Advances Made In Prostate Cancer Detection And Therapy

September Is Prostate Cancer
Awareness Month

From a new chemotherapy drug to improved means of early detection, prostate cancer breakthroughs in the last year have enhanced a man's chances of surviving the disease.

These advances are expected to help make one of the most survivable forms of cancer even less threatening, health experts predict.

That is a message physicians are looking to share in September, which is Prostate Cancer Awareness Month.

"Prostate cancer is a very treatable disease if it's caught early," says Howard Soule, executive vice president and chief science officer of the Prostate Cancer Foundation.

A walnut-sized gland located just below a man's bladder, the prostate's function is to produce seminal fluid (the fluid that carries sperm).

More than 230,000 new cases of prostate cancer are diagnosed each year, according to the National Prostate Cancer Coalition, making it the second most commonly diagnosed cancer among US men.

The best way to ensure survival is to detect prostate cancer early. Although some 29,900 men are expected to die of the disease this year, most cases are treatable with early detection, experts say.

Increasing Survival with New Approaches

During the past 20 years, the survival rate for prostate cancer has shot up from 67 percent to 97 percent, due to improvements in early detection.

And within the past year, research has found that one of the best tests for prostate cancer can do an even better job.

The prostate specific antigen (PSA) test looks for a protein produced by the cells of the prostate. When the prostate gland enlarges, it produces more of the antigen, giving physicians an unmistakable sign that something might be amiss.

Under previous guidelines, physicians would conduct a biopsy of the prostate if a man's PSA score went above 4.0.
But new research has found the rate of increase in a patient's PSA level is more important than the total score, says Jamie Bearse, a spokesman for the National Prostate Cancer Coalition.

The finding was reported recently in the New England Journal of Medicine.

"A high velocity in the increase in PSA scores should sound the alarms and set off little red lights," even if the total score is lower than 4.0, Bearse says.

Based on this new information, both the American Urological Society and the American Cancer Society have dropped the recommended age for men to begin annual prostate screenings, from 50 to 40.

That way, physicians will be better able to observe year-by-year changes as men age and are more susceptible to prostate cancer.

Another small but promising milestone in prostate cancer treatment was reached in May, when the US Food and Drug Administration (FDA) approved the use of the chemotherapy medication Taxotere, Soule says.

Clinical trials involving more than 1,000 men with advanced prostate cancer that did not respond to traditional hormonal therapy found that Taxotere, combined with the steroidal medication prednisone, extended survival times an average of 2.5 months, compared to men on a traditional regimen.

Taxotere works by inhibiting tubulin, a protein that encourages cancer cells to divide and reproduce. Side effects may include nausea, hair loss, fluid retention, and tingling sensations in the extremities, according to the FDA.

The promising news is that Taxotere is the first chemotherapy drug found that can tackle prostate cancer in its late stages.

"Nothing else in that clinical setting had been shown to promote survival," Soule says.

Taxotere also shows potential when combined with dozens of medications that can provide targeted therapy for the cancer and its effects, he says.

"Now investigators can add targeted therapies on top of Taxotere, in the hope of prolonging survival even longer," Soule says.

In a report at this year's meeting of the American Society of Clinical Oncology, a large European study found that men who were in a high-risk group for relapse benefitted from radiation therapy following surgery. "Post-operative radiotherapy results in improved biochemical and progression-free survival," the authors write.

These findings were confirmed by a study presented last month by Italian researchers in a publication of the American Society for Therapeutic Radiology and Oncology. The results showed that men with prostate cancer who receive radiation therapy after surgery typically live longer than men who do not receive early radiation treatment.

Link With Obesity Studied

Another new advance involved research by the American Cancer Society that revealed a link between obesity and prostate cancer, Bearse says.

Scientists found that if a man has a body-mass index of 30 or more - the clinical definition of obesity - he is one-third more likely to develop prostate cancer. Physicians do not yet know why this is so.

