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.
鈥淗aving been involved in this area for a long time, it was not shocking, but it is disappointing,鈥?said Dr. Timothy J. Wilt, lead researcher on the report, from the Minneapolis Veterans Affairs Center for Chronic Disease Outcomes Research. 鈥淚nformation is really lacking to determine whether over all one treatment is more effective and preferred.鈥?br>
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.
鈥淢en don鈥檛 go into the clinical trials,鈥?said Dr. Daniel P. Petrylak, associate professor of medicine and director of the genitourinary oncology program at the Columbia University Medical Center. 鈥淭hat鈥檚 the whole problem. Patients ask me all the time, 鈥榃hat is the best treatment?鈥?And I can鈥檛 give them an evidence-based approach for that, because we don鈥檛 have the data.鈥?br>
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.
鈥淲e鈥檙e at least a decade behind where breast cancer awareness is,鈥?Thomas Kirk, president of Us Too, said. 鈥淲e need to catch up. The lessons learned by breast cancer are the ones we鈥檙e trying to apply to prostate cancer.鈥?br>
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 鈥淔rosty the Snowman.鈥?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 the problem is finding the home-run marketing campaign
money
finding men who are willing to be in a proper study--maybe they would do it if they were paid? Dude do your own homework! sounds like a homework question. |
