Winning Battles in the Prostate Cancer War

Early detection is key to combating the disease

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HealthDay Reporter

TUESDAY, Sept. 21, 2004 (HealthDayNews) -- Prostate cancer is the second most common type of cancer afflicting American men.

And while one in six men will get the disease during his lifetime, only one in 32 will die from it. The death rate for prostate cancer is declining, cancer experts note, due to developments that range from a new chemotherapy drug to improved means of early detection.

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

That's a message doctors are looking to share in September -- Prostate Cancer Awareness Month.

"Prostate cancer is a very treatable disease if it's caught early," said 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 fluids.

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 American men, trailing only skin cancer.

Despite the medical advances, death from prostate cancer continues to generate headlines. Last week, Johnny Ramone, the guitarist of the seminal punk rock band the Ramones, died at his Los Angeles home from the disease. He was 55.

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, doctors say.

During the past 20 years, the survival rate for prostate cancer has risen 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 PSA test looks for prostate specific antigen (PSA), a protein produced by the cells of the prostate. When the prostate gland enlarges, it produces more of the antigen, giving doctors an unmistakable sign that something might be amiss.

"That's the beauty of PSA testing," Soule said.

Under previous guidelines, doctors 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, said Jamie Bearse, a spokesman for the prostate coalition.

"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 said.

The finding was reported in the July 8 issue of the New England Journal of Medicine.

So when should men be tested for prostate cancer?

The American Cancer Society recommends that health-care professionals should offer the PSA blood test and a digital rectal examination yearly, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk, such as blacks in general and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65), should begin testing at age 45.

Men at even higher risk -- because they have several first-degree relatives who had prostate cancer at an early age -- could begin testing at age 40. Depending on the results of this initial test, further testing might not be needed until age 45, according to the cancer society.

The PSA test, however, is not without its doubters. A study released this month by Stanford University researchers questioned the value of such testing.

Two decades ago, there was a strong correlation between a high PSA level and prostate cancer because the test was usually done only when a physician suspected cancer, the researchers said. Today, the test is usually done as a matter of routine. Since PSA production is related to the size of the prostate, a high level usually is related to benign prostatic hyperplasia, the harmless increase in prostate size that occurs with aging, the researchers said.

Another small but promising milestone in prostate cancer treatment was reached in May, when the U.S. Food and Drug Administration approved the use of the chemotherapy drug Taxotere, Soule said.

Clinical trials involving more than 1,000 men with advanced prostate cancer who hadn't responded to traditional hormonal therapy found that Taxotere, combined with the steroidal drug 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 said.

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

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

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

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. Doctors don't yet know why this is so.

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

More information

To learn more about prostate cancer, visit the National Cancer Institute.

SOURCES: Howard Soule, executive vice president and chief science officer, Prostate Cancer Foundation, Santa Monica, Calif.; Jamie Bearse, spokesman, National Prostate Cancer Coalition, Washington, D.C.

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