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As anatomy goes, the prostate is the
Rodney Dangerfield of human organs.
Tucked away below a man’s bladder, the
walnut-sized gland functions in relative
obscurity. In fact, few individuals can
describe what a prostate does or where
it resides, and many are even unsure
who has one. The prostate gland may be
exclusive to men, but a recent study by
the Prostate Foundation and
the Gillette Prostate Challenge
showed that a third of those polled
believed that women can get prostate cancer, too.
And yet, indications are that this
much-misunderstood organ may
finally be getting its due. Over the
Baby-boomers take note: Prostate
past year, a host of new informacancer is the most common and
tion regarding the prostate—its
most rapidly increasing cancer.
health, protection, and treatment—
has come to light. Early in 2007,
researchers announced discovery
of the genetic underpinnings of
prostate cancer, a development
sure to pave the way for new therapies and treatments. This year also
marked the start of advanced clini)%%
cal trials of EPCA-2, a biomarker
expected to provide far greater
accuracy in detecting prostate
cancer than current methods.
At the same time, prevention
is receiving increased attention.
Researchers are developing a
deeper understanding of how
environmental factors—including nutrition—affect and can im'*%
prove prostate health. “The days
of throwing everything up against
the wall and seeing what sticks
are behind us,” says Jonathan W.
Simons, MD, CEO and president
of the Prostate Association. “The
hope is that, in the very near future,
'%*% with the research progress we are
Source: Prostate Cancer Foundation
making now we’ll have a much
Are you at risk?
better sense of how to treat the
most common prostate problems
men encounter, understand the
molecular mechanisms involved,
intervene earlier, and achieve the
highest rates of survivability possible in those with prostate cancer.
A stated goal is to try to make prostate cancer either a chronic disease
or a preventable one.”
Until men reach their 50s or 60s,
the prostate often remains symptom-free, performing with little fanfare its behind-the-scenes role. It’s
job is to pump out the fluid needed
to nourish sperm cells on their way
to a chance rendezvous with a waiting egg. Believe it or not, it’s possible to be fertile without a prostate.
It is during middle age that conditions commonly arise that jeopardize
prostate health. One such condition
is prostatitis, an inflammation of the
prostate gland caused by bacteria.
Symptoms include burning during
urination; urinary frequency, especially at night; perineal, testicular,
bladder, and lower back pain; and
painful ejaculation. The condition
can be episodic, with flare-ups and
remissions. Doctors normally prescribe antibiotics for prostatitis,
and treatment may include heat
therapy, biofeedback, and relaxation
exercises to alleviate some of the
symptoms. “Once a correct diagnosis has been made, one of the best
therapies may be that of reassurance that the patient does not have a
life-threatening condition,” says Dr.
Paul Schellhammer, president of the
American Urological Society.
Another affliction common in
middle-aged men, benign prostatic
hyperplasia (BPH), often results
from noncancerous enlargement
of the prostate gland, which compresses the urethra and causes
difficulty in urination. BPH is a progressive disease that can lead to
bladder damage, infection, blood in
the urine, and, in rare cases, kidney
damage. For men with mild symptoms, the most common treatment
is watchful waiting. Medication treatments include alpha blockers and
finasteride, an enzyme inhibitor that
lowers prostatic androgen levels and
can decrease prostate size. Removal
of obstructive prostate tissue has
been the traditional surgical procedure used to treat BHP. A number of
new methods are now available, including laser surgery, hyperthermic
treatment (using high temperatures
to destroy prostate tissue), and the
use of stents to expand the prostatic
urethra and make urination easier.
In the majority of cases, BPH
affects the quality, not the quantity,
of life. Not so with prostate cancer,
the second-leading cause of death
in men, after heart disease. As members of the baby-boom generation
reach their 60s, some 50,000 men
annually are expected to die from
prostate cancer by the year 2020.
Symptoms include painful and frequent urination, including the need
to go to the bathroom at night; a
preference to sit rather than stand to
urinate; frequent pain or stiffness in
the lower back, hips, or upper thighs;
and an inability to urinate.
In its early stages, prostate cancer can be asymptomatic, which is
why getting men to schedule regular
prostate screening exams is crucial.
Just ask Damon Cormier, a 45-yearold chiropractor from Lake Charles,
La. Cormier’s cancer was discovered
unexpectedly one day last fall when
he landed in the doctor’s office
ter being injured in a car accident.
As a health professional, Cormier
had long been meticulous about
performing a yearly blood test on
himself to check the level of prostate-specific antigen (PSA) in his
blood. He knew that PSA levels that
rise rapidly are thought to signal the
presence of prostate cancer.
Cormier’s PSA levels had always
been low and steady, and thus he
believed his chances of having a
malignancy were not high. However,
he had not had a rectal exam. As his
internist was stitching his wounds
from the accident, the doctor noted
that Cormier hadn’t had a prostate
checkup in about five years. Several
weeks later, the physician performed
a digital rectal examination, a procedure in which a doctor accesses
the prostate through the rectum and
feels for hard or lumpy areas. Much
to Cormier’s surprise, his doctor
found a small but suspicious mass.
