Related Pages Cancer Advances In Focus Index 1

Yesterday

• In the mid-1970s, the annual death rate from prostate cancer in the United States was approximately 31 per 100,000 men, with African American men having a higher rate of approximately 55 per 100,000 men compared to white men with a rate of about 29 per 100,000 men.
• During the period 1974-1976, the 5-year overall survival rate for men diagnosed with prostate cancer was 69 percent. Among white men, the 5-year overall survival rate was 70 percent; among African American men, it was 61 percent. These survival rates may have been influenced by the method used to initially diagnose prostate cancer in the 1970s, i.e., digital rectal examination (DRE), which uses palpation to detect tumors. Tumors detected by DRE are often advanced.
• Early treatment options for prostate cancer included surgery, radiation therapy, and hormonal therapy (i.e., reducing male hormone levels either by removing the testicles or by administering estrogens, including diethylstilbestrol [DES]). Prostate cancers initially require male hormones, such as testosterone, to grow. Therefore, prostate tumors can often be treated by methods that lower blood levels of these hormones.
• In 1974, the National Cancer Institute (NCI) established the National Prostatic Cancer Project, an initiative that enabled collaborations among cancer researchers, epidemiologists, and pathologists to plan, coordinate, direct, and monitor the research being pursued in prostate cancer.

Today

• In 2007, an estimated 220,000 men will be newly diagnosed with prostate cancer in the United States and about 28,000 men will die from the disease.
• The most recent report available on cancer mortality shows that, in 2004, the overall death rate from prostate cancer among American men was 25 per 100,000. Since 1994, this rate has decreased by 4 percent each year, and, in 2004, there were an estimated 2 million prostate cancer survivors in the United States.
• African American men have mortality rates that are more than twice the rates observed in other racial and ethnic groups in the United States. An ongoing NCI-supported study is investigating a variety of risk factors that may contribute to the higher incidence and mortality rates observed in African American men.
• In the late 1980s, the widespread adoption of the prostate-specific antigen (PSA) test represented a major improvement in the management of prostate cancer. This test measures the amount of PSA protein in the blood, which is often elevated in patients with prostate cancer. In 1986, the U.S. Food and Drug Administration approved the use of the PSA test to monitor patients with prostate cancer and, in 1994, additionally approved its use as a screening test for this disease.
• Due to the widespread implementation of PSA testing in the United States, approximately 90 percent of all prostate cancers are currently diagnosed at an early stage, and, consequently, men are surviving longer after diagnosis. However, the results of two ongoing clinical trials, the NCI-sponsored Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial and the European Study of Screening for Prostate Cancer (ERSPC), will be needed to determine whether PSA screening actually saves lives.
• Advances in the treatment of prostate cancer have included new surgical approaches and improvements in radiotherapy. For example, in 1986, surgeons developed a technique that allowed the removal of the prostate while minimizing nerve damage, thereby decreasing adverse side effects. In addition, clinical researchers improved a long-established radiotherapy technique known as brachytherapy, which involves the implantation of a small amount of radioactive material (seeds) into the prostate. This radiation therapy method is an effective treatment for early-stage prostate cancer.
• Advances in hormonal therapy for prostate cancer have included the development of gonadotropin-releasing hormone (GnRH) agonists, which inhibit the ability of the pituitary gland to stimulate the testes to make testosterone. In 1984, results of a clinical trial showed that the GnRH agonist leuprolide was equivalent to DES in reducing blood levels of testosterone but caused less cardiovascular toxicity. Other GnRH agonists used today include goserelin, triptorelin, and histrelin.
• Advances have also been made in chemotherapy for prostate cancer. In 2004, results from two large NCI-sponsored clinical trials showed that use of the drug docetaxel could prolong the survival of men who had advanced prostate cancer that no longer responded to hormonal therapy.
• Ongoing clinical trials supported by NCI over the past 25 years have investigated the effectiveness of natural and synthetic compounds in the prevention of prostate cancer. The Prostate Cancer Prevention Trial (PCPT), which enrolled nearly 19,000 healthy men, found that finasteride, a drug approved for the treatment of benign prostatic hyperplasia (BPH), which is a noncancerous enlargement of the prostate, reduced the risk of developing prostate cancer by 25 percent. This was the first study to demonstrate that a drug could be used to prevent prostate cancer. Another trial, the Selenium and Vitamin E Cancer Prevention Trial (SELECT), is studying more than 35,000 men to determine whether daily supplements of selenium and vitamin E can reduce the incidence of prostate cancer in healthy men. Other prostate cancer prevention trials are currently evaluating the protective potential of multivitamins, vitamins C and D, soy, green tea, and lycopene, which is a natural compound found in tomatoes.
• NCI's commitment to basic research has led to recent discoveries that are shedding light on the molecular origins of prostate cancer. One study, reported in 2005, showed that specific genes were fused in 60 to 80 percent of the prostate tumors analyzed. This study represents the first observation of non-random gene rearrangements in prostate cancer. This genetic alteration may eventually be used as a biomarker to aid in the diagnosis and, possibly, treatment of this disease. Other studies have shown that genetic variations in a specific region of chromosome 8 can increase a man's risk of developing prostate cancer. These genetic variations account for approximately 25 percent of the prostate cancers that occur in white men. They are the first validated genetic variants that increase the risk of developing prostate cancer and may help scientists better understand the genetic causes of this disease.
• NCI is also supporting research that examines how proteins circulating in a patient's blood can be used to improve the diagnosis of prostate and other cancers. In 2005, NCI-supported scientists identified a group of specific proteins that are produced by a patient's immune system in response to prostate tumors. These proteins, a type of autoantibody, were able to detect the presence of prostate cancer cells in blood specimens with greater than 90 percent accuracy. When used in combination with PSA, these and other blood proteins may eventually be used to reduce the number of false-positive results obtained with PSA testing alone and, therefore, reduce the large number of unnecessary prostate biopsies that are performed each year due to false-positive PSA test results.

