[Congressional Record Volume 145, Number 87 (Friday, June 18, 1999)]
[Senate]
[Pages S7267-S7268]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. FRIST:
  S. 1243. A bill to amend the Public Health Service Act to revise and 
extend the prostate cancer preventive health program; to the Committee 
on Health, Education, Labor, and Pensions.


              PROSTATE CANCER RESEARCH AND PREVENTION ACT

  Mr. FRIST. Mr. President, this year 37,000 American men will die, and 
179,300 will be diagnosed with prostate cancer, the second leading 
cause of cancer-related deaths in American men. Cancer of the prostate 
grows slowly, without symptoms, and thus is often undetected until in 
its most advanced and incurable stage. It is critical that men are 
aware of the risk of prostate cancer and take steps to ensure early 
detection.

  While the average age of a man diagnosed with prostate cancer is 66, 
the chance of developing prostate cancer rises dramatically with age--
which makes it important for men to be screened or consult their 
healthcare professional. The American Cancer Society and the American 
Urological Association recommend that men over 50 receive both an 
annual physical exam and a PSA (prostate-specific antigen) blood test. 
African-American men, who are at higher risk, and men with a family 
history of prostate cancer should begin yearly screening at age 40.
  Even if the blood test is positive, however, it does not mean that a 
man definitely has prostate cancer. In fact, only 25 percent of men 
with positive PSAs do. Further testing is needed to determine if cancer 
is actually present. Once the cancer is diagnosed, treatment options 
vary according to the individual. In elderly men, for example, the 
cancer may be especially slow growing and may not spread to other parts 
of the body. In those cases, treatment of the prostate may not be 
necessary, and physicians often monitor the cancer with follow-up 
examinations.
  Unfortunately, preventive risk factors for prostate cancer are 
currently unknown and the effective measures to prevent this disease 
have not been determined. In addition, scientific evidence is 
insufficient to determine if screening for prostate cancer reduces 
deaths or if treatment of disease at an early stage is more effective 
than no treatment in prolonging a person's life. Currently, health 
practitioners cannot accurately determine which cancer will progress to 
become clinically significant and which will not. Thus, screening and 
testing for early detection of prostate cancer should be discussed 
between a man and his healthcare practitioners.
  In an effort to help address the serious issues of prostate cancer 
screening, to increase awareness and surveillance of prostate cancer, 
and to unlock the current mysteries of prostate cancer through 
research, I rise to introduce the ``Prostate Cancer Research and 
Prevention Act.''
  The ``Prostate Cancer Research and Prevention Act'' expands the 
authority of the Centers for Disease Control and Prevention (CDC) to 
carry-out activities related to prostate cancer screening and overall 
awareness and surveillance of the disease and extends the authority of 
the National Institutes of Health to conduct basic and clinical 
research in combating prostate cancer.
  The bill directs the CDC to make grants to States and local health 
departments to increase awareness, surveillance, information 
dissemination regarding prostate cancer, and to examine the scientific 
evidence regarding screening for prostate cancer. The main focus is to 
comprehensively evaluate of the effectiveness of various screening 
strategies for prostate cancer and the establishment of a public 
information and education program about the issues regarding prostate 
cancer. The CDC will also strengthen and improve surveillance on the 
incidence and prevalence of prostate cancer with a major focus on 
increasing the understanding of the greater risk of this disease in 
African-American men.
  The bill also reauthorizes the authority of the CDC to conduct a 
prostate screening program upon consultation with the U.S. Preventive 
Services Task Force and professional organizations regarding the 
scientific issues regarding prostate cancer screening. The screening 
program, when implemented, will provide grants to States and local 
health departments to screen men for prostate cancer with priority 
given to low income men and African-American men. In addition the 
screening program will provide referrals for medical treatment of those 
screened and ensure appropriate follow up services including case 
management.
  Finally, to continue the investment in medical research, the bill 
extends the authority of the National Cancer Institute at the National 
Institutes of Health to conduct and support research to expand the 
understanding of the cause of, and find a cure for, prostate cancer. 
Activities authorized include basic research concerning the etiology 
and causes of prostate cancer, and clinical research concerning the 
causes, prevention, detection and treatment of prostate cancer.
  Mr. President, as we celebrate Father's Day this weekend, I hope that 
we

[[Page S7268]]

take time to reflect on the serious health threat of prostate cancer. 
It is my hope that my colleagues will join me in supporting the 
``Prostate Cancer Research and Prevention Act,'' so that we can further 
understand the issues surrounding this disease and continue to move 
forward on developing effective treatment and finding a cure.
  Mr. President, I ask unanimous consent that letters of support be 
printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

