New treatments lift rates for all patients to nearly 97 percent,
experts say
By Holly VanScoy

HealthDay Reporter

SUNDAY, Sept. 5 (HealthDay News) --
Scientists are chalking up continued gains in the fight against prostate
cancer.
According to the U.S. National Institutes of Health, advances in
diagnosing and treating the disease are tied to a dramatically improved
overall prognosis for prostate cancer patients. Survival rates for
patients at all stages of the disease are now nearing 97 percent.
That's encouraging news worth sharing during September, Prostate Cancer
Awareness Month.

   
   
The National Cancer Institute (NCI) lists prostate cancer as the second
most common cancer in men, after skin cancer. Some 230,110 American men
will be diagnosed with the disease this year, and about 30,000 will die
from it, most from diagnoses in previous years.
But because the disease progresses slowly over the years, experts
predict that men are much more likely to die with prostate cancer than
from it. Recent autopsy studies show many men over age 50 have early,
undiagnosed prostate cancer, and most early cancers remain harmless,
taking years for them to become life-threatening.
A healthy prostate gland is quite small, about the size and shape of a
chestnut. It is located in front of the rectum, just below the bladder,
and wraps around the urethra, the tube that carries urine from the
bladder through the tip of the penis.
One of the newest findings about prostate cancer is that men with low
prostate specific antigen (PSA) levels on screening tests may still have
the disease. In an NCI-funded study published in May 2004, researchers
detected prostate cancers by biopsy in men with normal PSA levels.
Dr. Ian Thompson, head of the Department of Urology at the University of
Texas Health Science Center at San Antonio, led the NCI-research team.
He said the study was the first to systematically evaluate men with PSA
levels from 0 to 4 nanograms per milliliter (ng/ml). A PSA level below
4.0 ng/ml is considered to be a normal reading. Physicians usually
recommend that men with a reading above 4.0 ng/ml have a prostate biopsy
to check for cancer or other conditions.
"The main study finding was that 15 percent of the men in the PCPT
control group had a positive end-of study biopsy even though they had
PSA levels below 4 ng/ml and normal DREs throughout the study," said
Thompson. "Our research shows that cancer of the prostate can be present
in men with 'normal' PSAs."
Since the late 1980s, PSA tests have been widely used in the United
States in an attempt to detect prostate cancer at an early stage.
However, PSA testing carries a risk of "over-diagnosing" the disease,
which could lead to unnecessary surgery or radiation therapy. For this
reason, PSA screening still isn't a universally recommended screening
procedure.
Dr. Leslie Ford, associate director for clinical research in the NCI's
Division of Cancer Prevention, also participated in the research. "The
good news from our study is that the vast majority of the cancers found
in men with PSA levels below 4.0 ng/ml were low- and intermediate-grade
malignancies, which often are not clinically significant."
"We need better methods to distinguish the harmless, slow-growing
cancers from the more aggressive ones," Ford said. "If more biopsies are
performed at lower PSA levels, more cancers will be found and treated.
But some men would undergo treatment, and the risks associated with it,
for tumors that would never have been clinically significant."
Treatment for prostate cancer can sometimes lead to impotence, urinary
incontinence, and other problems, causing a substantial health burden
for men.
"Lowering the PSA threshold for proceeding to prostate biopsy would
increase the risks of overdiagnosing and overtreating clinically
unimportant disease," explained Thompson.
The NCI-funded researchers are now looking for ways to determine which
men with low PSA levels harbor aggressive tumors. Some are using the new
tools of genomics and proteomics to look at how gene expression patterns
and proteins in the blood may differ in men with aggressive tumors vs.
those with slow-growing ones.
"There is a great need for methods, beyond tumor grade, to better
predict which men have prostate cancers requiring treatment," said
Thompson.
Another important advance in prostate cancer has come from doctors'
willingness to use a range of more powerful interventions more often,
including radiation, CT-treatment and androgen deprivation therapy.
According to research published in the July 15, 2004, issue of the
International Journal of Radiation Oncology Biology Physics, radiation
oncologists are now using higher doses of external beam radiation
therapy to treat both earlier stages and more aggressive forms of
prostate cancer. In 1999, 45 percent of prostate cancer patients were
treated with higher doses of radiation therapy, compared to 3 percent in
both 1989 and 1994.
The 1999 Patterns of Care Survey concluded that the results of clinical
trials have persuaded many radiation oncologists to add androgen
deprivation therapy to radiation therapy when treating more aggressive
or well-established prostate cancers. The research also showed a
significant increase in the use of CT-based treatment planning and
radiation therapy for treatment delivery.
"This is an important study because it looks at changing trends over
many years in the use of radiation therapy for curing prostate cancer in
the United States," said Dr. Michael J. Zelefsky, lead author of the
study and a radiation oncologist at Memorial Sloan-Kettering Cancer
Center in New York City.
"After careful analysis, we have learned that, in general, more
radiation oncologists are applying the results of clinical trials, which
have taught us to use higher dose levels of radiation and integrate
hormone therapy in conjunction with radiation therapy to achieve more
successful outcomes for prostate cancer patients. In short, the trends
are demonstrating more precise delivery of high dose treatment," he
said.
More information
The National Institutes of Health's Senior Health site has more
information about prostate cancer (nihseniorhealth.gov ).
   
SOURCES: Ian Thompson, M.D., professor and chief, Department of Surgery,
Division of Urology, University of Texas Health Science Center at San
Antonio; Leslie Ford, M.D., associate director for clinical research,
National Cancer Institute, National Institutes of Health, Division of
Cancer Prevention, Washington, D.C.; Michael J. Zelefsky, M.D.,
radiation oncologist, Memorial Sloan-Kettering Cancer Center, New York
City; National Cancer Institute, National Institutes of Health,
Washington, D.C.;

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."