Program Review – National Conference on Prostate Cancer, June 23, 2005 INTRODUCTION Dr. Charles Myers, medical oncologist specializing in prostate cancer, opened the Conference and acted as moderator throughout. To set the framework he referred to the fact that there were some 39,000 deaths from prostate cancer annually versus 33,000 from heart disease in 1990. For this year, Dr. Myers said some 30 million men will be dealing with PCa in one way or another but only some 30,000 will die of it. That calculates to a death rate of only 0.5%. He then talked about the importance of early diagnosis and the potential consequences of an inadequate diagnosis. Dr. Myers referred to some work by Dr. P. Lange in Seattle where he was able to identify PCa cells in serum and marrow using the highly sensitive analytical tool called RT-PCR. This is short for Reverse Transcriptase Polymerase Chain Reaction: a highly sensitive RNA analytical technique that can detect one tumor cell in a million! If these tumor cells are detected at the time of initial diagnosis then the question becomes whether any local therapy can prevent a recurrence of tumor later on. Dr. Myers made the point that our inability to detect already micro-metastatic disease in different tissue locations is the reason there are so many subsequent recurrences of PCa following aggressive primary treatments. Federal Budget Issues and Prostate Cancer Presented by Ms. Monica Alexander, VP Govt. Relations, UsToo, Inc In FY 1996, the Govt. funded PCa research to the tune of $92.7 million. In FY 2005, the number was $502 million. The Dept. of Defense (DOD) is a major source of funding for both breast and prostate cancer. She reported that the breast cancer community is trying to get about $150 million to conduct requisite clinical trials for new BrCa drugs and therapies while the prostate community is looking for $100 million for the same purpose. Through House procedural changes, funding for these and other health related issues is being cut by Congress and the Administration. She pointed out that the VA funding is to be cut by some $13.5 billion, yes BILLION, over the next five years. And this is to be done in spite of the fact that the Iraq/Afghanistan wars are adding a new generation of veterans needing medical care. The DoD must compete with the VA for funding. Ms. Alexander left the audience wondering how the needed research can be funded given the climate prevailing in Washington. Flat funding sought by many equates to reduced funding simply because of health inflation of costs. She concluded by urging the attendees to become actively involved at the local level to influence some of the funding legislation that will take place at both the state and federal levels. She also pointed out some of the national programs that the NPCC is conducting. Pathology of Prostate Cancer 2005 Presented by David G. Bostwick, MD Dr. Bostwick is one of the country’s leading prostate pathologists who has researched and published many papers dealing with PCa. His laboratory acts as both a source for primary biopsies as well as for second opinions interpreting slides from around the world. He pointed out that PCa is 80% multi-focal. That is it can be present in the gland in multiple locations. Each focus of PCa can have a different Gleason score. One cannot tell whether the foci are different tumors or represent early metastatic sites of a single primary cancer. He illustrated this point by showing a whole mount slide with different areas of PCa within a single prostate gland. He also talked about the differences in ploidy for the different tumor sites. Although some laboratories do not report Ploidy for prostate biopsy samples, he made the point that this analysis is highly useful in predicting the future course of the disease. Because PCa is a disease that is strongly age associated, Dr. Bostwick presented a working hypothesis for PCa. 80% of men by the time they reach 80 will have some degree of prostate cancer! Starting with the basic inflammatory response of the body and working up through time with oxidative stresses, genetic instabilities to the development of PIN, he ends up with prostate cancer. We can’t do much about genetic instability since this is “in our genes”, but we can deal with inflammation and oxidation to some degree. He also discussed a new biomarker called uPM3. This is short for urine and PM3. PM3 is a new gene highly expressed in prostate cancer cells. It is a urinalysis that will work with very low levels of this over-expressed gene occurring in urine when the prostate has been manually massaged. His laboratory is the exclusive licensee of the process and is offering it currently to urologists nationally. It is not a replacement for PSA but does offer an additional method for adding to one’s diagnostic parameters. Early results indicate high levels of specificity (>85%) and sensitivity across a wide range of PSAs. He reported a Negative Predictive Value of 82%, and a positive predictive value of 74%, but again with small sample sizes. Bostwick reported an overall accuracy of 81%. As the test begins to get wider use, better statistics will be generated. But in the meanwhile, anybody having to get more diagnostic information about his PCa should consider having this urinalysis done. He also discussed the use of Toremifene as a cancer preventative tool for men with high grade PIN. The reported risk reduction was about 22% for Toremifene vs placebo for men with PIN after 1 year. A large trial is getting underway this year to test this result. “PC 101” – Dr. Charles Myers This lecture by Dr. Myers set the framework for the remainder of the Conference. He talked about the need to obtain as much clinical information as possible about one’s own cancer. The disease severity is highly variable ranging from nearly benign and very slow growing, to highly dangerous and rapidly multiplying. He did write that at any given time some 30 million men have prostate cancer but since only 30,000 (approx.) die each year the death rate was about 0.5%. However, 30,000 in 30,000,000 is only 1 in 1,000. This writer has asked Dr. Myers to clarify this point. He discussed the meaning of Gleason scores, the importance of knowing PSA doubling time, and the actual distribution of the cancer within the gland and, outside the gland, if the disease has spread already. Of particular interest was his description of how blood flow in and around the pelvic region can contribute to the spread of the tumor cells. In point of fact, Dr. Myers suggested that is the nature of the blood flow in the pelvic region that allows PCa cells from the gland to migrate to bone in the lower pelvis and spine initially. The lymphatic system was also discussed by Dr. Myers and especially how the PCa cells can and do move along the lymph chain connected to the iliac artery at the sides of the pelvis. When they migrate from the pelvic region they can and often do, end up in the abdominal cavity and the chest. Once PCa has left the gland, the chances of curing it drop dramatically. He made the point that at the time of initial diagnosis, PCa may already have invaded the bone marrow. Cancer cells may be seeded by spread through the blood system and may remain in place very quietly for years. Dr. Myers said that these “seeds” can become active and start to grow again even 5, 10, or 20 years after primary therapy. He recommended that men get their PSA monitored at least quarterly to detect any changes early. The so-called Mediterranean diet was suggested as one approach to slowing the regrowth of PCa after primary tx. It’s probably a good dietary approach to reducing PCa risk for all men. The use of statin drugs and ACE inhibitors is showing impact on PCa development. Possibly more indication of the inflammatory roots of PCa like heart disease. (Ed. note: Here’s a medical approach with a real double whammy! Reduce your risk of heart disease AND prostate cancer at the same time with statin therapy. If trials confirm the early data, it could represent a major advance in whole concept of preventive medicine. Imagine the impact on the Drug Industry’s profits!) PSA and Other Tumor Markers – Jon McDermed, Diagnostic Products Corp. [TO BE CONTINUED] Two presentations, 2005 Two presentations, 2005 Imaging talks and cryoablation presentations Talks on Leukine and Chemo combos Presentations by Drs. Nelson and Strum Drs Oliver Sarton and Mitchell Gross Presentations by the Alterwitzs and Donald Coffey Presentation by Dr. Mark Scholz Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.