New Clues in Prostate Cancer Therapy

July 27, 2005

(USA TODAY) -- Two new studies could help men and their doctors better
treat prostate cancer.
Doctors have struggled for years over how aggressively to treat prostate
cancer, a disease more common than it is fatal, says Stephen Freedland,
an author of one of the articles and a clinical instructor at Johns
Hopkins School of Medicine in Baltimore. A man has a 17% lifetime risk
of being diagnosed with prostate cancer, for example, but a 3% risk of
dying from it.
Yet about one in three prostate cancer patients who have surgery
eventually show signs of a relapse, according to a study published today
in the Journal of the American Medical Association.
Doctors have few reliable ways, however, to determine which of these
relapses -- detected by PSA tests -- will be deadly and which will prove
relatively harmless.
The article suggests that doctors might be able to combine three
measurements to select those who need strong therapy.
Time to recurrence: the time it takes after surgery to detect levels of
PSA, or prostate-specific antigen, in the blood.
This protein, which is made by the prostate, should be undetectable
after surgery if a patient is cancer-free.
The presence of PSA in the blood after surgery indicates that some tumor
cells remain hidden in the body.
PSA doubling time: the time it takes for the PSA level to double after
surgery. This measures how quickly the cancer is growing.
The Gleason score: a measure of aggressiveness assigned after examining
prostate cancer cells under a microscope. Scores above 8 are considered
the most dangerous.
In the study, men whose PSA doubled in less than three months survived
an average of six years. Among these men, however, those whose cancer
recurred in less than three years and who had Gleason scores of 8 to 10
survived about three years. After 15 years, no
prostate-cancer-related deaths were found in men whose disease took more
than three years to return and whose PSA took more than 15 months to
double.
Men who are at high risk could benefit from aggressive treatments, such
as hormone suppression and chemotherapy, Freedland says.
A study in the same journal reported another potential way to predict
which prostate cancers are most worrisome.
Among patients treated with radiation, men had the greatest risk of
death if their PSA increased by more than 2 nanograms per milliliter in
the year before they were diagnosed.
Some experts say that doctors need to verify these results before
changing the way they treat patients.
Mitchell Anscher, a professor at Duke University who wrote an editorial
accompanying the articles, notes that hormone suppression and
chemotherapy cause serious side effects.
Chemo can make patients very sick. Suppressing testosterone, sometimes
called "chemical castration," can cause impotence, hot flashes and bone
loss.
"You don't yet know if those treatments are really going to do
(patients) any good," Anscher says.
Copyright 2005 USA TODAY, a division of Gannett Co. Inc.

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."
http://community.webtv.net/PALMER_ENT/doc