Prostate Cancer

WASHINGTON--The American Urological Association (AUA) has urged Congress to pass the Medicare Preventive Benefit Improvement Act of 1997, which would provide coverage for annual prostate cancer screening for Medicare-eligible men over the age of 50. The screening procedures covered would include prostate-specific antigen (PSA) blood tests and digital rectal exams.

Dr. DeAntoni provides a timely, critical review of the concept of age-specific prostate-specific antigen (PSA) ranges, as well as other frequently used attempts to improve the accuracy of serum PSA testing in the diagnosis of unsuspected prostate cancer. His review is complete, and his assessments of each of the modalities reflect not only the majority view but also realistic appraisals of the limitations of this less-than-perfect test.

CHICAGO--Because of its high cost and lack of universal availability, magnetic resonance imaging (MRI) has not been a prominent tool in the initial evaluation of prostate cancer. However, MRI is proving to be a highly accurate method of identifying local recurrence of prostate cancer after radical prostatec-tomy, Jeffrey M. Silverman, MD, said at the Radiological Society of North America (RSNA) annual meeting.

BETHESDA, Md--It's called "Know Your Options: The National Prostate Cancer Education Program," and it's a joint effort by the National Cancer Institute and US TOO International, the world's largest men's cancer group.

NEW YORK--Medical leaders and prostate cancer patient advocacy groups have joined with Immunex Corporation to launch Empowered Patients in Control (EPIC), an education program designed to help men with late-stage prostate cancer confront the physical and emotional issues related to their disease.

In a lively session featured at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO), Jerome P. Richie, MD, Brigham and Women's Hospital, Boston, and Steven H. Woolf, MD, MPH, Medical College of Virginia,

We read with interest the recent practice guidelines on prostate cancer published by the National Comprehensive Cancer Network (NCCN) in a supplement to the November 1996 issue of ONCOLOGY (pp 265-288). The establishment of such

Researchers at Columbia-Presbyterian Medical Center have identified a gene that may control the metastatic spread of prostate cancer and tumor growth. If confirmed, the preliminary findings may eventually help doctors identify patients whose

Improved diagnostic techniques for prostate cancer, the most common cancer among American men, have led to a threefold increase in the rate of diagnosis since 1988. But that presents physicians with a dilemma: Many of these early cancers are

In the United States, racial variations have been documented in the incidence, mortality, and clinical management of cancers of the breast, colon, lung, and prostate.[1-4] In conjunction with similar findings from nonmalignant diseases, such as cardiovascular and cerebrovascular disease, these data suggest that racial variations in medical care are widespread.[5-8] However, few empirical studies explain why these racial variations exist at all.

WASHINGTON--An international team of researchers has mapped a major gene that predisposes men to prostate cancer to the long arm of chromosome 1, finally resolving the question of whether genes for this cancer actually exist. Dubbed HPC-1, for hereditary prostate cancer 1, the gene appears to account for about 3% of the 340,000 prostate cancers diagnosed annually in the United States.

In a lively session at the 32nd Annual Meeting of the American Society of Clinical Oncology (ASCO), Jerome P. Ritchie, MD, Brigham and Women's Hospital, Boston, and Steven H. Woolf, MD, MPH, Medical College of Virginia,

LOS ANGELES--By using hyper-fractionation, radiation oncologists at Wayne State University were able to deliver an isocenter dose of 85 Gy to the prostate in men with locally advanced prostate cancer, producing a 95% negative biopsy rate.

The excellent article by Monaco and Goldschmidt summarizes potential pitfalls that must be confronted and avoided as we balance the cost and allocation of health-care resources with the state-of-the-art cancer care that we as a society have come to expect. As a clinician and researcher who is devoting most of my professional efforts to prostate cancer, I would like to put Monaco and Goldschmidt's article in the context of the most common cancer now affecting American men.[1] Although these are my personal opinions, they are based on a number of recent practice guidelines, as will be noted.

After increasing sharply from 1989 through 1992, US prostate cancer incidence rates dropped by 16% for white men and nearly stabilized for African-American men (2% increase) in the latest period available for analysis, 1992 to 1993. These findings, based on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer registry information and US Census population estimates, are reported in the November 20th issue of the Journal of the National Cancer Institute.

ROCKVILLE, Md--The FDA has approved a new indication for Novan-trone (mitoxantrone), making it the first chemotherapy agent approved for the treatment of advanced hormone-refractory prostate cancer. Novantrone in combination with corticosteroids has been shown to reduce bone pain and stabilize or reduce reliance on analgesics in these patients without adversely affecting quality of life.

