A War of Strategy
COMBATING PROSTATE CANCER
Today's Tomorrows, Volume 10, Issue 2 - Summer 2002
H. Lee Moffitt Cancer Center and Research Institute Community Newsletter
|By Janet Zink|
M.D. and Bob Samuels have a lot in common when it comes to fighting
prostate cancer. They both take an all-out, hands-down, full-court
press approach to battling a disease that will claim the lives of more
than 30,000 men in 2002.
For Samuels, it's a war of words. The retired banker and two-time cancer survivor spends his days moving mountains of information to the people who need it most men over age 50 who haven't been paying attention to their risk for prostate cancer. (See related story)
For Pow-Sang, it's a war of strategy. The 47-year-old leader of the Genitourinary Oncology Program at Moffitt Cancer Center figures the best offense is to develop as many relevant offensive strategies as possible, thereby creating obstacles at every stage of the disease. It's a game plan that includes:
"We deal with the full spectrum of genitourinary (GU) cancers from prevention to the management of advanced disease, and the research component puts our physicians on the front line in the fight against these diseases," says Pow-Sang. "This means we can offer all the treatment options available and give patients as much information as possible so they can make an informed decision."
Likewise, the GU team is made up of interdisciplinary members who represent a wide range of specialties necessary to treating genitourinary diseases, which include prostate, bladder, kidney, testicular and penile cancers. Specialties include urology, medical oncology, radiation oncology, radiology, nursing, nutrition, pharmacy, clinical research and psychosocial oncology.
High Incidence in Florida
Prostate, bladder, kidney and penile cancers can occur at any age but are far more common in older people. Because Florida has many senior citizens, the incidence of certain urologic cancers is higher than in other areas of the United States. In fact, prostate cancer is the number one diagnosed non-skin cancer in Florida, and the state is number two in prostate cancer incidence and death. California has the highest incidence.
The trend today toward early detection is leading to improved survival rates for prostate cancer. "Once prostate cancer becomes symptomatic, it's terminal. That's why it's important to screen for it," says urologist John Seigne, M.B., B.Ch., who directs the Diagnostic Prostate Clinic at Moffitt's Lifetime Cancer Screening & Diagnostic Center. The clinic's sole purpose is to evaluate men who have had abnormal results from a prostate specific antigen (PSA) blood test or digital rectal examination (DRE).
Seigne recommends that men get screened for prostate cancer starting at age 50. Screenings consist of a DRE and a PSA blood test. When either is abnormal, an evaluation by a urologist should be the next step. Men who are at risk of developing prostate cancer, such as those with a family history of the disease and African-Americans, should start their screenings at age 45.
"African-Americans have the highest incidence of prostate cancer in the nation and the highest death rate from the disease," Seigne says. He attributes the high incidence to a combination of genetics and diet.
Treatment Options Vary
There are five treatment options for prostate cancer, all of which are available at Moffitt under one roof: surgery, radiation, seed implants, external beam radiation, cryosurgery and observation. Pow-Sang says the availability of these state-of-the-art resources and the patient's involvement in his treatment choices, make the program unique to the region.
Because prostate cancer progresses slowly, the stage of the cancer and the age of the patient help determine the best course of treatment, Pow-Sang says. Treatment can sometimes cause incontinence and impotence. However, many older men choose to do nothing, as it's not unusual to live symptom-free with the disease for 20 years.
Surgery involves removal of the prostate via a minimal incision that decreases recovery time and approximates the outcome of laparoscopy, which is a longer and more complicated surgery. External beam radiation therapy is delivered on state-of-the-art equipment by radiation oncologists who are specially trained in prostate cancer. Seed implants (brachytherapy), which are gaining in popularity because of their simplicity, involve placing radioactive pellets directly into the prostate to eliminate the cancer. The process has comparable outcomes to surgery or radiation therapy 10 years after treatment. Cryosurgery, which has undergone improvements in technology, freezes the cancerous tumors with argon gas, producing good outcomes when compared to radiation therapy at five years after treatment. And for metastatic prostate cancer, investigators are evaluating chemotherapy for hormone-refractory prostate cancer.
Research Focusing on New Treatments
"Research is the best hope for making new inroads in the treatment, early detection and prevention of prostate cancer," says Pow-Sang. An emphasis on "traditional" research at Moffitt Cancer Center takes discoveries made in the laboratory and fast-tracks their translation into improved patient care in the clinic.
Scientific investigators at Moffitt who are exploring answers to prostate cancer include:
Moffitt also is one of 400 sites in the U.S., Puerto Rico and Canada working in conjunction with the NCI to recruit participants for the Selenium and Vitamin E Cancer Prevention Trial (SELECT). The study will examine the direct relationship between prostate cancer and certain dietary supplements. More than 32,000 men will be enrolled in the study, which will take up to 12 years to complete. The goal for enrollment at Moffitt is 150 men over a five-year period.
"The research our team members are conducting on GU cancers brings the scope of our program full circle," Pow-Sang says. "The work we do gives patients access to the most current information on the best methods for prevention and treatment."
Prostate Cancer Signs And Symptoms
Most of these symptoms are nonspecific and are similar to those caused by benign conditions
Source: American Cancer Society, Cancer Facts & Figures 2002