologist • Primary Care Physician

Other Health Care Professionals:

• Oncology Social Worker • Physical Therapist • Nutritionist • Navigator • Sexual Health Professional

TREATMENT OPTIONS Early Stage Prostate Cancer

• Active Surveillance – close monitoring of the status of the prostate cancer through regular office visits and repeat medical tests. Prostate cancer can grow slowly, allowing time to evaluate options. • Surgery – known as a radical prostatectomy, is the removal of the entire prostate by a surgeon. • Radiation therapy – uses radiation to destroy the cancer cells in the prostate while leaving the prostate in the body. It can be given in two ways, externally (from the outside) and internally (placed inside) to fight prostate cancer.

• Cryotherapy – freezing of the tumor to destroy the cancer cells.

• HIFU (high intensity focused ultrasound) – uses heat to kill prostate cancer cells.

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Advanced Prostate Cancer Hormone Therapy

Hormone therapy, also called androgen deprivation therapy (ADT), lowers the testosterone level in a man’s body. Because prostate cancer cells use testosterone as fuel, ADT starves the tumor cells. Hormone therapies cannot kill prostate cancer, but can improve the quality of life and extend survival. Hormone therapy can be used at many points during the treatment of men with prostate cancer, including with surgery and radiation. Immunotherapy Immunotherapy stimulates the immune system to kill cancer cells in men with advanced prostate cancer. Targeted Therapy Targeted therapy for prostate cancer is a type of therapy that identifies, or “targets”, a particular genetic mutation in the tumor, with the goal of interfering with the specific molecules that drive the growth of the tumor. A targeted therapy approach is a form of personalized cancer treatment and is often times associated with fewer side effects than other treatments Chemotherapy Chemotherapy uses anti-cancer drugs to kill cancer cells. The drugs for prostate cancer are usually given into a vein (intravenously) with a needle. This treatment is routinely given at a clinic or doctor’s office. Radiation Radiation therapy uses high-energy rays to target the prostate and any surrounding areas with cancer or at risk of cancer.

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CLINICAL TRIALS A clinical trial is an investigation of an experimental treatment to see if it is safe to use and effective in fighting a disease, such as prostate cancer.

CLINICAL TRIALS EVALUATE:

NEW COMBINATIONS OF TREATMENTS

NEW DRUGS & MEDICINES

NEW APPROACHES TO SURGERY OR RADIATION THERAPY

NEW METHODS SUCH AS GENE THERAPY

All clinical trials vary depending on the objective of the test. However, placebos are almost never used in cancer treatment trials.

Clinical trials follow strict guidelines and are highly controlled and regulated to provide the best protection to participants. A clinical trial consists of at least two groups depending upon the study protocol. A study protocol is a plan that describes the schedule of tests, procedures, medications and dosages, and the length of the study. One group of patients will receive the experimental drug or treatment and the other group of patients will receive either the standard of care or a placebo which has no therapeutic value. However, placebos are almost never used in cancer treatment trials. Clinical trials are highly controlled and regulated. They are typically sponsored by pharmaceutical or biotech companies, the federal government, medical institutions, or private foundations.

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QUESTIONS TO ASK YOUR DOCTOR

Before starting treatment, you should talk to your doctor about your options. You may want to seek a second opinion or even talk to several different doctors about all treatment options, their side effects, and the expected results.

FOR THE DOC QUESTIONS

What are my treatment options? Which do you recommend for me? Why? Q What are the expected benefits of each kind of treatment? Q the side effects be managed? Q What can I do to prepare for treatment? Q Will I need to be hospitalized? If so, for how long? Q What is the cost of treatment? Will my insurance cover it? Q What are the risks and possible side effects of each treatment? How can How will treatment affect my normal activities? Will it affect my sex life? Q Is a clinical trial an option for me? Q Will I have urinary problems? Will I have bowel problems?

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MANAGING SIDE EFFECTS The side effects from treatment can range from temporary to long term incontinence, trouble controlling your bladder, and erectile dysfunction, to other issues such as pain and depression. Fortunately, side effects can be managed. Talk with your doctor to learn how potential side effects can be managed. Side effects may include: • Incontinence: Prostatectomy and radiation • Erectile Dysfunction: Erectile dysfunction is a common side effect following prostatectomy and radiation therapy. • Depression: Feelings of sadness, anger, and anxiety are common for people going through a major challenge like cancer. If you are having trouble coping, don’t be afraid to talk to your doctor. Joining a support group may also be helpful. therapy can cause muscle damage that disrupts the way the bladder holds and discharges urine.

YOUR DOCTOR TALK TO

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HEALTHY LIVING An overall wellness plan of healthy living is critical when it comes to prostate health and fighting prostate cancer. A growing list of studies show a strong connection between fighting cancer and important choices in diet, physical activity, and lifestyle.

MILK

Tips for Healthy Living • Eat a healthy, plant-based diet and limit animal products • Be physically active • Seek to maintain a healthy weight • Limit the amount of alcohol you drink • If you use tobacco, stop; and if you don’t, do not start • Protect your skin from UV radiation

• Have regular physical exams and talk with your doctor about your risk for prostate and other cancers

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HEALTHY CAN HELP. EATING AND EXERCISE

The ZERO Prostate Cancer Run/Walk is the largest men’s health event series in America. Every year, the ZERO Prostate Cancer Run/

Walk Series takes place in nearly 50 cities across the country. These events bring local communities together to promote awareness, provide support, and raise funds. Join us as a walker, runner, or volunteer for this family friendly event in a city near you. Register at: zerocancer.org/runwalk .

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RESOURCES Life with prostate cancer can bring profound changes and challenges. Understanding the disease and how to manage it can increase your confidence in making changes to improve and maintain your health. At ZERO, we are dedicated to helping you live your best life possible. Learn more about our resources available on our website at zerocancer.org/learn . ZERO360 – No man should face prostate cancer alone. Now men don’t have to. We offer a free service to help patients make treatment decisions, access financial resources to cover treatment and other needs, and find emotional support. Our team of experienced case managers is ready to help you and your family through your personal prostate cancer journey. Contact us toll-free at 1-844-244-1309 or zerocancer.org/zero360 .

Educational Webinars and Videos – Hear directly from experts in the prostate cancer community on various topics from the comfort of your home. Our live webinar programs are taped and available for you to listen to at any time on our website. Fact Sheets, Worksheets, and Questions for Your Doctor – Download one of our fact sheets today to learn more about prostate cancer. We also provide worksheets to track your disease and questions to ask your doctor. For Families – If someone you love has been diagnosed with prostate cancer, you are not alone. Read our tips for coping and taking care of your loved one. Support Groups – Join an Us TOO support group in your area to connect with others with similar experiences. Social Media – Like and follow ZERO on social media, where we share educational resources.

WEBINARS & VIDEOS

FACT SHEETS

QUESTIONS FOR THE DOCTOR

SUPPORT GROUPS

SOCIAL MEDIA

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ABOUT ZERO - THE END OF PROSTATE CANCER ZERO — The End of Prostate Cancer is the leading national nonprofit with the mission to end prostate cancer and help all who are impacted. ZERO advances research, provides support, and creates solutions to achieve health equity to meet the most critical needs of our community.

515 King Street, Suite 420 Alexandria, VA 22314 Ph: 202-463-9455 Toll-free 888-245-9455 info@zerocancer.org facebook.com/zerocancer twitter.com/zerocancer instagram.com/zeroprostatecancer

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