                                      American Cancer Society,

                                    Washington, DC, June 15, 1999.
     Hon. Bill Frist,
     U.S. Senate, Washington, DC.
       Dear Senator Frist: On behalf of the more than 2 million 
     volunteers of the American Cancer Society, I am writing to 
     offer our support for the Prostate Cancer Research and 
     Prevention Act. Thank you for introducing this important 
     legislation that reauthorizes important programs, with 
     respect to prostate cancer research and prevention activities 
     at the National Institutes of Health (NIH), the Agency for 
     Health Care Policy (AHCPR), the Health Resources and Services 
     Administration (HRSA) and the Centers for Disease Control and 
     Prevention (CDC).
       Prostate cancer represents one of the most significant 
     medical and social challenges facing our country today. In 
     1999, approximately 179,300 new cases of prostate cancer will 
     be diagnosed in the United States and it is estimated that 
     this disease will cause more than 37,000 deaths this year. 
     While aggressive detection and treatment programs have begun 
     to show some promise of reducing the mortality rate for this 
     disease, we still have a long way to go.
       The Society support the continuation of prostate cancer 
     research programs at the NIH, APCPR, HRSA and CDC. These 
     programs may yield better tests to detect prostate cancer at 
     an early stage, new treatments to cure prostate cancer, and 
     improved knowledge of the psychosocial and quality-of-life 
     impacts of men diagnosed with prostate cancer.
       Your legislation also recognizes the need for more 
     information on how best to tackle the many challenges this 
     disease brings. Specifically, the bill addresses the need 
     for: additional research on the effectiveness of prostate 
     cancer screening strategies; more data on how best to improve 
     training, education, and skills of health practitioners with 
     regards to prostate cancer; and more information about how 
     men seek medical attention, make decisions about treatment, 
     and follow-up on treatment recommendations.
       All of this information would support the development and 
     communication of messages by public and private health 
     professionals about prostate cancer early detection and 
     treatment for men and their families, as well as provide for 
     the establishment of a prostate cancer screening program. The 
     American Cancer Society believes that prostate cancer 
     education, awareness and screening programs should give 
     priority to those populations at high risk of developing this 
     disease--specifically, African American and older men.
       Lastly, your legislation takes a crucial first step at 
     addressing several critical issues related to increasing 
     access to prostate cancer screening and appropriate follow-up 
     care. While the American Cancer Society recognizes that often 
     an incremental approach to complex health care issues is 
     preferable than attempting comprehensive reform or crafting 
     multifaceted policy solutions, the Society asks that you and 
     your colleagues take this opportunity to consider some of the 
     larger health care quality and access challenges to our 
     health care delivery system. We urge you to explore other 
     legislative provisions that would help to assure access to 
     quality care--for all patients--especially those 
     disproportionately affected by cancer.
       Again, the American Cancer Society applauds your leadership 
     and support for the reauthorization of these valuable 
     programs. Thank you for your continued dedication to cancer 
     control and prevention.
           Sincerely,
                                          Charles J. McDonald, MD,
     President of the Board of Directors.
                                  ____

                                               American Urological


                                            Association, Inc.,

                                     Baltimore, MD, June 17, 1999.
     Hon. Bill Frist,
     The U.S. Senate, Washington, DC.
       Dear Senator Frist: As President of the American Urological 
     Association (AUA), representing 9,200 urologists in this 
     country, I would like to thank you for introducing the 
     ``Prostate Cancer Research and Prevention Act.'' The AUA 
     supports this legislation, which recognizes that prostate 
     cancer early detection and education are vital tools in the 
     fight against prostate cancer. As you know, the American 
     Cancer Society (ACS) estimates that 179,300 new cases of 
     prostate cancer will be diagnosed in 1999, and that 37,000 
     men will die from this disease this year.
       In a recent paper by Roberts et al (Journal of Urology 
     161:529, 1999), U.S. prostate cancer deaths per 100,000 men 
     from the years 1989 to 1992 were compared to the years 1993 
     to 1997. The authors found that prostate cancer deaths have 
     fallen significantly, and conclude that early detection may 
     have led to a decline in prostate cancer deaths.
       We would only point out a concern we have about the bill's 
     reliance on the United States Preventive Services Task Force 
     (USPSTF), which currently does not recommend prostate cancer 
     early detection. This varies from the AUA and ACS policy 
     positions (see attachment), and we believe this could send a 
     confusing message to patients. Moreover, Congress enacted 
     prostate cancer early detection coverage for Medicare 
     beneficiaries aged 50 and older in 1997. We believe reliance 
     on USPSTF could engender confusion about the value of 
     prostate cancer early detection.
       Again, thank you for introducing this important 
     legislation, and we look forward to working with you to 
     advance this effort. To coordinate any future efforts, please 
     contact Scott Reid, AUA Government Relations Manager.
           Sincerely,

                                          Lloyd H. Harrison, M.D.,
     President.
                                  ____



                                         Men's Health Network,

                                    Washington, DC, June 16, 1999.
     Hon. Bill Frist, M.D.,
     Chairman, Subcommittee on Public Health, Senate Committee on 
         Health, Education, Labor and Pensions, U.S. Senate, 
         Washington, DC.
       Dear Senator Frist: I am writing on behalf of the Men's 
     Health Network (MHN) in support of legislation which will 
     revise and extend the prostate cancer prevention health 
     program at the Centers for Disease Control. We thank you for 
     proposing this important legislation. As you know, educating 
     the public as to the prevalence and risks of prostate cancer 
     is of great importance in fighting this deadly disease.
       As the baby boom generation ages, the risk of prostate 
     cancer, if unchecked, will continue to increase. Prostate 
     cancer is the most commonly occurring cancer in America, 
     affecting about 200,000 men in 1999. Nearly 40,000 men will 
     lose their lives to the disease this year. A man has a one in 
     six chance of getting prostate cancer in his lifetime. If he 
     has a close relative with prostate cancer, his risk doubles. 
     With two close relatives, his risk increases five-fold. With 
     three close relatives, his risk is nearly 97%. Today, 
     African-American men have the highest prostate cancer 
     incidence rate in the world. The African-American mortality 
     rate from the disease is more than twice that of the rate for 
     Caucasian Americans.
       With the right investment in education and research, 
     prostate cancer is preventable, controllable and curable. 
     There is no better time than National Men's Health Week for 
     all of us to focus on prostate cancer and men's health. It is 
     vitally important to educate not only men but their families 
     as to the risk factors associated with this disease and the 
     need for annual screenings.
       Thank you for addressing this critical public health issue. 
     If there is anything we can do in the future to assist in the 
     passage of your bill, please do not hesitate to let us know.
           Sincerely,
                                                   Tracie Snitker,
                                             Government Relations.
                                 ______