Treatment of Prostate Cancer

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William (Bill) Cavanaugh is director of research and education for the Prostate Cancer Research Institute (PCRI) in Los Angeles, CA. He has extensive prior experience in the development of immunotherapeutic options for the treatment of prostate cancer.

“Health Care” Program?

Saturday, August 01, 2009

10 Reasons Why American Healthcare Is Better Than You’ve Been Told

By Jonah Goldberg

From Hoover’s Scott Atlas (who’s also the head of neuroradiology at Stanford University Medical School:

1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

2. Americans have lower cancer mortality rates than Canadians. Breast cancer mortality in Canada is 9 percent higher than in the United States, prostate cancer is 184 percent higher, and colon cancer among men is about 10 percent higher.

3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.

4. Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate, and colon cancer:

Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).

Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.

More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).

Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent).

5. Lower-income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report “excellent” health (11.7 percent) compared to Canadian seniors (5.8 percent). Conversely, white, young Canadian adults with below-median incomes are 20 percent more likely than lower-income Americans to describe their health as “fair or poor.”

6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

7. People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand, and British adults say their health system needs either “fundamental change” or “complete rebuilding.”

8. Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the “health care system,” more than half of Americans (51.3 percent) are very satisfied with their health care services, compared with only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).

9. Americans have better access to important new technologies such as medical imaging than do patients in Canada or Britain. An overwhelming majority of leading American physicians identify computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade—even as economists and policy makers unfamiliar with actual medical practice decry these techniques as wasteful. The United States has thirty-four CT scanners per million Americans, compared to twelve in Canada and eight in Britain. The United States has almost twenty-seven MRI machines per million people compared to about six per million in Canada and Britain.

10. Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other developed country. Since the mid- 1970s, the Nobel Prize in medicine or physiology has gone to U.S. residents more often than recipients from all other countries combined. In only five of the past thirty-four years did a scientist living in the United States not win or share in the prize. Most important recent medical innovations were developed in the United States.

Despite serious challenges, such a

A diagnosis of prostate cancer is scary enough. But just as scary is that nobody can tell a man the best way to treat it.

This month, the Agency for Healthcare Research and Quality issued a sweeping review of prostate cancer treatments, including surgical removal, radiation, hormone therapy and so-called watchful waiting, which involves careful monitoring but no active treatment until the cancer shows signs of growing.

Because none of these treatments emerged as superior, the agency came to the troubling conclusion that it could not recommend one over the others.

“Having been involved in this area for a long time, it was not shocking, but it is disappointing,” said Dr. Timothy J. Wilt, lead researcher on the report, from the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research. “Information is really lacking to determine whether over all one treatment is more effective and preferred.”

Prostate cancer is the single most common cancer in the United States and the second most lethal among men after lung cancer. In 2008, the American Cancer Society estimates, 186,320 men will learn that they have it and 28,660 will die from it. The estimates for breast cancer are 182,460 and 40,480.

Prostate cancer is often diagnosed with a blood test that looks for prostate-specific antigen, P.S.A. There is widespread consensus that the test casts too wide a net, resulting in overdiagnosis and overtreatment. And the treatment can be devastating, leaving men impotent, incontinent or both.

The reasons behind the lack of data on prostate cancer are complex. A lack of financing and advocacy have roles. But so does the fact that prostate tumors grow slowly and can take 10 or more years to turn deadly. Not only does that make the disease particularly expensive and time consuming to study, but it is also a built-in disincentive for the drug industry, which typically has patent protection from 7 to 20 years.

A bigger obstacle to finding answers may be the patients, who have long been reluctant to participate in clinical trials, and their doctors, who tend to scorn such trials because they are already convinced that their chosen treatment is the best option.

One major clinical trial called Spirit, for Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial, would have compared surgical removal with brachytherapy, which involves implanting radioactive seeds. Just 56 of the 1,980 needed patients enrolled, and the trial was called off in 2004.

“Men don’t go into the clinical trials,” said Dr. Daniel P. Petrylak, associate professor of medicine and director of the genitourinary oncology program at the Columbia University Medical Center. “That’s the whole problem. Patients ask me all the time, ‘What is the best treatment?’ And I can’t give them an evidence-based approach for that, because we don’t have the data.”

Prostate doctors and patient advocates often compare their cause with that of the other leading sex-specific cancer: one of the largest prostate cancer support groups is called Us Too, a play on the Y-ME National Breast Cancer Organization. The dismal state of prostate cancer research and advocacy pales in comparison to the campaign against breast cancer.

“We’re at least a decade behind where breast cancer awareness is,” Thomas Kirk, president of Us Too, said. “We need to catch up. The lessons learned by breast cancer are the ones we’re trying to apply to prostate cancer.”

Prostate cancer groups have tried to replicate the success of the pink ribbon campaign with their own blue ribbon, but it has yet to gain widespread acceptance. A group advocating the development of imaging technology for prostate screening created a mascot, Prosty the Spokesgland, complete with a theme song, to the tune of “Frosty the Snowman.” Not surprisingly, it has not caught on, either.

