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| # Department of                                                       |
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| # Veterans Affairs                                                    |
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### Agent Orange Brief

**Prepared by the Environmental Agents Service (131)**

D10 VA Central Office, Washington, DC 20420 August 2005

###### 

#### AGENT ORANGE AND PROSTATE CANCER

> **Why are Vietnam veterans worried about prostate cancer?**
>
> Prostate cancer is one of the most common cancers among men. The rate
> varies dramatically by age and race. The risk of getting prostate
> cancer increases fivefold between the ages of 45-49 and 50-54 years,
> and nearly triples between 50-54 and 55-59. African-American men have
> the highest recorded incidence of prostate cancer in the world. Their
> risk is approximately double that of white men. The causes of prostate
> cancer are uncertain. Risk factors other than race and age include a
> family history of the disease and a diet high in fats. Prostate cancer
> is expected to account for about 29 percent of new diagnoses and 13
> percent of cancer death per year in the United States.
>
> Some Vietnam veterans have already reached, while many are
> approaching, the age when prostate cancer is typically detected. Since
> prostate cancer is a slow-growing tumor, many men diagnosed with
> prostate cancer will actually die from other unrelated causes.
> Nevertheless, prostate cancer is the second leading cause of death in
> men. It is estimate that more than 200,000 cases of prostate cancer
> (including about 10,000 veterans) will be diagnosed annually with an
> approximately 40,000 death. A problem with prostate cancer is that in
> about 40 percent of the cases the tumors have spread beyond the
> prostate before it is diagnosed, making treatment more difficult.
>
> **How is prostate cancer detected?**
>
> There are currently three methods of screening: (1) digital rectal
> examination, (2) transrectal ultrasound, and (3) prostate specific
> antigen (PSA, a blood test to measure a protein found only in prostate
> tissue). Unfortunately, there are significant problems with each of
> these screening techniques. For each cancer detected, there are many
> false positives that may incorrectly diagnose a patient as having
> prostate cancer.
>
> **What treatments are available?**
>
> Since prostate cancer is a relatively slow-growing tumor compared to
> other cancers, the paradox in managing it is the need to intervene
> early to stop the disease and also being cautious about using the
> major treatment, a surgery known as radical prostatectomy. This is a
> serious procedure with significant complications. From 25 to 75
> percent of patients will be impotent and 2 to 6 percent severely
> incontinent after the surgery.
>
> In addition to surgery, current treatments for prostate cancer include
> radiation therapy, which also has some unpleasant side effects, and
> male hormone (androgen) deprivation. Chemical or surgical deprivation
> or administration of estrogen is effective in relieving pain, reducing
> urinary obstruction, and improving general well-being. Endocrine
> therapy delays disease progression, but has not been shown to prolong
> survival.
>
> A relatively new approach to treatment is known as "expectant
> management," which means following the patient and giving hormonal or
> surgical treatment as necessary. This approach is reasonable because
> the progression of the tumor for each patient is uncertain, the
> treatment effectiveness is uncertain, and many patients with prostate
> cancer eventually die of other causes.
>
> **What did the National Academy of Sciences (NAS) conclude about the
> relationship between exposure to herbicides and the development of
> prostate cancer in its 1993 report, entitled [Veterans and Agent
> Orange - Health Effects of Herbicides Used in Vietnam]{.underline}**?
>
> The NAS reviewers observed that most of the agricultural studies they
> examined indicate "some elevated risk" of prostate cancer.
> Furthermore, one large well-done study in farmers showed an increased
> risk, and subanalyses in this study indicate that the increased risk
> specifically associated with herbicide exposure. The three major
> production worker studies reviewed by the NAS all show a small, but
> *not* statistically significant, elevation in risk. The NAS report
> noted that most of the associations seen in the studies reviewed are
> "relatively weak." The NAS added that Vietnam veterans have "not yet
> reached the age when this cancer tends to appear." In the report
> released in July 1993, the NAS concluded that there is
> "limited/suggestive evidence" of an association between exposure to
> herbicides used in Vietnam and prostate cancer.
>
> **What action did VA take in response to this NAS finding?**
>
> In its July 1993 report, the NAS placed three health outcomes in its
> second highest category of association (limited/suggestive evidence of
> an association): multiple myeloma, respiratory cancers, and prostate
> cancer. After careful review, VA's Secretary Brown concluded that the
> credible scientific evidence for an association is equal to or
> outweighs the evidence against an association between exposure to
> herbicides used in Vietnam and the development of multiple myeloma and
> of respiratory cancers. On the other hand, the evidence for an
> association between these herbicides and prostate cancers failed to
> reach that standard.
>
> In January 1994, VA published a notice in the
> [Federal Register]{.underline} that Secretary Brown has determined
> that a presumption of service connection based on exposure to
> herbicides used in Vietnam is not warranted for a long list of
> conditions identified in the NAS report. Prostate cancer was included
> in this list. (See 59 [Fed. Reg.]{.underline} 341, January 4, 1994).
>
> VA asked the NAS, in its follow-up report, to further consider the
> relationship between exposure to herbicides and the subsequent
> development of prostate cancer.
>
> **What did the 1996 NAS update conclude about prostate cancer?**
>
> Citing additional studies, the NAS report concluded that there is
> "limited/suggestive evidence" of an association between exposure to
> herbicides used in Vietnam and prostate cancer.
>
> **What was VA's response to the NAS 1996 finding regarding prostate
> cancer?**
>
> Secretary Brown found that the credible evidence for an association
> equals or outweighs the evidence against an association between
> exposures to herbicides used in Vietnam and prostate cancer. He
> concluded that prostate cancer should be added to the list of
> conditions recognized for presumption of service connection for
> Vietnam veterans based on exposure to herbicides. President Clinton
> announced this, along with other decisions, on May 28, 1996. The
> proposed rule to implement this decision was published for public
> comment in the [Federal Register]{.underline} in August 1996. (See 61
> [Fed. Reg.]{.underline} 41368, August 8, 1996). The final rule was
> published in the [Federal Register]{.underline} in November 1996. (See
> 61 [Fed. Reg.]{.underline} 57587, November 7, 1996).
>
> **What did the subsequent NAS updates conclude about prostate
> cancer?**
>
> The 1998 report concludes that there is limited/suggestive evidence of
> an association between exposure to the herbicides used in Vietnam and
> prostate cancer. The report includes the following statement:
>
> > Although the associations are not large, a number of studies provide
> > evidence that is suggestive of a slight increase in either morbidity
> > or mortality from prostate cancer. The evidence regarding
> > association is drawn from occupational studies in which subjects
> > were exposed to a variety of herbicides and herbicide components and
> > is also based on data from studies of Vietnam veterans. An important
> > consideration is the fact that prostate cancer tends not to be
> > fatal; thus, mortality studies have lower statistical power to
> > detect a comparable effect than a similar-sized morbidity study
> > would have.
>
> In the 2000 update, the NAS concluded that there is limited/suggestive
> evidence between exposure to herbicides and prostate cancer. Although
> the associations are not large enough, there are a number of studies
> providing evidence suggestive of a small increase in either morbidity
> or mortality from prostate cancer.

