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Prostate Cancer: New 5-Point Plan to Jump-start Progress

Eastman, Peggy

doi: 10.1097/01.COT.0000390351.10554.1a
Prostate Cancer Foundation

Prostate Cancer Foundation

WASHINGTON, DC—A group of prostate cancer organizations and the American Urological Association have called on Congress and President Obama to take advantage of recent scientific advances by putting more research funds into early diagnosis, effective treatment, and development of investigational new drugs for prostate cancer. At a news conference here sponsored by the Prostate Cancer Foundation (PCF), speakers outlined a five-point plan contained in a letter they sent to members of Congress and the President dated September 14.

Noting that new research on gene fusions indicates that there are at least 24 subtypes of prostate cancer, PCF President and CEO Jonathan W. Simons, MD, said that with enough resources it should be possible to predict prostate cancer, diagnose it earlier, differentiate between slower-growing tumors and more aggressive, life-threatening tumors, and treat the disease in a targeted fashion. He said that curing more cases and not over-treating those men who do not need aggressive therapies could save the country an estimated $3 billion a year.

At the news briefing, the Foundation's Vice President, Dan Zenka, APR, announced a plan to launch a $5 million online proactive surveillance—i.e., “watchful waiting”—program for qualified prostate cancer patients with less aggressive disease in January with Cedars-Sinai Medical Center and Johns Hopkins University.

Mr. Zenka said the national program, designed to help physicians track patients with less aggressive disease and avoid over-treatment, will use a Johns Hopkins University Medical Center proactive surveillance protocol.

Prostate Cancer Foundation President and CEO JONATHAN W

Prostate Cancer Foundation President and CEO JONATHAN W

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Gene Fusion Discoveries

Prostate cancer research is at a defining moment now because new gene fusion discoveries offer the hope of individualizing diagnosis and treatment, Dr. Simons said. Three key families of 24 gene fusions—ETS, SPINK, and RAF—have now been identified, said another speaker, Arul Chinnaiyan, MD, PhD, a Howard Hughes Medical Institute Investigator, S.P. Hicks Endowed Professor of Pathology, Professor of Pathology and Urology, Director of Pathology Research Informatics, and Director of Cancer Bioinformatics at the University of Michigan Medical School.

Dr. Chinnaiyan's laboratory has not only identified gene fusions, but has also characterized prostate cancer biomarkers including sarcosine and developed the Oncomine cancer profiling bioinformatics resource. He said that before the recent prostate cancer gene fusion findings, gene fusions were thought to occur primarily in blood cancers rather than solid tumors, such as Bcr-Abl in chronic myelogenous leukemia. But now, he said, the hope is that knowledge that there are 24 subtypes of prostate cancer based on gene fusions will be able to lead to an understanding of where these 24 subtypes fall in the three key families of gene fusions, and whether subtypes in a given gene family may respond similarly to certain therapies.

Thus, he said, the gene fusion research could lead to more rational therapy based on a specific prostate cancer subtype. Dr. Chinnaiyan told OT that he and his colleagues are working with Gen-Probe, a molecular diagnostics company, to develop diagnostic tests for the clinic that can identify subtypes of prostate cancer.

Asked whether the new cancer treatment vaccine Provenge might be more effective for men with certain gene fusions, Dr. Chinnaiyan said that because it's still unclear what the exact mechanism of action is, for now it is still not possible to know which subtypes of prostate cancer will respond best to the vaccine.

ARUL CHINNAIYAN, MD, PHD, noted it had previously been thought that gene fusions occurred primarily in blood cancers rather than solid tumors, such as Bcr-Abl in chronic myelogenous leukemia

ARUL CHINNAIYAN, MD, PHD, noted it had previously been thought that gene fusions occurred primarily in blood cancers rather than solid tumors, such as Bcr-Abl in chronic myelogenous leukemia

Dr. Simons agreed, and said that of the three main families of gene fusions, it is not yet known whether Provenge works better in one rather than another.

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Muddied Messages

During the news briefing, speakers said the ongoing controversy over whether prostate-specific antigen (PSA) screening leads to over-treatment has muddied the message that the nation needs to put more resources into prostate cancer research and has led to a confused public. The PCF considers PSA to be an “unfairly maligned” test, said the organization's medical director, Stuart Holden, MD, Director of the Louis Warschaw Prostate Cancer Center at Cedars-Sinai Medical Center.

He said the discussion and the “excitement” about PSA have gotten a little out of hand, and that it is probably true that up to 90% of men with early-stage prostate cancer may be treated inappropriately. “As clinicians, we've known this for a long time; many men who are treated for prostate cancer may have a disease that will not be a threat to them in their lifetime.”

“PSA may be overused, but it is not a test that is without utility,” since this test has likely played a role in a marked reduction in prostate cancer deaths in recent years and its use can help to monitor treatment. Rather than using PSA for wholesale population screening, the test may be more effective if used more selectively, he said. Some men may need only one baseline PSA test when they are age 45, for example, rather than repeated screenings—“It's through research that we're going to answer these questions,” Dr. Holden noted.

PSA screening may be especially useful for African American men, who are twice as likely to die of the disease as are whites, said another speaker, Stanley K. Frencher, MD, MPH, Robert Wood Johnson Clinical Scholar and Director of the Black Barbershop Health Outreach Program.

This is especially true if they lack health insurance and regular medical care, he noted. Dr. Frencher has initiated a dialogue about the controversies surrounding prostate cancer screening in the informal setting of barbershops, and noted that some 15,000 men have been screened through the black barbershop community outreach program.

Thomas A. Farrington, a prostate cancer survivor and founder and President of the Prostate Health Education Network, went farther than Dr. Holden in decrying the negativity surrounding the ongoing PSA screening controversy: “We're losing the political battle,” he said. “I sit here a little bit disappointed; research dollars are flat. I think this debate has been hijacked by the PSA fiasco.”

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5-Point Plan to Combat Prostate Cancer

  1. Increase the $5 billion annual budget of the National Cancer Institute to accelerate basic and treatment sciences research for human prostate cancer, by boosting prostate cancer funds from $294 million to $400 million.
  2. Increase appropriations for the Congressionally Directed Medical Research Program for Prostate Cancer at the Department of Defense to $120 million from $80 million. This amount would expand access to and participation in early clinical trials by those who have served in the American military and American citizens at large.
  3. Establish an Office on Men's Health in the US Department of Health and Human Services equivalent to the Office on Women's Health, which was established in 1991 and is credited with helping to move research on women's health issues forward.
  4. Create a Prostate Cancer Scientific Advisory Board for the Office of the Chief Scientist at the US Food and Drug Administration to accelerate real-time sharing of the latest research data on prostate cancer and speed the movement of new medicines from bench to bedside.
  5. Create human capital by using funds to launch more early-stage careers of the best and the brightest US scientists to work on prostate cancer research.
© 2010 Lippincott Williams & Wilkins, Inc.
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