Prostate Cancer

In a recent poll of the American people, cancer was cited as the disease that most Americans (53%) feared would end their lives. Even though heart disease is 50% more likely than cancer to cause an American to die, it is the concern of only 37% of Americans. Among the African-American community, 78% believe that cancer is a major problem, and 17% believe it is a minor problem. Of American women, 40% are very worried that they may develop breast cancer.

Often overshadowed by more common genitourinary cancers, such as prostate, testicular, and kidney cancers, penile and urethral cancers nonetheless represent difficult treatment challenges for the clinician. The management of these cancers is slowly evolving. In the past, surgery, often extensive, was the treatment of choice. Recently, however, radiation and chemotherapy have begun to play larger roles as initial therapies, with surgery being reserved for salvage. With these modalities in their treatment armamentarium, oncologists may now be able to spare patients some of the physical and psychological sequelae that often follow surgical intervention without compromising local control and survival. Part 1 of this two-part article, published in last month’s issue, dealt with cancer of the penis. This second part focuses on cancer of the urethra in both females and males. [ONCOLOGY 13(11):1511-1520, 1999]

Prostate cancer is the most commonly diagnosed cancer among American men. The majority of patients with advanced disease have metastatic bone lesions, which are frequently very painful. These lesions tend to respond well to treatment with both nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, although careful dose titration and individualized treatment plans may be needed to achieve maximal analgesia. Opioid side effects are often transient or well controlled with additional medication. Patients with intolerable side effects may experience fewer adverse reactions with a different opioid. Palliative radiation provides pain relief in up to 80% of prostate cancer patients with single or at most a few sites of localized bone pain. Bisphosphonates, powerful inhibitors of osteoclast-mediated bone resorption, are promising new agents for the treatment of painful bone lesions in prostate cancer patients. Radioisotopes, which deliver high-dose radiation to bone lesions without significantly affecting normal bone, are highly effective in providing some degree of pain relief in up to 80% of patients with diffuse, painful bone metastases. Also, chemotherapy shows promise in alleviating pain and possibly extending survival in patients with advanced prostate cancer.[ONCOLOGY 13(11):1537-1549, 1999]

WASHINGTON-The US Postal Service has issued a 33 cent postage stamp designed to encourage the early detection and treatment of prostate cancer. The stamp features a drawing of the male gender symbol against a red background. The words “Prostate Cancer Awareness-Annual Checkups and Tests” appear on the stamp, which was designed by Michael Cronan of San Francisco.

Large Study Confirms Radiation therapy not only destroys prostate cancer in patients with early disease but keeps it from returning, a very large study of patients from six medical centers has found.

PHILADELPHIA-Black men have reduced levels of insulin-like growth factor binding protein 3 (IGF-BP3), compared to white men, and this may be a factor in the higher prostate cancer rates seen in this population, researchers reported at the 90th annual meeting of the American Association for Cancer Research (AACR) in Philadelphia.

BUFFALO, NY-Prostate cancer screening protocols and treatment for localized prostate cancer are less standardized than for other cancers such as breast cancer, and treatment choices remain difficult for many men and their physicians, Jerome P. Richie, MD, said at the Surgical Oncology Symposium, hosted by Roswell Park Cancer Institute.

NEW YORK-Advances in nuclear medicine may meet the need for more accurate detection and higher-resolution imaging in breast and prostate cancer management, especially in the assessment of bone metastases, speakers said at a symposium on nuclear oncology co-sponsored by Memorial Sloan-Kettering Cancer Center and Johns Hopkins University.

In 1991, the United States Congress expressed a growing concern over the incidence of prostate cancer and the controversy over the optimal treatment of the various stages of the disease. Congress also supported the need for both basic

BETHESDA, Md-The National Institutes of Health has unveiled a 5-year plan that, if fully funded, will nearly quadruple its total budget for prostate cancer research, from the $113.6 million spent in fiscal year 1998 to $420.1 million in FY 2003. NIH anticipates spending $180.3 million on researching the disease this fiscal year, the first year of the 5-year program, an increase of 58.7% over FY 1998.

