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The Third Annual Interdisciplinary Prostate Cancer Congress (IPCC) took place March 27 in New York, New York. ArcMesa Educators organized the event, which was open to urologists, radiologists, and medical oncologists. Seating was limited, and Judy Lum, MPA, president of ArcMesa, said they had to add extra rows to accommodate the number of people who signed up to hear the nationally known experts speaking at the event.
Prostate cancer is the most common cancer in men of all races in the United States, with an annual incidence of ~153 cases per 100,000 men. This exceeds the 119 cases of breast cancer diagnosed per 100,000 women each year. The yearly number of deaths from breast and prostate cancer per capita are nearly the same, at 23.6 prostate cancer deaths per 100,000 men and 23.4 breast cancer deaths per 100,000 women. Even so, there are far more national meetings dedicated exclusively to breast cancer than to prostate cancer, creating a need for regional meetings like the IPCC to keep community oncologists and others who treat men with prostate cancer abreast of the latest developments.
Co-chair Leonard G. Gomella, MD, Bernard W. Godwin Professor of Prostate Cancer, chairman of the Department of Urology, and associate director of clinical affairs at the Jefferson Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, opened the meeting. “When you look at different people with prostate cancer, it is really almost different diseases—how it is detected and how it is treated,” said Gomella.FIRST THINGS FIRST: RISK REDUCTION
The first session, presented by Gomella, focused on prostate cancer prevention, a logical place to begin since preventing the disease would be greatly preferred to treating it. “In reference to prostate cancer chemoprevention…it’s not really clear if we’re preventing prostate cancer from developing per se or reducing the risk of being diagnosed with clinically important prostate cancer,” Gomella said.
Prostate cancer is an ideal malignancy to seek to prevent because it takes years to grow, said Gomella, and it begins with a precursor lesion, such as a prostatic intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP). “Now, some people debate whether a PIN or an ASAP are histologically early markers of the development of prostate cancer,” Gomella said, “but in general, it’s accepted.” This gives clinicians ample time to intercede, either in the premalignant state or in early disease.
Gomella described a famous study done at Wayne County University in Detroit, Michigan, in the early 1990s. Any male aged 10 to <50 years whose death was due to traumatic causes and required an autopsy had his prostate removed and examined for signs of cancer. Out of 152 prostate glands, 36 (24%) had PIN. The incidence of PIN for men in their 20s was 9%, but all cases were low-grade and none in this subgroup had prostate cancer. The rate of PIN jumped to 20% for men in their 30s, who had a 27% rate of prostate cancer; rates were even greater in the 40- to 49-year-old demographic, reaching 44% for PIN and 34% for cancer. Gomella said, “Clearly, this is a wake-up call to say, ‘Gee, if we’re going to prevent prostate cancer, maybe we need to start thinking about it a little earlier than waiting until a man is 50 to 60 years old,’” a man who Gomella described as only becoming concerned about prostate health after hearing one of the many radio advertisements targeting his demographic.Prevention Strategies
“Hormonal prevention today is really the big dog,” explained Gomella. “Other strategies being looked at include dietary factors—fat, soy, lycopenes; COX-2 inhibitors; vitamins D and E; and micronutrients like selenium,” he said. Gomella noted there are data from large clinical trials that support or refute some of the recent thinking on prostate cancer prevention and seem to indicate that dietary measures have limited utility.
In recent decades, several major trials have investigated various avenues for preventing prostate cancer, Gomella said, singling out SELECT (Selenium and Vitamin E Cancer Prevention Trial), PCPT (Prostate Cancer Prevention Trial), and REDUCE (Reduction by Dutasteride of Prostate Cancer Events). “The field should be very proud of [these chemoprevention trials] and they deserve more attention,” he added.
SELECT tested claims that selenium and vitamin E could reduce the risk of prostate cancer. Approximately 32,000 men aged >55 years with a low risk of prostate cancer were randomized to take placebo only, vitamin E or selenium, or vitamin E plus selenium. Not only did the supplements fail to reduce cancer, men taking only vitamin E had a higher rate of cancer (Table 1). Investigators also observed a statistically insignificant increase in diabetes among men taking only selenium. The study closed about 6 years ago because of these adverse findings but the men continue to be followed. “Our patients are still taking a lot of vitamins under the misperception that vitamins help,” Gomella cautioned.