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Specialists Fight Cancer of Prostate -- Killer Gets New Attention As Doctors Try to Determine Causes, Prevention

Posted on: Tuesday, 29 March 2005, 12:00 CST

ORLANDO, Fla. - It's the most common major cancer in America, even though it affects only one sex. Lifetime odds of getting it are 1 in 6. Testing for it is controversial, and treating it robs many of a body part that's important to their sexuality.

Prostate cancer gets a fraction of what is spent on breast cancer research, and virtually nothing is known about what causes it.

It is the only cancer that doctors debate not just how to treat but whether they should at all. Nine out of 10 men don't need treatment but the rest will die, and there's no good way to tell them apart. It also kills at a higher rate than breast cancer. Nearly 32 men out of 100,000 will die of prostate cancer; 27 women out of 100,000 die of breast cancer.

Advocacy has been weak. Men don't like to wear little blue ribbons, and the field has suffered from lack of support.

Consider Dr. Ernie Bodai's situation. The California surgeon got a special postage stamp that has raised $50 million to fight breast cancer, a disease he cuts out of dozens of women's bodies each year. But he's been unable to win a similar stamp for his own cancer.

"The prostate cancer community is 10 years behind the breast groups in terms of being acknowledged and coming forward," he lamented.

Now, many are trying to catch up.

More than a thousand specialists, from surgeons to radiologists to dietitians, met in Orlando recently for a first-of-its-kind conference similar to the breast cancer symposium that's been held in Texas for 27 years.

"As San Antonio is to breast cancer, we want this to be for prostate cancer," said Dr. Eric Small of the University of California in San Francisco, who organized the meeting with several big cancer organizations.

What emerged from the conference was a clearer picture of the disease and new insights into preventing, detecting and treating it. Among them:

The immune system might be more effectively harnessed to fight this cancer than many other types.

Smoking has less of an effect on prostate cancer risk than other cancers.

Obesity affects the odds of dying from the disease more than the odds of getting it.

Diet may play a key role. More is known about how specific nutrients affect the risk of prostate cancer than any other cancer type. Diet might even help explain why African-Americans have double the rate of the disease than white patients.

Treatments are improving. New techniques are minimizing surgery's side effects, and newer ways of giving radiation are allowing higher doses and better control of the disease.

Use of the PSA blood test is being refined. Studies are evaluating whether a rising score means more than the score itself, and other ways to fine-tune interpretation.

Doctors are starting to prescribe finasteride for some men at high risk of the disease after a big study found the drug could prevent prostate cancer, much as tamoxifen prevents breast cancer. The study was notable not just for its outcome, but also because 18,000 men took part, after years of studies begging for participants.

"This was a real question in the 1990s: If you gave a party, would the men show up?" said Dr. Howard Parnes, director of cancer prevention at the National Cancer Institute, which funded the study.

More than 232,000 American men are expected to be diagnosed this year with cancer of the prostate, a walnut-shaped gland beneath the base of the penis that makes seminal fluid. About 30,000 will die of it. Worldwide, 680,000 cases and 221,000 deaths are projected - figures that seem low primarily because in many poor countries men don't live long enough to develop it.

Cases climbed dramatically in the United States in 1988 and 1989 with the advent of the PSA blood test, which measures a protein the prostate makes when it's inflamed. The test is controversial because PSA can be high for many reasons, and there's no proof that screening saves lives.

In most men, prostate cancer grows so slowly that it will never threaten their lives. Treatment often leads to problems having sex or controlling the bladder, so finding a way to distinguish which tumors can safely be left alone is the field's top priority.

"We need to know who those people are so they can be spared unnecessary treatment," said Dr. Philip Kantoff, a prostate specialist at the Dana-Farber Cancer Institute in Boston.

It would help to know what causes the disease. It regresses when men are given drugs to block testosterone, yet the incidence of the disease rises as men age, when levels of the male hormone diminish.

"We still don't understand it to the degree we do any other cancer," said Dr. Durado Brooks, who heads prostate cancer research for the American Cancer Society.

Two genes have been implicated, and both are linked to inflammation, said Dr. William Nelson of Johns Hopkins University.

Chronic inflammation or infection may set the stage, and a carcinogen, like smoking, may finish the job.

Scientists have done elaborate studies on carcinogens, like those generated by cooking meat at high heat. The bottom line: Charring meat isn't good.

Can diet prevent prostate cancer?

"The short answer to that is 'probably yes,'" said Dr. Meir Stampfer, chief of epidemiology at Harvard Medical School, where the possible benefit of selenium was first seen in studies in the 1980s.

"It's taken 25 years to get a randomized trial off the ground," he complained.

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The role of diet

Diet is emerging as a possible way to prevent prostate cancer. June Chan, a dietitian at the University of California in San Francisco, summarized studies on risk.

Bad: Diets high in fat, red meat, dairy products and calcium.

Good: Fish, soy, vegetables like broccoli and Brussels sprouts, and cooked tomato products rich in lycopene.

Diet may be especially important in later life; a Harvard study found that most of the benefit of lycopene was in men 70 and older.

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Source: Commercial Appeal, The

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