"What's New in Treating Prostate Cancer" is the focus of the Health for Your Lifetime program this evening at the University of Iowa Hospitals and Clinics. Richard Williams, MD, FCAS, head of the Department of Urology at UI Hospitals and Clinics, talks about prostate cancer:
Is the diagnosis of prostate cancer more common now than a decade ago?
Yes, primarily because we have better screening and diagnostic methods than we had before; and the aging population in the United States means a higher percentage of men are going to develop prostate cancer.
Are all men at risk for developing prostate cancer?
Yes, but not until the ages 45 and 50. Younger men are more prone to develop it if they have a family history—a father or a brother, in particular. Older men have a higher incidence, but as time goes on the risk of it being a problem to them is a little bit less as they get older.
What signs or symptoms of prostate cancer should men be aware of?
Unfortunately, early on, when we'd like to diagnose it and do something about it, there really isn't much in the way of symptoms. Later; they have difficulty passing urine; pain in their bones, and other symptoms.
How is prostate cancer detected?
We recommend a rectal exam—a finger in the rectum to feel the nodules on the prostate. The other is a blood test—serum prostate-specific antigen (PSA). Both of these are done at the same time determine whether the patient does or doesn't have prostate cancer.
What are treatment options for prostate cancer?
There's a large number of them, and let me try to put them in perspective. If someone:
- Has a very low-grade tumor
- Has a PSA that is not terribly elevated
- Has significant other diseases
- Is in their middle 70s
we might consider watchful waiting or active surveillance; that is watching to see if the PSA is rising rapidly and treat them only if it was rising.
Other approaches in younger men—men who are healthier—we would consider:
- Surgically removing the prostate (there are multiple methods)
- Implanting radiation seeds into the prostate (put in through the perineum and/or rectum by a radiation therapist and a surgeon)
- External beam radiation therapy (given from outside into the prostate)
- Freezing the prostate
I understand you are also involved in research that may lead to a vaccine for prostate cancer? How might that work with regard to prevention and treatment?
Yes, in the laboratories of the Department of Urology, by our basic scientists, David Lubaroff, PhD, developed a vaccine that is attached to an adenovirus, which won't harm the patient. The vaccine carries the gene for prostate-specific antigen directly into the patient and causes the body to develop antibodies to the PSA-producing cells. It also develops the white cells—the patient's own white cells—to kill tumor cells that develop or produce PSA.
Have you been able to do any clinical trials on this? What's your result—or do you have data on this yet?
We do indeed. Let me just put it in perspective. One applies to the FDA for different kinds of trials and use of these new drugs or new vaccines. You start with what's called a Phase I trial and that means you try to figure out if is it harmful—to some degree, does it work—but primarily is it harmful.
Our first study indeed was a Phase I trial and we treated 32 patients. There were minimal side-effects, and the patients did see some good signs of response. These were patients who had large volumes of tumor, so they were beyond initial treatment and were into later treatment.
Now we are in Phase II. We're treating a group of patients on two different protocols:
- One is for patients who had primary treatment—either radiation or surgery—but treatment failed
- Second is for men who have failed hormone therapy—one of the therapies we use after primary therapy—and then they get the injections
They get three injections, one a month, and we've seen some pretty decent responses.
In the first trial, we saw minimal side-effects, some drop in PSA, and some change in the tumor size. In this trial, the tumors are smaller and we're seeing if the patient's long-term benefit seems to be better than it was when we only gave them the one injection.
For people who want to learn more by attending tonight's event, can you tell us more about the program?
Fadi Joudi, MD, FRCS (C) and I will talk about what prostate cancer is, how we diagnose it, how we stage it, what are the different treatments.
He's going to get into the minimally invasive surgical approach to prostate cancer, to put in perspective what we have to offer—what's new, what's happening. I'm going to talk about the gene therapy and what we have to offer and give some specific data.
This will be from 6:30 to 8:30 p.m. in University of Iowa Hospitals and Clinics East Room Elevator F, Level 8). We encourage people register ahead of time by calling 319-335-8886 or 877-MEDIOWA.
Who should consider coming to this free event?
- Patients who already have the diagnosis
- Men who are family members of others who have prostate cancer
- Men who are concerned about the diagnosis itself
- Significant others and/or family members who have concerns or want to know more about the disease
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