## 

> The 2002 and 2004 updates also concluded there is limited/suggestive
> evidence of prostate cancer being linked to exposure to herbicides.
> The associations are not large but there are studies providing
> evidence that suggest a small increase in either morbidity or
> mortality from prostate cancer.

## 

## Where can a veteran get additional information about prostate cancer?

> Information regarding prostate cancer and related matters can be
> obtained at VA medical center libraries, from the Environmental Health
> Clinicians at every VA medical center, or from the Environmental
> Agents Service (131), Department of Veterans Affairs, 810 Vermont
> Avenue, N.W., Washington, DC 20420.
>
> The October 2001 and March 2002 issues of the VA's Agent Orange Review
> newsletter reprint in two parts an excellent brochure provided by the
> American Urological Association (AUA). The Web address for the AUA is
> [www.auanet.org](http://www.auanet.org/). The Agent Orange Review can
> be seen at the Web site listed below.
>
> **Where can a veteran get additional information regarding Agent
> Orange -- related issues**?
>
> The following Agent Orange Brief fact sheets (including the one you
> are reading) are available on the World Wide Web at
> [www.va.gov/AgentOrange](http://www.va.gov/AgentOrange): **A1**.Agent
> Orange - General Information; **A2**.Agent Orange Class Action
> Lawsuit; **B1**.Agent Orange Registry Program; **B2**.Agent Orange --
> Health Care Eligibility; **B3**.Agent Orange and VA Disability
> Compensation; **B4**.VA Information Resources on Agent Orange and
> Related Matters; **C1**.Agent Orange -- The Problem Encountered in
> Research; **C2**.Agent Orange and Vietnam Related Research -- VA
> Projects; **C3**.Agent Orange and Vietnam Related Research -- Non-VA
> Projects; **D1**.Agent Orange and Birth Defects; **D2**.Agent Orange
> and Chloracne; **D3**.Agent Orange and Non-Hodgkin's Lymphoma;
> **D4**.Agent Orange and Soft Tissue Sarcomas; **D5**.Agent Orange and
> Peripheral Neuropathy; **D6**.Agent Orange and Hodgkin's Disease;
> **D7**.Agent Orange and Porphyria Cutanea Tarda; **D8**.Agent Orange
> and Multiple Myeloma; **D9**.Agent Orange and Respiratory Cancers;
> **D10**.Agent Orange and Prostate Cancer; **D11**.Agent Orange and
> Spina Bifida; **D12.**Agent Orange and Diabetes; and **D13**.Agent
> Orange and Chronic Lymphocytic Leukemia. Hard copies can be obtained
> from local VA medical centers or from the VA Central Office at the
> Environmental Agents Service (131) Department of Veterans Affairs, 810
> Vermont Avenue, N.W., Washington, DC 20420.
>
> **\
> **At the same Web site you will find copies of past and current issues
> of the "Agent Orange Review" newsletter and other items of interest.
>
> This fact sheet was updated in August 2005 and does not include any
> subsequent developments.