Government spending for prostate cancer lags, too. In 2007, the National Cancer Institute spent an estimated $551.1 million on breast cancer research and $305.6 million on prostate cancer. For 2008, the Defense Department, which has a history of supporting health research, has allocated $138 million for breast cancer and $80 million for prostate cancer.

Prostate cancer researchers say the real problem is not so much financing as enlisting doctors and patients on board for clinical trials.

By 2010, men should have some answers from Pivot, the Prostate Cancer Intervention Versus Observation Trial, which is comparing surgical removal with watchful waiting. Results of studies looking at P.S.A. screening as well as the preventive benefits of the supplements vitamin E and selenium are also expected in a few years

A diagnosis of prostate cancer is scary enough. But just as scary is that nobody can tell a man the best way to treat it.

This month, the Agency for Healthcare Research and Quality issued a sweeping review of prostate cancer treatments, including surgical removal, radiation, hormone therapy and so-called watchful waiting, which involves careful monitoring but no active treatment until the cancer shows signs of growing.

Because none of these treatments emerged as superior, the agency came to the troubling conclusion that it could not recommend one over the others.

“Having been involved in this area for a long time, it was not shocking, but it is disappointing,” said Dr. Timothy J. Wilt, lead researcher on the report, from the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research. “Information is really lacking to determine whether over all one treatment is more effective and preferred.”

Prostate cancer is the single most common cancer in the United States and the second most lethal among men after lung cancer. In 2008, the American Cancer Society estimates, 186,320 men will learn that they have it and 28,660 will die from it. The estimates for breast cancer are 182,460 and 40,480.

Prostate cancer is often diagnosed with a blood test that looks for prostate-specific antigen, P.S.A. There is widespread consensus that the test casts too wide a net, resulting in overdiagnosis and overtreatment. And the treatment can be devastating, leaving men impotent, incontinent or both.

The reasons behind the lack of data on prostate cancer are complex. A lack of financing and advocacy have roles. But so does the fact that prostate tumors grow slowly and can take 10 or more years to turn deadly. Not only does that make the disease particularly expensive and time consuming to study, but it is also a built-in disincentive for the drug industry, which typically has patent protection from 7 to 20 years.

A bigger obstacle to finding answers may be the patients, who have long been reluctant to participate in clinical trials, and their doctors, who tend to scorn such trials because they are already convinced that their chosen treatment is the best option.

One major clinical trial called Spirit, for Surgical Prostatectomy Versus Interstitial Radiation Intervention Trial, would have compared surgical removal with brachytherapy, which involves implanting radioactive seeds. Just 56 of the 1,980 needed patients enrolled, and the trial was called off in 2004.

“Men don’t go into the clinical trials,” said Dr. Daniel P. Petrylak, associate professor of medicine and director of the genitourinary oncology program at the Columbia University Medical Center. “That’s the whole problem. Patients ask me all the time, ‘What is the best treatment?’ And I can’t give them an evidence-based approach for that, because we don’t have the data.”

Prostate doctors and patient advocates often compare their cause with that of the other leading sex-specific cancer: one of the largest prostate cancer support groups is called Us Too, a play on the Y-ME National Breast Cancer Organization. The dismal state of prostate cancer research and advocacy pales in comparison to the campaign against breast cancer.

“We’re at least a decade behind where breast cancer awareness is,” Thomas Kirk, president of Us Too, said. “We need to catch up. The lessons learned by breast cancer are the ones we’re trying to apply to prostate cancer.”

Prostate cancer groups have tried to replicate the success of the pink ribbon campaign with their own blue ribbon, but it has yet to gain widespread acceptance. A group advocating the development of imaging technology for prostate screening created a mascot, Prosty the Spokesgland, complete with a theme song, to the tune of “Frosty the Snowman.” Not surprisingly, it has not caught on, either.

Government spending for prostate cancer lags, too. In 2007, the National Cancer Institute spent an estimated $551.1 million on breast cancer research and $305.6 million on prostate cancer. For 2008, the Defense Department, which has a history of supporting health research, has allocated $138 million for breast cancer and $80 million for prostate cancer.

Prostate cancer researchers say the real problem is not so much financing as enlisting doctors and patients on board for clinical trials.

By 2010, men should have some answers from Pivot, the Prostate Cancer Intervention Versus Observation Trial, which is comparing surgical removal with watchful waiting. Results of studies looking at P.S.A. screening as well as the preventive benefits of the supplements vitamin E and selenium are also expected in a few years

I just found out that my dad has this and he’s not very good about giving me details about the seriousness of this disease. He says he has to go through chemo and Radiation? Does anybody know more about this disease?

Mark Moyad, MD is a professor of preventive and alternative medicine at the University of Michigan, and an acknowledged authority on the roles of diet, supplements, and other forms of integrative care in the prevention and treatment of prostate cancer.

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