Tomorrow

• NCI is committed to supporting research into the biological and molecular mechanisms of prostate cancer. Programs such as the Institute's Early Detection Research Network (EDRN) and the Clinical Proteomic Technologies Initiative (CPTI) are supporting research to identify biomarkers—substances in blood and tissues—to aid not only in diagnosis but also in prognosis, which is critical in helping men decide whether to undergo immediate therapy (surgery or radiation) or to be observed by their physician (also known as watchful waiting or active surveillance). Furthermore, an NCI initiative is supporting a partnership of scientists who are studying the use of nanoparticles to improve our ability to image (visualize) prostate tumors. These new technologies could lead to more precise targeting of therapies.
• To support investigations into the molecular mechanisms of prostate cancer initiation and progression, NCI has established a collection of high-quality blood and tissue specimens from prostate cancer patients, called a biorepository, which can be used to evaluate genes and proteins as potential clinical biomarkers or targets for drug development.
• Advances are also being made in the development of new surgical techniques, such as robotic-assisted laparoscopic surgery, which may help decrease the time needed to recover from surgery and shorten the length of hospitalization.
• Ongoing NCI-supported clinical trials are evaluating new treatments for prostate cancer. These include studies of molecularly-targeted agents, novel drug combinations, and vaccines designed to help a patient's own immune system fight this disease.

Glossary Terms

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called expectant management, observation, and watchful waiting.

A change resulting in something that is different from the original.

A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy and BPH.

A biological molecule found in blood, other body fluids, or tissues that is a sign of a normal or abnormal process, or of a condition or disease. A biomarker may be used to see how well the body responds to a treatment for a disease or condition. Also called molecular marker and signature molecule.

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

A facility that collects, catalogs, and stores samples of biological material, such as urine, blood, tissue, cells, DNA, RNA, and protein, from humans, animals, or plants for laboratory research. If the samples are from people, medical information may also be stored along with a written consent to use the samples in laboratory studies.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A benign (not cancer) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hyperplasia and benign prostatic hypertrophy.

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called implant radiation therapy, internal radiation therapy, and radiation brachytherapy.

Having to do with the heart and blood vessels.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Treatment with drugs that kill cancer cells.

Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

Having to do with the colon or the rectum.

In science, a substance that is made up of more than one ingredient.

A synthetic form of the hormone estrogen that was prescribed to pregnant women between about 1940 and 1971 because it was thought to prevent miscarriages. DES may increase the risk of uterine, ovarian, or breast cancer in women who took it. It also has been linked to an increased risk of clear cell carcinoma of the vagina or cervix in daughters exposed to DES before birth. Also called diethylstilbestrol.

The process of identifying a disease, such as cancer, from its signs and symptoms.

A synthetic form of the hormone estrogen that was prescribed to pregnant women between about 1940 and 1971 because it was thought to prevent miscarriages. Diethylstilbestrol may increase the risk of uterine, ovarian, or breast cancer in women who took it. It also has been linked to an increased risk of clear cell carcinoma of the vagina or cervix in daughters exposed to diethylstilbestrol before birth. Also called DES.

An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Also called DRE.

A drug used together with other drugs to treat certain types of breast cancer, stomach cancer, prostate cancer, and certain types of head and neck cancer. It is also being studied in the treatment of other types of cancer. Docetaxel is a type of mitotic inhibitor. Also called Taxotere.

An examination in which a doctor inserts a lubricated, gloved finger into the rectum to feel for abnormalities. Also called digital rectal examination.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones. Estrogens can also be made in the laboratory. They may be used as a type of birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.

A drug used to reduce the amount of male hormone (testosterone) produced by the body.

