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Pathways to Discovery: Spring 2012

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Systemic Prostate Cancer Viewed as Chronic, Manageable Illness

The real question for 2012 and beyond is "How do we identify those cancers that
will cause problems?"
Walt Stadler, MD

Most cancers are considered to be an acute problem, but this may no longer be true for prostate cancer. Systemic prostate cancer—or prostate cancer that has spread—is now considered a chronic disease.

"We can successfully manage prostate cancer for years and even decades," said
Walter Stadler, MD, Fred C. Buffett Professor of Medicine and Surgery and director of the Genitourinary Program.

One reason why the prostate cancer program at UChicago is a "program of distinction" is the vast and innovative resources available to treat the entire spectrum of the disease. A second reason is the program's integrative approach, which incorporates the expertise of multiple medical specialists.

"As a patient ages and the cancer changes, we can incorporate novel therapies and standardized approaches based on input from medical oncologists, as well as radiation oncologists, urologists, and geriatricians," said Dr. Stadler.

New Therapies
Many new treatments for prostate cancer are available, and many more are being
tested. Currently, UChicago has 25 open prostate cancer clinical trials.

One avenue of pursuit is the development of therapies that target the stroma—the tissue in which metastatic cancer grows. In metastatic prostate cancer, the most common metastatic site and stroma is the bone environment. By targeting
the stroma, the cancer may have a significantly reduced opportunity to grow or
metastasize further.

Another avenue showing great promise is immunotherapy. One such treatment, sipuleucel-T, was FDA approved in 2010. Researchers are now trying to determine
if using the bone-seeking radionuclide samarium prior to a vaccine administration
could also be effective. "We are seeing some evidence in the laboratory that radiation helps the immune system respond better to vaccines, and we are now testing this in patients," explained Dr. Stadler.

A third avenue of pursuit involves a seminal discovery at UChicago. In 1939, Charles B. Huggins, MD, used hormone therapy to treat a 75-year-old man with prostate cancer. The man lived for another 13 years. In 1966, Dr. Huggins was awarded the Nobel Prize for his discovery that some cancers are dependent upon hormones, such as the male sex hormone androgen.

"We are now re-discovering that the androgen receptor remains a critical therapeutic
target in this disease," explained Dr. Stadler. "Drugs, including the newly approved abiraterone and a few others in development, are effective in treating patients—even those with resistant disease."

Biggest Challenges
Prostate cancer is second in incidence only to skin cancer in American men.
The National Cancer Institute estimates there will be 242,000 new prostate cancer
diagnoses this year, with 28,000 deaths from the disease.

Yet, with the number of prostate cancer cases expected to rise to 382,000 annually by 2030, Dr. Stadler said incidence is not the real problem. "Not all prostate cancers need to be treated. In fact the vast majority are so indolent that they will never cause a problem for a patient within his lifetime," said Dr. Stadler. "The real question
for 2012 and beyond is 'How do we identify those cancers that will cause problems?'"

Knowing the difference is the crux of the controversy in prostate-specific antigen
(PSA) screening. Dr. Stadler called the decision about whether or not to undergo
PSA screening a "complex medical decision" that needs to take into account the
patient's age, family history, race, prostate changes, and other factors.

His advice? "Don't go to your local library and take a blood test. Go to your physician and discuss your unique situation," said Dr. Stadler.

UChicago physician-scientists, including Scott Eggener, MD, are using national and international forums to address the overdiagnosis and treatment of prostate cancer, while imaging experts, including Aytekin Oto, MD, are developing better methods, such as magnetic resonance imaging, to more accurately identify the prostate cancers that require treatment.

The National Cancer Institute has a booklet, "What You Need To Know About™ Prostate Cancer," available at cancer.gov/cancertopics/wyntk/prostate. Learn more about the urologic cancer team at UChicago Medicine at uchospitals.edu/specialties/cancer/urologic.

Walt Stadler