------From the New York Times several days back------

No Answers for Men With Prostate Cancer (February 5, 2008)

This month, the Agency for Healthcare Research and Quality issued a sweeping
review of prostate cancer treatments, including surgical removal, radiation,
hormone therapy and so-called watchful waiting, which involves careful
monitoring but no active treatment until the cancer shows signs of growing.

Because none of these treatments emerged as superior, the agency came to the
troubling conclusion that it could not recommend one over the others.

"Having been involved in this area for a long time, it was not shocking, but
it is disappointing," said Dr. Timothy J. Wilt, lead researcher on the
report, from the Minneapolis Veterans Affairs Center for Chronic Disease
Outcomes Research. "Information is really lacking to determine whether over
all one treatment is more effective and preferred."

Prostate cancer is the single most common cancer in the United States and
the second most lethal among men after lung cancer. In 2008, the American
Cancer Society estimates, 186,320 men will learn that they have it and
28,660 will die from it. The estimates for breast cancer are 182,460 and
40,480.

Prostate cancer is often diagnosed with a blood test that looks for
prostate-specific antigen, P.S.A. There is widespread consensus that the
test casts too wide a net, resulting in overdiagnosis and overtreatment. And
the treatment can be devastating, leaving men impotent, incontinent or both.

The reasons behind the lack of data on prostate cancer are complex. A lack
of financing and advocacy have roles. But so does the fact that prostate
tumors grow slowly and can take 10 or more years to turn deadly. Not only
does that make the disease particularly expensive and time consuming to
study, but it is also a built-in disincentive for the drug industry, which
typically has patent protection from 7 to 20 years.

A bigger obstacle to finding answers may be the patients, who have long been
reluctant to participate in clinical trials, and their doctors, who tend to
scorn such trials because they are already convinced that their chosen
treatment is the best option.

One major clinical trial called Spirit, for Surgical Prostatectomy Versus
Interstitial Radiation Intervention Trial, would have compared surgical
removal with brachytherapy, which involves implanting radioactive seeds.
Just 56 of the 1,980 needed patients enrolled, and the trial was called off
in 2004.

"Men don't go into the clinical trials," said Dr. Daniel P. Petrylak,
associate professor of medicine and director of the genitourinary oncology
program at the Columbia University Medical Center. "That's the whole
problem. Patients ask me all the time, 'What is the best treatment?' And I
can't give them an evidence-based approach for that, because we don't have
the data."

Prostate doctors and patient advocates often compare their cause with that
of the other leading sex-specific cancer: one of the largest prostate cancer
support groups is called Us Too, a play on the Y-ME National Breast Cancer
Organization. The dismal state of prostate cancer research and advocacy
pales in comparison to the campaign against breast cancer.

"We're at least a decade behind where breast cancer awareness is," Thomas
Kirk, president of Us Too, said. "We need to catch up. The lessons learned
by breast cancer are the ones we're trying to apply to prostate cancer."

Prostate cancer groups have tried to replicate the success of the pink
ribbon campaign with their own blue ribbon, but it has yet to gain
widespread acceptance. A group advocating the development of imaging
technology for prostate screening created a mascot, Prosty the Spokesgland,
complete with a theme song, to the tune of "Frosty the Snowman." Not
surprisingly, it has not caught on, either.

Government spending for prostate cancer lags, too. In 2007, the National
Cancer Institute spent an estimated $551.1 million on breast cancer research
and $305.6 million on prostate cancer. For 2008, the Defense Department,
which has a history of supporting health research, has allocated $138
million for breast cancer and $80 million for prostate cancer.

Prostate cancer researchers say the real problem is not so much financing as
enlisting doctors and patients on board for clinical trials.

By 2010, men should have some answers from Pivot, the Prostate Cancer
Intervention Versus Observation Trial, which is comparing surgical removal
with watchful waiting. Results of studies looking at P.S.A. screening as
well as the preventive benefits of the supplements vitamin E and selenium
are also expected in a few years.

"This is the state of prostate cancer," Mr. Kirk of Us Too said. "There aren
't any clear answers."

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As I have posted here before, the article confirms that women are 20 + years
ahead of men demanding evidence-based treatments for breast cancer.  The
studies to do the same for men could not even get volunteers!!!!