An agency in the U.S. federal government whose mission is to protect public health by making sure that food, cosmetics, and nutritional supplements are safe to use and truthfully labeled. The Food and Drug Administration also makes sure that drugs, medical devices, and equipment are safe and effective, and that blood for transfusions and transplant tissue are safe. Also called FDA.

The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.

A hormone made by the hypothalamus (part of the brain). GnRH causes the pituitary gland to make luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones are involved in reproduction. Also called gonadotropin-releasing hormone.

A hormone made by the hypothalamus (part of the brain). GnRH causes the pituitary gland to make luteinizing hormone (LH) and follicle stimulating hormone (FSH). These hormones are involved in reproduction. Also called GnRH.

A drug that belongs to the family of drugs called gonadotropin-releasing hormone analogs. Goserelin is used to block hormone production in the ovaries or testicles.

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called endocrine therapy, hormone therapy, and hormone treatment.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

The complex group of organs and cells that defends the body against infections and other diseases.

The number of new cases of a disease diagnosed each year.

Surgery done with the aid of a laparoscope. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Also called laparoscopic-assisted resection.

The active ingredient in a drug used to treat symptoms of advanced prostate cancer. It is also used to treat early puberty in children and certain gynecologic conditions. It is being studied in the treatment of other conditions and types of cancer. Leuprolide blocks the body from making testosterone (a male hormone) and estradiol (a female hormone). It may stop the growth of prostate cancer cells that need testosterone to grow. It is a type of gonadotropin-releasing hormone analog.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

A red pigment found in tomatoes and some fruits. It is an antioxidant and may help prevent some types of cancer.

The state of being mortal (destined to die). Mortality also refers to the death rate, or the number of deaths in a certain group of people in a certain period of time. Mortality may be reported for people who have a certain disease, live in one area of the country, or who are of a certain gender, age, or ethnic group.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

Having to do with the ovaries, the female reproductive glands in which the ova (eggs) are formed. The ovaries are located in the pelvis, one on each side of the uterus.

The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer. The overall survival rate is often stated as a five-year survival rate, which is the percentage of people in a study or treatment group who are alive five years after diagnosis or treatment. Also called survival rate.

Examination by pressing on the surface of the body to feel the organs or tissues underneath.

Medical doctor.

The main endocrine gland. It produces hormones that control other glands and many body functions, especially growth.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

The likely outcome or course of a disease; the chance of recovery or recurrence.

In medicine, the course of a disease, such as cancer, as it becomes worse or spreads in the body.

Cancer that forms in tissues of the prostate (a gland in the male reproductive system found below the bladder and in front of the rectum). Prostate cancer usually occurs in older men.

A blood test that measures the level of prostate-specific antigen (PSA), a substance produced by the prostate and some other tissues in the body. Increased levels of PSA may be a sign of prostate cancer.

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Giving off radiation.

To become well and healthy again.

In medicine, an improvement related to treatment.

Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.

A person who has studied science, especially one who is active in a particular field of investigation.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

A mineral that is needed by the body to stay healthy. It is being studied in the prevention and treatment of some types of cancer. Selenium is a type of antioxidant.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A product from a plant of Asian origin that produces beans used in many food products. Soy contains isoflavones (estrogen-like substances) that are being studied for the prevention of cancer, hot flashes that occur with menopause, and osteoporosis (loss of bone density). Soy in the diet may lower cholesterol levels and reduce the risk of heart disease. Also called Glycine max, soya, and soybean.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Adding nutrients to the diet.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

One who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.

Having to do with substances that are man-made instead of taken from nature.

One of two egg-shaped glands inside the scrotum that produce sperm and male hormones. Also called testis.

One of two egg-shaped glands inside the scrotum that produce sperm and male hormones. Also called testicle.

A hormone made mainly in the testes (part of the male reproductive system). It is needed to develop and maintain male sex characteristics, such as facial hair, deep voice, and muscle growth. Testosterone may also be made in the laboratory and is used to treat certain medical conditions.

Treatment.

A group or layer of cells that work together to perform a specific function.

The extent to which something is poisonous or harmful.

A drug that is used to treat advanced prostate cancer, and is being studied in the treatment of breast cancer. It belongs to the family of hormonal drugs called gonadotropin-releasing hormone analogs. Also called Trelstar.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. A vaccine can help the body recognize and destroy cancer cells or microorganisms.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

A nutrient that the body needs in small amounts to function and stay healthy. Vitamin E helps prevent cell damage caused by free radicals (highly reactive chemicals). It is fat-soluble (can dissolve in fats and oils) and is found in seeds, nuts, leafy vegetables, and vegetable oils. Not enough vitamin E can result in infertility (the inability to produce children). It is being studied in the prevention and treatment of some types of cancer. Vitamin E is a type of antioxidant.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called active surveillance, expectant management, and observation.