Report Urges More Prostate Cancer Research

Seeks better treatment, coordination among specialists

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HealthDay Reporter

WEDNESDAY, Sept. 22, 2004 (HealthDayNews) -- A new report calls for the urgent need to improve treatments and find a cure for prostate cancer, a disease that strikes one in six American men.

The report from the Prostate Cancer Foundation was written by 24 leading researchers into the disease and is a comprehensive review of the state of the art in prostate cancer prevention, diagnosis, treatment, and research.

"There is lots of information available about prostate cancer," said foundation senior vice president Gregg Britt. However, he added, it is difficult for laypeople and physicians to make sense of all the new data.

The goal of the report is also to set out what needs to be accomplished in treatment and research, Britt said.

"The report is a wonderful compilation of some of the most up-to-date research in prostate cancer," said Dr. Durado Brooks, director of prostate cancer at the American Cancer Society. "It also raises some very important issues in terms of where we need to be heading in diagnosis and long-term care for men with prostate cancer."

The highlights of the report include the need for specialists to coordinate care. "Outside of academic centers, that is not the norm," said Dr. Anthony V. D'Amico, a professor of radiation oncology at Brigham and Women's Hospital in Boston.

In addition, because of the recent debate on the effectiveness of prostate specific antigen (PSA) as a marker for the cancer, the report calls for new and better diagnostic methods to maximize early detection of the disease.

"We know that with PSA screening, cancers are detected early. Whether that prolongs survival is not known," D'Amico said. The value of PSA testing may be in how it changes from year to year, he added. A rapid, larger change in PSA over a year may be more significant than any single PSA level, D'Amico said.

"There is no argument that we need something that is more specific than PSA, that gives us a greater level of the prognosis of the disease," Brooks said.

The goal of the foundation's report is to find a better way of detecting cancer early while avoiding unnecessary biopsies and treating cancers that do not require therapy, the report said. Also needed are better ways of determining which cancers are fast-growing and aggressive and need aggressive treatments, as opposed to slower-growing cancers that may not affect patients during their life.

The foundation also calls for better treatment for prostate cancer patients and better data about survival rates associated with various therapies and common side effects.

Specifically, the report recommends further research on androgen-deprivation therapy, which is an accepted treatment for advanced prostate cancer. But when it should be started is still unsettled, as is its use with other therapies.

In addition, the report says that developing treatments for high-grade prostatic intraepithelial neoplasia, which is believed to be a premalignant precursor for prostate cancer, may be an approach that will prevent or delay cancer.

Moreover, for patients whose cancer has spread to the bones, zoledronic acid has been shown to reduce bone complications. But, according to the report, new practice guidelines are needed in its use.

The foundation is calling on the U.S. Food and Drug Administration to approve drugs more quickly. And it seeks more clinical trials with increased patient enrollment. "Unfortunately, only a minuscule portion of men who have advanced stage disease are ever offered the possibility of enrolling in a clinical trial," Brooks said.

D'Amico said the FDA is considering using changes in patients' PSA levels in deciding whether a new drug is beneficial to those with aggressive prostate cancer, and making the drug available early to these patients.

Brooks said there has been an improvement in the past decades in the survival of prostate cancer. "This can be attributed to improvements in therapy," he said.

"This has come about because of a wealth of information that has connected changes in PSA with outcome, particularly in poor-risk patients who have a very bad PSA profile after surgery or radiation," D'Amico said.

"We are finally getting to the point where we have effective systemic agents for prostate cancer," D'Amico said. "This message is hopeful, because in the not-too-distant future we will have answers to what the best treatment is for men with prostate cancer."

More information

Learn more about the disease from the Prostate Cancer Foundation.

SOURCES: Gregg Britt, senior vice president, Prostate Cancer Foundation, Santa Monica, Calif.; Durado Brooks, M.D., director of prostate cancer, American Cancer Society, Atlanta; Anthony V. D'Amico, M.D., Ph.D., professor of radiation oncology, Brigham and Women's Hospital, Boston; Sept. 22, 2004, Prostate Cancer Foundation, Report to the Nation on Prostate Cancer 2004

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