A biopsy confirmed that Cormier
had prostate cancer.
As Cormier was to learn, PSA
scores are far more reliable in predicting other prostate diseases other
than prostate cancer. Moreover, a
man’s PSA levels can be affected
by many factors, including activities
that cause vibrations in the body;
they can also be temporarily elevated if a man has an ejaculation
within three or four days prior to taking the test. While neither the PSA
test nor the digital rectal exam are
foolproof, they can, taken together,
help save lives. “I was very lucky to
have that car accident when I did,”
Cormier says. “Had I continued to
rely on my yearly PSA tests, I might
not have gone in for the exam. That’s
what made all the difference.”
Meanwhile, major advances are
being made in the tests that detect
the disease. A new EPCA-2 test
for a protein found in cancer cells
has been shown to detect prostate
cancer rather than simply prostate
disease, and thus would eliminate
the need for biopsies in men whose
PSA is elevated for other reasons.
“If the findings are confirmed in
Do You Know
Your Score?
he following questionnaire has
been devised by the American
Urological Association (AUA) to
assess the presence and severity of
benign prostatic hyperplasia (BPH),
a noncancerous condition caused by
enlargement of the prostate gland. To
take the quiz, indicate the number that
applies for each question: Not at all
(0); Less than one time in five (1); Less
than half the time (2); About half the
time (3); More than half the time (4);
Almost always (5).
Over the past month, how often have
… had a sensation of not
emptying your bladder
completely after you finished urinating?
… had to urinate less than
two hours after you finished
… stopped and started several
times after you urinated?
… found it difficult to postpone
… had a weak urinary stream?
… had to push or strain to begin
On average, how many times
during the month did you get up
to urinate after you went to bed?
Total the points to calculate your
BPH score. If your score is higher
than seven, or if you have symptoms
of an enlarged prostate, the AUA
recommends that you see your urologist
for an evaluation and treatment
Dr. Surena F. Matin,
M.D. Anderson
cancer surgeon
Robotic hand,
da Vinci surgical robot
at M.D. Anderson
At The University of Texas M.D. Anderson Cancer Center,
the most experienced cancer surgeons in the country are
pioneering minimally invasive procedures to fight prostate,
lung, gynecologic, and other cancers.
Using the da Vinci surgical robot and a range of other
laparoscopic and endoscopic techniques, this team of minimally
invasive experts can remove cancer with less pain, and a
shorter recovery time. So you can get back to your life sooner.
Our team of cancer experts, and the incredible technology
available to them, are among the reasons U.S.News & World
Report ranks M.D. Anderson number one in cancer care.
So if you’re fighting cancer, put yourself in our hands.
Advanced technology in the right
hands can make a big difference.
F O R M O R E I N F O R M A T I O N , C A L L 1- 8 7 7 - M D A - 6 7 8 9
O R V I S I T M D A N D E R S O N . O R G / M I N I M A L L Y I N VA S I V E
Researchers are
developing a deeper
understanding of
how environmental
factors affect
prostate health.
larger clinical trials, the use of the
EPCA-2 tests could help physicians
identify patients who are more
likely to have prostate cancer, and
therefore minimize the number
of biopsies performed,” says the
Prostate Foundation’s Simons.
The genetic basis for prostate
cancer is also coming into sharper
focus. In June, researchers from the
Icelandic Cancer Registry in Reykjavik reported that a genetic mutation
known as Icelandic BRCA2 999del5
is strongly predictive of lethal,
aggressive prostate cancer. The
study, reported in the Journal of the
National Cancer Institute, analyzed
the occurrence of the mutation in
527 prostate cancer patients. About
30 patients (or 5.7% of the sample)
carried the mutation, according
to the study. Carriers tended to be
Recipe for Health?
an what you eat help ward off
prostate disease? Researchers at
UCLA’s David Geffen School of Medicine
hope so. To find out, they are studying the
prospect that pomegranate juice and the
omega-3 fatty acids found in fish and other
foods may offer some protection.
A clinical trial is currently underway at
the Clark Urology Center to compare the
effects of a low-fat diet using omega-3
supplements and a standard Western diet,
in men undergoing prostate removal due to
cancer. The omega-6 fatty acids contained
in corn, safflower oil, and red meat are
the predominant polyunsaturated
fatty acids in the Western
diet. The healthier marine
omega-3 fatty acids are
found in cold-water fish
like salmon, tuna, and
Earlier animal studies
at the UCLA Department of
Urology support the notion
that altering a man’s diet to
include more omega-3 fatty
acids while decreasing the
amount of omega-6 fatty acids may reduce
prostate cancer tumor growth rates and
levels of prostate specific antigen (PSA), a
biomarker that can indicate the presence
of cancer. However, more trials need to be
completed in humans before any clinical
recommendations can be made, says Dr.
William Aronson, the principal investigator.
