An All-Out Assault on
Prostate Cancer
Dr. Jerald Killion (right) and urology
fellow Dr. Joel Slaton are actively involved in prostate cancer research.
Every two minutes a man is diagnosed with prostate cancer, and every
year more than 41,000 men will die from the disease.
Once thought to be part of the normal aging process, prostate cancer
now represents one of the most urgent health problems for men, with more
than 209,000 cases reported in the United States every year. With improved
detection, the disease is increasingly being diagnosed more frequently
in younger men, ages 50 to 65 years old, who are in the prime of their
lives and who stand to suffer the most from the impact of the disease and
the associated disabilities such as impotence and incontinence.
To combat the physical, psychological and financial toll of prostate
cancer, researchers at M. D. Anderson have launched an all-out assault.
"Based on our strong multidisciplinary integrated program, we are
working with regional, national and international collaborators to put
a stop to this debilitating and deadly disease," says Dr. Andrew C.
von Eschenbach, vice president for academic affairs ad interim and director
of the Prostate Cancer Research Program.
Through intensive research, "it is our goal to eliminate prostate
cancer as a major medical and socioeconomic threat for men and their families
everywhere - and, ultimately, to find a cure," Dr. von Eschenbach
says.
For years, researchers have known that men experience progressively
disordered cell growth in the prostate by virtue of growing older. What
they don't know is why some cellular changes lead to benign tumors or small,
treatable cancers, while others become more serious and progress locally
and/or metastasize rapidly to other organs.
"Prostate cancer represents a real dilemma for patients and their
physicians. It is a complex disease with multiple challenges because there
are no reliable methods to predict which prostate tumors will progress
into clinical cancer - and, more importantly, which cancers will spread
and become unresponsive to the best treatment currently available,"
says Dr. von Eschenbach, who holds the Roy M. and Phyllis Gough Huffington
Clinical Research Chair in Urologic Oncology.
As in most cancers, genetics seem to play an important role in determining
who will and who won't develop diseases of the prostate. However Dr. von
Eschenbach emphasizes, environmental factors, too, appear to influence
aging prostate cells, making them more susceptible to damage by tumor cells.
Knowing which factors are critical in the development of prostate cancer,
researchers "aim to better understand the biology of prostate cancer
and apply that knowledge to preventing the progression of the disease and
improving its therapy," says Dr. von Eschenbach.
Co-directors of the Prostate Cancer Research Program are Dr. Isaiah
J. Fidler, chairman of the Department of Cell Biology and holder of the
R. E. "Bob" Smith Chair in Cell Biology, and Dr. Christopher
J. Logothetis, chairman of the Department of Genitourinary Medical Oncology
and holder of the Bessie McGoldrick Professorship in Clinical Cancer Research.
Through a multidisciplinary, integrated and translational approach,
scientists are focusing their efforts in the following research areas:
· The Epidemiology of Prostate Cancer. Epidemiologists are focusing
on genetics, the environment and other risk factors, such as diet that
may predispose men to the disease, as well as how to predict and prevent
susceptibility.
In addition, they are examining ethnic variations and incidence as
prostate cancer occurs nearly 40 percent more often among black men than
white men. In fact, black Americans have the highest prostate cancer incidence
and death rate in the world.
· The Development and Progression of Prostate Cancer. Through
various scientific methods, researchers seek to identify the molecules
and genes responsible for the rapid growth and spread of prostate cancer,
as well as identify tumor suppressor genes that lose their cancer-fighting
properties during carcinogenesis, in hopes of developing new techniques
that will kill cancer cells or prevent them from spreading.
· Biology of Prostate Cancer Progression and Metastasis. According
to Dr. von Eschenbach, a complete understanding of the changes that take
place in prostate cell cycling, including the genetic mechanisms that instruct
prostate cells to divide, invade and metastasize, is critical to the development
of new technologies and treatments that halt the progression of the disease.
· Control of Angiogenesis for Therapy of Prostate Cancer Metastasis.
Understanding the host factors that support cancer such as angiogenesis
is currently one of the most important areas of research not only for prostate
cancer, but also for all cancers, Dr. von Eschenbach says. For cancer cells
to survive and multiply, they must develop new blood vessels, a process
called angiogenesis. Once researchers discover ways to stop this action,
they will be able to develop new therapeutic approaches that either control
or arrest tumor growth.
· Gene Therapy for Prostate Cancer. As with many other cancers,
prostate cancer researchers are investigating ways to introduce specific
genes into the body that either destroy or stop the progression of tumor
cells.
· Induction of Apoptosis (Cell Death) in Human Prostate Cancers.
Through intensive research, scientists now have the ability to activate
some genes and "down-regulate" other genes to induce an irreversible
biochemical program resulting in cell death. Such knowledge would offer
opportunities for enhancing or developing therapies aimed at inducing cell
death within the tumor.
Within these areas, researchers are rapidly evolving new knowledge
leading to the development of new therapies that hopefully will have fewer
debilitating side effects, Dr. von Eschenbach says.
Until the fruits of their labor are realized, however, prostate cancer
specialists must rely on standard detection practices to identify the disease
and conventional therapies to treat it. Today, the prostate specific antigen
(PSA) blood test and rectal exam are the best ways to detect prostate cancer
early. And when the disease is found in its early stages, it is most often
treated successfully, Dr. von Eschenbach says.
In terms of treating those diagnosed with prostate cancer, surgery,
radiation, hormone therapy, chemotherapy or a combination of these therapies
often yields the best hope, according to Dr. von Eschenbach. While these
treatments help save lives, they also come with a cost. Many of these therapies
have undesirable side effects such as incontinence, impotence and sexual
dysfunction.
With new therapies on the horizon, however, these side effects will
hopefully be minimized, and the quality of life for these men will be better,
Dr. von Eschenbach says.
"The bottom line is that we need more effective strategies for
treating and managing prostate cancer," he adds, "and if we're
going to change the outcome for treating the disease, then we simply must
have a better understanding of it."