Radiation therapy not only destroys prostate cancer in patients with early disease but keeps it from returning, a very large study of patients from six medical centers has found.

BETHESDA, Md -The National Cancer Institute plans to spend $13.6 million over the next 4 years to fund industry/academic collaborations aimed at developing noninvasive imaging technologies for diagnosing and treating prostate cancer. The Institute hopes the new initiative will bring academic institutions and companies together to pursue image-guided therapy techniques. Image-guided therapy couples images obtained either before or during surgery with computers, sensors, and other devices to help guide more accurate treatments.

The NCI will face some of the difficulties related to insurance coverage that discourage clinical trial participants as the institute ratchets up its prostate cancer research program. NCI director Richard Klausner, MD, told Congress in June that the NCI

ROCKVILLE, Md-The Center for Prostate Disease Research (CPDR) has opened a new freestanding research center to consolidate its many initiatives and allow these programs to continue to develop and expand. The new site is the nation’s only facility dedicated solely to prostate disease research.

Doctors have suspected that radiation therapy helps prevent patients from dying of prostate cancer, but they had little scientific evidence to support that theory. Now, Richard Valicenti, MD, assistant professor of radiation oncology at Jefferson

NEW YORK-When cancer patients go to the Internet for information on their disease, they are often overwhelmed by the thousands of sources available. The new Prostate Cancer Treatment Guidelines for Patients, issued jointly by the American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN), “is an attempt to give patients a structure for processing information,” said Rodger Winn, MD, of M.D. Anderson Cancer Center and a key player in the NCCN guidelines development. The NCCN is an alliance of 17 of the nation’s leading cancer centers.

Docetaxel (Taxotere) combined with estramustine phosphate (Emcyt) and low-dose hydrocortisone appears to be a promising treatment for men with hormone-refractory prostate cancer, according to the results of a phase II trial conducted

PHILADELPHIA-Lycopene, the phytonutrient that produces the red color in tomatoes, showed beneficial effects on the prostate cancers of a group of men scheduled for prostatectomy, researchers reported at the American Association for Cancer Research annual meeting.

Discontinuing the practice of drawing blood every week from patients undergoing radiation therapy for prostate cancer can save time and money without jeopardizing the patient’s care, a new study has found.

ASCO-A leuprolide (Lupron) implant that provides continuous testosterone suppression for up to a year has been shown to be safe and effective in patients with advanced prostate cancer. The experimental implant spares patients the need for frequent injections of the LHRH (luteinizing hormone-releasing hormone) agonist.

ASCO-Docetaxel (Taxotere) plus estramustine phosphate (Emcyt) and low-dose hydrocortisone proved effective and well tolerated in a phase II study of men with hormone-refractory prostate cancer. The study was conducted by the Cancer and Leukemia Group B (CALGB) and presented at the ASCO annual meeting.

DALLAS-The American Urological Association is one of the premier specialist medical associations and has done a great deal to advance patient care in this field. I know the AUA works closely with AFUD, the American Foundation for Urological Diseases, and I have a great appreciation for the work you do. Although I’m not a doctor or a scientist, I’m working with you to accomplish some of the same objectives.

NEW YORK--The National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) have collaborated to translate the NCCN prostate cancer guidelines into a patient-friendly resource for appropriate treatment, the two organizations announced at a press briefing.

A prospective, randomized clinical trial was conducted to evaluate the efficacy of endocrine chemotherapy with uracil and tegafur (in a molar ratio of 4:1 [UFT]) in patients with prostate cancer. The study included two

Dr. Moul has done a wonderful job of outlining the scope and magnitude of the “phenomenon” of patients found to have a progressively rising prostate-specific antigen (PSA) level after potentially curative local treatment for prostate cancer. His