The Report To The Nation on Prostate Cancer and the "It's a TEAM Approach: Prostate Cancer Treatment, Education, and Awareness and Management" were unveiled today at the New York Academy of Sciences.
Report Executive Editor, Peter Carroll, M.D., Chair of the Department of Urology at the University of California, San Francisco, commented, "It is imperative that continued advances be made in the scientific understanding and optimal treatment of prostate cancer. Despite the high profile and high prevalence of the disease, there remains considerable controversy surrounding the benefits and risks of early detection and there continues to be a lack of consensus for the management of many stages of the disease. The Report to the Nation on Prostate Cancer identifies the areas of consensus and frames the debates regarding the treatment of prostate cancer. Most importantly, it helps to establish an agenda for research that must be undertaken to advance the field." 

The PCF's Report to the Nation on Prostate Cancer, authored by 24 leading prostate cancer physician-scientists, offers a comprehensive review of the state of the art in prostate cancer prevention, diagnosis, treatment, and research. One key aim of this Report is to present and summarize current and emerging information on treatment strategies for every stage of the disease -- establishing a common framework for a dialogue among the various specialists treating patients with prostate cancer. An underlying theme of the Report is the need for multidisciplinary collaboration among urologists, radiation oncologists and medical oncologists at all stages of the disease to optimize therapy and to expedite the development of new therapies. 

The Report to the Nation on Prostate Cancer was unveiled today at a panel presentation at the New York Academy of Sciences. The Report's most urgent calls to action included: 

1) The coordination of care among urologists, radiation oncologists and
medical oncologists is crucial to the well-being of patients and to the
proper management of prostate cancer, but many patients are not made
aware of a multidisciplinary team approach until their cancer has
progressed to a late stage. The Report supports the multidisciplinary
model of treatment widely employed in the treatment of other cancers
but still generally lacking in the treatment of prostate cancer
patients.

2) As the debate about the use of prostate specific antigen (PSA) testing
and the optimal PSA-level threshold for biopsy continues, new and
better diagnostic methods must be developed rapidly to maximize the
early detection of prostate cancer. Physicians continue to be
concerned about diagnosing prostate cancer at the earliest stage when
it is most treatable, while at the same time avoiding unneeded biopsies
and treatment of prostate cancers that might not become clinically
meaningful.

3) Because of the very large number of men entering the target zone for
prostate cancer, beginning at age 50, it is imperative to find better
ways to distinguish between aggressive, fast-growing prostate cancers
that require assertive treatment versus less-aggressive, slow-growing
prostate cancers that may not become clinically meaningful during the
life of the patient. Recent data show that PSA doubling time can be
predictive of patient outcomes. This must be validated for its
utility as a surrogate for survival benefit in clinical trials.
Currently, nomograms and artificial neural networks can help in
evaluating multiple factors in predicting patient outcomes, but better
tests are needed.

4) A top priority must be to provide the 230,000 men who are diagnosed
with prostate cancer each year better data for deciding how they
should be treated. While significant progress is being made to
improve surgery and radiation therapy, we still are not able to
provide patients meaningful data on relative survival rates and the
relative frequency of major side effects, including incontinence,
impotence, and bowel disorders. Another pressing research priority is
to determine the potential benefits of androgen-deprivation therapy
prior to surgery, as clinical trials to date have yielded equivocal
results.

5) To help identify and treat signs of prostate cancer at its earliest
stages, developing treatments for high-grade prostatic intraepithelial
neoplasia (PIN), a premalignant precursor for prostate cancer, may be
a viable approach for preventing or delaying prostate cancer and
should receive appropriate attention from the research community.

6) Androgen-deprivation therapy (ADT) is well accepted for the treatment
of advanced prostate cancer. Yet, key questions about its use -
optimal time to initiate therapy and whether to treat continuously or
intermittently - are not resolved and need to be subjected to rigorous
clinical studies. New clinical trials must also be designed to test
ADT in conjunction with other therapies, including docetaxel or
targeted agents.

7) In patients with bone metastases, the bisphosphonate zoledronic acid
has been shown to reduce skeletal complications. New practice
guidelines must be developed for the use of bisphosphonates in
preventing destruction of bone and delaying spread of bone metastases.

