Prostate Cancer (cont.)

The treatment of organ-confined prostate cancer to date has involved cutting out, radiating, or freezing the gland in trying to cure the disease. In more advanced cases, the goal has been to control the cancer for at least some time by using hormonal treatment or chemotherapy. Earlier diagnosis and improved treatment techniques in recent years have certainly led to better results.

The key to curing prostate cancer, however, ultimately will come from an understanding of the genetic basis of this disease. Genes, which are chemical compounds located on the chromosomes, determine the characteristics of individuals. Accordingly, investigators at research centers have focused on identifying and isolating the gene or genes responsible for prostate cancer. For example, studies are being conducted in men who have a family history of prostate cancer to try to uncover the genetic links of the disease. The investigators ultimately will try to block or modify the offending genes so as to prevent or alter the disease.

Recently, the FDA approved a prostate cancer vaccine called sipuleucel-T (Provenge) that has been made for people who are at an advanced stage of prostate cancer. Although clinical experience with this vaccine is limited, it has been shown to improve survival in patients whose cancer has become resistant to hormones. This treatment involves taking a patient's own white blood cells and using a drug that trains them to more actively attack cancer cells. Once these cells are removed from the patient, they are treated with the drug and placed back into the patient. After the treatment of these cells, it kills cancer cells while leaving normal cells unharmed.

Another area of research is focal therapy for prostate cancer that attempts to mirror the evolution of breast cancer treatment, which often involves "lumpectomy" as part of the initial management of the disease. It involves treatment of only that part of the prostate that is affected by cancer and uses methods like cryotherapy (freezing), HIFU (heating), and brachytherapy (seed implantation) to treat the cancer. Focal therapy is still at its infancy and its role is unclear because of unresolved problems related to lack of a proper method for complete evaluation of cancer location within the prostate and the potential coexistence of many different cancerous areas within the same prostate.

There is also a great interest in inventing better methods to image prostate cancer to detect its location and spread in the body. Newer techniques like MRS (magnetic resonance spectroscopy), PET (positron emission tomography) and certain molecular imaging techniques hold promise in this regard.

• Prostate cancer is the second leading cause of deaths from cancer among U.S. men.
• While the causes of prostate cancer are still unknown, some risk factors for the disease, such as advancing age and a family history of prostate cancer, have been identified.
• Prostate cancer is often initially suspected because of an abnormal PSA blood test or a hard nodule (lump) felt on the prostate gland during a routine digital (done with a finger) rectal examination.
• Refinements in the PSA test, including the PSA ratio, age-specific PSA, and PSA velocity or slope have improved the accuracy of the test.
• If one of the screening tests is abnormal, the diagnosis of prostate cancer should be suspected and a biopsy of the prostate gland is usually done.
• The diagnosis of prostate cancer is made when cancerous prostatic cells are identified in the biopsy tissue under a microscope.
• In some men, prostate cancer is life threatening, while in many others, it can exist for many years without causing health problems.
• The choice of treatment for prostate cancer depends on the size, aggressiveness, and extent or spread of the tumor, as well as on the age, general health, and preference of the patient.
• The many options for treating prostate cancer include surgery, radiation therapy, hormonal treatment, cryotherapy, chemotherapy, combinations of some of these treatments, and watchful waiting/active surveillance.
• Research is under way to identify the genes that cause prostate cancer.

For further information on prostate cancer, contact your local branch of the American Cancer Society or call 1-800-ACS2345.

Medically reviewed by Paul Oneill, MD, Board Certified Oncology

REFERENCES:

Chang, S.S., M.C. Benson, S.C. Campbell, J. Crook, R. Dreicer, C.P. Evans, et al. "Society of Urologic Oncology Position Statement: Redefining the Management of Hormone-Refractory Prostate Carcinoma." Cancer 103.1 Jan. 1, 2005: 11-21.

Kataja, V.V., and J. Bergh. "ESMO Minimum Clinical Recommendations for Diagnosis, Treatment and Follow-up of Prostate Cancer." Ann Oncol 16.1 (2005): i34-6.

Loblaw, D.A., D.S. Mendelson, J.A. Talcott, K.S. Virgo, M.R. Somerfield, E. Ben-Josef, et al. "Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: 2006 Update of an American Society of Clinical Oncology Practice Guideline." J Clin Oncol 22.14 July 15, 2004: 2927-2941.

Zaheer, A., S.Y. Cho, and M.G. Pomper. "New Agents and Techniques for Imaging Prostate Cancer." J Nucl Med 50.9 Sept. 2009: 1387-1390.

Last Editorial Review: 7/12/2010

Source: MedicineNet.com
http://www.medicinenet.com/prostate_cancer/article.htm