Prostate cancer is the most common nonskin cancer in America, affecting one
in six men. According to the Prostate Cancer Foundation, more than 234,000 men
will be diagnosed with prostate cancer and 27,000 will die from the disease in
this year alone.
Early detection is a key component to winning the battle against this curable
cancer.
“Historically, prostate cancer was not detected early, and the vast majority
of men who were diagnosed with it died from it,” says Dr. Robert Reiter, a
professor of urology at UCLA Medical Center. “Nowadays, with early diagnosis
it’s very curable. We believe — because of increased curability — the number of
men who are dying from this cancer has decreased by about 25 percent during the
last 10 years.”
Smart Business spoke with Reiter about who is most at risk for
prostate cancer, what types of treatment options are available and what types of
advances he expects in the future.
What are some of the typical symptoms of prostate cancer?
Early prostate cancer is almost always asymptomatic: it has no symptoms. In
its late stages, when it progresses or grows in the prostate, it can cause
urinary blockage. Also, if it metastasizes, it can cause bone pain which is the
most typical symptom of late-stage cancer. The important point for most men to
know is prostate cancer, when it’s curable, causes no symptoms.
What role does genetics play in prostate cancer?
If you have a first-degree relative, such as a father or a brother who has
prostate cancer, your risk increases significantly. African-Americans have a
much higher risk than Caucasians, and Asian-Americans have a lower risk than
Caucasians.
What treatment options are available?
Radical prostatectomy — the removal of the prostate — has traditionally been
done through an incision. At UCLA we now do this with robotic assistance, which
is a minimally invasive approach; it minimizes the hospitalization, the blood
loss associated with the operation, and speeds up the recovery time of patients.
Radiation can be done in a number of different ways: a radioactive seed is a
safe approach that works well for older men who have very low-risk prostate
cancer. IMRT is a form of external radiation therapy that minimizes the number
of side effects and is also appropriate for many individuals.
There a number of different treatments. The message that I have for patients
is that one size does not fit all. You should seek care from someone who
understands this and can give objective information about all of the different
available treatments.
Currently, all of the approved treatments for prostate cancer have
side effects. In the future, how could applying targeted therapies result in
fewer side effects?
With a better ability to actually see the cancers and more knowledge about
which cancers pose danger to individuals — and which do not — we can foresee
utilizing what we call focal treatments. Instead of removing the entire prostate
gland, just the actual cancer is removed. I would warn that there are people out
there saying that they can do this now, but there is no evidence that it works.
The reason is because prostate cancers are almost always multifocal: there are
usually two or three or more tumors within the prostate. We don’t yet know which
one is the dangerous one, so right now it’s beyond the edge of what technology
permits.
From start to finish, how long does it take for a new drug — like the
one for prostate cancer that’s in clinical trial — to be approved by the Food
& Drug Administration?
Clinical trials usually occur in three stages. The first phase determines the
safety of the drug. The second phase is a slightly larger trial to determine if
it is effective. The third phase, which is the longest, is a very large trial —
sometimes more than 1,000 patients — and it establishes whether a drug can
prolong life or have some effectiveness. The total amount of time it can take
from the first phase until acceptance by the FDA can be 10 years or more.
What advances do you envision in the fight against cancer over the
next decade?
Within the next decade there will be major advances in diagnostics — that is,
the ability to figure out which cancers are dangerous and which ones are not.
This will allow us to decide who needs treatment and who does not — which is a
big issue with prostate cancer.
We will probably have better ability to image tumors and determine the stage
of the tumor. There will be further refinements in surgery and in radiation.
Also, I think we are beginning to see new targeted therapies that will prolong
the life of men even more.
ROBERT REITER is a professor of urology at UCLA Medical Center. Reach
the UCLA Medical Center Department of Urology at (310)
825-5088.
download the complete newsletter