8) With one recently approved agent, docetaxel, showing survival benefit
in advanced prostate cancer, more work needs to be done to determine
its optimal use and to bring additional therapies to the market.
Tyrosine kinase inhibitors, angiogenesis inhibitors, inhibition of
endothelin-1, therapeutic vaccines and monoclonal antibodies have all
shown promise in clinical studies. A major initiative to accelerate
the testing of these promising new drugs must be launched, including
the development of better clinical trial designs, the identification
of better surrogate markers or intermediate end points, and an
increase in patient enrollment in clinical trials.

9) A key call to action is to determine the optimal timing of chemotherapy
in androgen-independent prostate cancer. Additionally, determining
the role of chemotherapy earlier in the disease, such as prior to or
immediately following localized treatment in high-risk patients, must
be evaluated in clinical trials. Similar uses of chemotherapy have
been validated in high-risk breast cancer patients, in whom surgery,
radiation and chemotherapy are used early in the disease to minimize
the risk of relapse.

"The need for innovation is more urgent than ever, as the baby boomer men reach the target age for prostate cancer, beginning at age 50," says Leslie Michelson, PCF Vice-Chairman and CEO. "Prostate cancer is already the most common non-skin cancer in the U.S. and will have the greatest increase in incidence over the next decade. The number of new prostate cancer cases in the U.S. is anticipated to increase by 50 percent to more than 300,000 new cases per year by 2012." 

Mr. Michelson continued, "The PCF's goal is to change the approach to the management and treatment of prostate cancer and bring together all specialties to benefit patients. We must also greatly accelerate new drugs through clinical testing in our search for better treatments and a cure. Since 1993, the Prostate Cancer Foundation has played a pivotal role in supporting and funding R&D breakthroughs to defeat this disease, and we are proud of our continuing contributions to this field." 

The TEAM Approach: Prostate Cancer Management
This initiative, supported by Arnold Palmer, is designed to raise awareness among the nearly two million men battling the disease that an integrated team of health care professionals -- a urologist, radiation oncologist, and medical oncologist -- should be involved, especially in the treatment of advanced prostate cancer to optimize patient outcomes and maximize survival. 

This educational campaign is called "It's a TEAM Approach: Prostate Cancer Treatment, Education, Awareness and Management." Specifically, it urges men to speak with their physician about including a medical oncologist if they are undergoing hormone therapy to treat their prostate cancer and their prostate-specific antigen (PSA) levels are rising. 

"When I was diagnosed with prostate cancer, I did everything I could to fight the disease. With the advice of my medical team, I chose the most aggressive form of treatment recommended for my type of cancer," Palmer said. "I want men whose lives have been impacted by prostate cancer to know that they should seek a team of specialist who can help them manage their disease, and if their current treatment is not working, to ask their doctor about adding a medical oncologist to their team." 

Diagnosed during the height of his career, Palmer worked with his medical team to ensure he received the treatment that was right for him. Now he is urging other men to do the same. During Prostate Cancer Awareness Month and beyond, Palmer will reach men with the disease through public service announcements airing on television stations nationwide. 

"Prostate cancer treatment has lagged behind other cancers, such as breast, colon, and brain cancer, where multidisciplinary teams of physicians collectively guide treatment," says Leslie Michelson, PCF Vice Chairman and CEO. "Unlike with other cancers, men with prostate cancer often do not know to seek the advice of a medical oncologist until their cancer has progressed to a late stage of the disease. We need to change our approach to the management and treatment of prostate cancer and bring together all specialties to benefit patients." 

Nearly 30,000 men are expected to die from the disease this year. While there is no "one size fits all" treatment for prostate cancer, most men with advanced disease or disease that has recurred after localized therapy, such as surgery or radiation, typically receive hormonal therapy to delay disease progression. However, hormonal therapy typically stops working after 18-24 months in most men and their PSA levels begin to rise again -- likely indicating that the prostate cancer is spreading. At that point, it is particularly important for patients to seek the advice of a medical oncologist who can work with the rest of the patient's healthcare team to determine the best treatment plan. 

"The integration of care among urologists, radiation oncologists and medical oncologists is crucial to the well-being of patients and to the proper management of prostate cancer, but many patients are not aware of the treatment specialties until their cancer has progressed to a late stage in the disease," said Daniel P. Petrylak, MD, Associate Professor of Medicine at Columbia University College of Physicians & Surgeons, Director of the Genitourinary Oncology Program at New York-Presbyterian Hospital. "The team of experts works very well with various other cancers, and now we need to bring these benefits to men suffering with prostate cancer."