LOS ANGELES--"Prostate cancer is a disease of options," Douglas Keyser, MD, said at the American Society for Therapeutic Radiology and Oncology (ASTRO) meeting. And individual treatment decisions are difficult to make because of the lack of randomized studies and head-to-head comparisons between radiation therapy and surgery.

In a surprising finding that suggests radical changes in the way prostate cancer is managed, researchers at the University of Chicago Medical Center have shown in laboratory experiments that the male hormone testosterone, which fuels prostate cancers early in their growth, can in later stages cause tumors to stop growing or even shrink.

NEW YORK--Baseball-Hall-of-Famer Bob Watson remembered feeling "on top of the world" in October, 1993, after being named the first African-American general manager of a major league ball club (the Houston Astros), but the very next year, at the age of 47, he was feeling "angry and afraid" after learning he had prostate cancer.

NEW YORK--Michael Korda, best-selling author and editor-in-chief and vice president of Simon and Schuster, had never heard of PSA until a routine test showed that his was elevated; he had never thought about prostate cancer as something that could happen to him. After all, he was asymptomatic, a "fanatic exerciser," had given up smoking 20 years ago, and ate carefully.

GAITHERSBURG, Md--Members of the FDA's Oncology Drug Advisory Committee (ODAC) agreed that Immu-nex Corp.'s Novantrone (mitoxan-trone)--in combination with corticosteroids--offers a clinical benefit to patients with hormone-resistant prostate cancer.

NEW YORK--Pharmaceutical companies are currently investigating 25 new treatments for prostate cancer, including a potential vaccine, Alan Holmer, president of the Pharmaceutical Research and Manufacturers of America, said at a media briefing conducted by the American Cancer Society and the New York City-based Cancer Research Institute.

NEW YORK--Marion Morra, associate director of the Yale Cancer Center, has collaborated with her sister Eve Potts, a medical writer for more than 30 years, to produce The Prostate Cancer Answer Book: An Unbiased Treatment Guide, published in September by Avon Books to coincide with Prostate Cancer Awareness Month.

Physicians screening African-American men for prostate cancer should use different cut-off points for a popular blood test because they will accurately detect 95% of cases in this high-risk group, according to a study published in the August 1 issue of The New England Journal of Medicine. The revised normal values for the prostate-specific antigen (PSA) test are based on a new diagnostic strategy and age-specific ranges for African-Americans, who have the world's highest prostate cancer rate.

BETHESDA, Md--Physicians have long hypothesized that natural variation in sex hormones may influence prostate cancer risk, said Meir Stampfer, MD, of the Harvard School of Public Health. Efforts to prove this, however, have yielded unclear results. Now, by examining the interrelationship of different sex hormones, Dr. Stampfer and his colleagues have achieved what he calls the first clear demonstration that circulating levels of sex hormones can predict a man's risk of developing prostate cancer.

Thomas Jefferson University in Philadelphia has received a patent for a molecular-based blood test that provides a novel approach to diagnosing prostate cancer. Jefferson has given exclusive licensing rights to the test to UroCor, Inc., for the United States and Canada, and to the Italian-based biotechnology firm Raggio-Italgene, for Europe and Japan.

The treatment of advanced prostate cancer continues to be an enigma. Every few years, it seems, a new variation in treatment is espoused and offered to the public. To date, two trends seem to have emerged: For men under 70 years of age, there seems to be a consensus that definitive treatment should be pursued for low-grade, low-stage, localized tumors. Prostatectomy or radiation therapy may cure or at least increase survival; for men over age 70, less vigorous treatment is often the preferred choice [1,2]. Nevertheless, outside of these two points of agreement, many other controversial questions remain and will persist for some time.

Over the last 10 years, we have learned more about not only the natural history of untreated locally advanced prostate cancer but also the ways in which we can effectively modify radiation therapy to treat this disease. There are now sufficient data to suggest that patients with prostate cancer that is considered locally advanced (stages T2b to T4) have a propensity for the development of lymph node metastasis and occult distant spread. In these patients, there also is a recognized difficulty in controlling the disease locally with radiation, due to the bulk of tumor present and the surrounding dose-limiting, late-reacting normal tissues.

The staging and treatment of prostate cancer are complex, particularly in patients with clinical disease that has advanced locally beyond the confines of the gland. Management choices are made more difficult by a paucity of

BETHESDA, Md--Physicians who screen for prostate cancer using prostate-specific antigen (PSA) need to use a different set of normal age-adjusted values for their African-American patients, say Judd W. Moul, MD, LTC, MC, USA, and colleagues from the Walter Reed Army Medical Center, Mayo Clinic, and Uniformed Services University of the Health Sciences funded by the Department of Defense (DOD) Center for Prostate Disease Research.