"One of the possibilities is that when you have bad cholesterol (a byproduct of obesity), your body also makes bad testosterone," Bearse says. "When you have bad testosterone metabolizing in the prostate, you have a greater risk of cancer."

Studies such as these are critical to success in the fight against prostate - or any type - of cancer, Soule says. He advises any man suffering from prostate cancer to sign up for a clinical trial that tests new therapies.

"We will not advance this field without men participating in the clinical evaluation of new drugs," he says.

Always consult your physician for more information.

Online Resources

American Cancer Society

American Prostate Society

American Urological Society

Centers for Disease Control and Prevention (CDC)

Healthfinder, US Department of Health and Human Services (HHS)

National Cancer Institute Prostate Cancer Information

National Institutes of Health (NIH)

National Library of Medicine

National Prostate Cancer Coalition

September 2004

Advances Made In Prostate Cancer Detection And Therapy

Increasing Survival with New Approaches

Link With Obesity Studied

Prostate Cancer Detection

Online Resources

Other Resources:

Find a St. John's Mercy Physician

Sports & Therapy Services at St. John's Mercy

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Prostate Cancer Detection

The National Cancer Institute (NCI) states that prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, they may include:

• Frequent urination, especially at night
  
  
• Inability to urinate
  
  
• Trouble starting or holding back urination
  
  
• A weak or interrupted flow of urine
  
  
• Painful or burning urination
  
  
• Blood in the urine or semen
  
  
• Painful ejaculation
  
  
• Frequent pain in the lower back, hips, or upper thighs

These can be symptoms of cancer, but more often they are symptoms of non-cancerous conditions. It is important to check with a physician.

As a man gets older, his prostate may grow bigger and block the flow of urine or interfere with sexual function. This common condition, called benign prostatic hyperplasia (BPH), is not cancer, but can cause many of the same symptoms as prostate cancer.

Although BPH may not be a threat to life, it may require treatment with medicine or surgery to relieve symptoms. An infection or inflammation of the prostate, called prostatitis, may also cause many of the same symptoms as prostate cancer.

Two tests can be used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam (DRE), in which a physician feels the prostate through the rectum to find hard or lumpy areas.

The other is a blood test used to detect a substance made by the prostate called prostate specific antigen (PSA). Together, these tests can detect many “silent” prostate cancers, those that have not caused symptoms.

At present, however, it is not known whether routine screening saves lives. The benefits of screening and local therapy (surgery or radiation) remain unclear for many patients.

Because of this uncertainty, the NCI is currently supporting research to learn more about screening men for prostate cancer. Currently, researchers are conducting a large study to determine whether screening men using a blood test for PSA and a DRE can help reduce the death rate from this disease.

They are also assessing the risks of screening. Full results from this study, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial or PLCO, are expected by 2015.

Neither of the screening tests for prostate cancer is perfect, the NCI states. Most men with mildly elevated PSA levels do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. Also, the DRE can miss many prostate cancers. The DRE and PSA test together are better than either test alone in detecting prostate cancer.

The diagnosis of prostate cancer can be confirmed only by a biopsy, the NCI states. During a biopsy, a urologist removes tissue samples, usually with a needle.

This is generally done in the physician's office with local anesthesia. Then the sample is sent to the lab in order to check for cancer cells.

Prostate cancer is described by both grade and stage.

Grade describes how closely the tumor resembles normal prostate tissue. Based on the microscopic appearance of tumor tissue, pathologists may describe it as low-, medium-, or high-grade cancer. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10.

Another system uses G1 through G4. In both systems, the higher the score, the higher the grade of the tumor. High-grade tumors generally grow more quickly and are more likely to spread than low-grade tumors.

Stage refers to the extent of the cancer. Early prostate cancer, stages I and II, is localized. It has not spread outside the gland. Stage III prostate cancer, often called locally advanced disease, extends outside the gland to the seminal vesicles. Stage IV means the cancer has spread to lymph nodes and/or to other tissues or organs.

Always consult your physician for more information.