A glass of pomegranate juice a day
may also keep prostate cancer recurrence
away. A three-year study led by Dr. Allan
Pantuck, associate professor of urology at
the medical school, showed that drinking a
glass of the juice daily increased
by nearly four times the period
during which PSA levels in
men treated for prostate
cancer remained stable. While
it’s too early to make dietary
recommendations based on this
preliminary study, a multiplecenter Phase III randomized
trial of the juice is now
in the works. Until then,
imbibing a glass each day
will likely cause no adverse
effects, says Pantuck. Salud!
diagnosed at a younger age and
have a more aggressive cancer. The
presence of the mutation was also
strongly linked to survival rates:
Risk of dying from prostate cancer
was 2.35 times higher for BRCA2
carriers than for non-carriers.
For Cormier and the other one-insix men who will be diagnosed with
prostate cancer during their lifetimes, detection is just the beginning
of the road. For treatment, Cormier
turned to the M.D. Anderson Cancer Center in Houston, where doctors performed an innovative type
of surgery known as robot-assisted
minimally invasive radical prostatectomy. The surgery combines the
best of two practices—laparoscopy,
which allows a surgeon to perform
operations through tiny keyhole
punctures rather than large incisions—and robotic surgery, which
employs robotic arms that offer
optimum control, dexterity, and
visualization of the prostate.
To perform the surgery, Dr.
Surena Matin, assistant professor of
urology at M.D. Anderson, sat at a
console a short distance away where
he could view a real-time, highly
magnified three-dimensional image
of Cormier’s prostate. From this
improved vantage point, he operated the controls at the console, and
the robotic arms at the bedside replicated his actions with better-than
human precision. “Through very
small punctures less than an inch
long we can insert high-definition
cameras and instruments that can
perform a variety of functions,” says
Dr. Matin. “They can cut or burn or
grasp, and even through these small
punctures we can accomplish what
we used to with a big incision.”
The goal in Cormier’s surgery, as
in all noninvasive surgery, Matin
says, was “to duplicate what we do
with open surgery but do it with the
least impact to the patient’s wellbeing. We focus on getting a very
good cancer outcome, while minimizing short-term side effects of surgery, such as pain, and maximizing
the patient’s ability to walk, return to
T H E S H R I N K I N G P R O S T A T E C H R O N I C L E S # 26
“She thinks she had it bad?
You used to go five times a night.”
term. Ask your doctor if Avodart is right
for you. And start spending your night in
bed and not in the bathroom.
Important Safety Information About
Prescription AVODART® (dutasteride):
Avodart is used to treat urinary
symptoms of Enlarging Prostate. Only
your doctor can tell if your symptoms
are from an enlarged prostate and not a
more serious condition, such as prostate
cancer. See your doctor for regular
prostate exams. Women and children
should not take Avodart. Women
who are or could become pregnant
should not handle Avodart due to the
I T.
potential risk of a specific birth defect.
Do not donate blood until at least six
months after stopping Avodart. Tell
your doctor if you have liver disease.
Avodart may not be right for you.
Possible side effects, including sexual
side effects and swelling or tenderness
of the breast, occur infrequently. For
more information, call 1.800.448.8176.
See important patient information on
next page.
© 2007 The GlaxoSmithKline Group of Companies All rights reserved. AVO915R0
ot only can an enlarging prostate
interfere with your daily life, it
can also prevent you or your partner
from getting a good night’s rest.
• Are you always going to the bathroom?
• Do you get up to go two or more times
a night?
• Are you starting and stopping?
• Do you have difficulty going once you
get to the bathroom?
If you have these urinary symptoms,
you might have an enlarging prostate.
Untreated, it’s a problem that could
get worse. That’s why there’s Avodart.
Other medications don’t treat the cause,
because they don’t shrink the prostate.
Over time, Avodart can actually help
bring the prostate down to size and
improve urinary symptoms over the long
By 2015, the
number of new
prostate cancer
cases will increase
30%, from about
232,000 today.
—Prostate Cancer Foundation
Patient Information
AVODART® (dutasteride)
Soft Gelatin Capsules
AVODART is for use by men only.
work, and feel good. We also
focus on long-term quality-of-life
outcomes such as preserving sexual
and urinary function.”
Cormier’s cancer was caught
in time. After his surgery, he was
deemed cancer-free and was able
to leave the hospital within 24 hours
and drive home to Louisiana the
next day. He began work about four
weeks later. “I had an amazing recovery,” he says. “I tell my patients
how lucky I was, and now they’re all
running to get checkups.”
Dr. Paul Schellhammer, head of
the American Urological Association, used to approach advanced
prostate cancer from a doctor’s
point of view. Then, seven years ago,
he tested his own PSA level and noticed that it had risen substantially.
“I began to sweat, and as I was
standing there looking at my own
test results, I said to myself, “Oh, no.
I’ve got the same disease I treat.”
Dr. Schellhammer later learned that
his disease was in the advanced
stage, but he has since employed a
combination of approaches including surgery, radiation, a clinical trial
of a targeted therapy called lapatinib, and intermittent hormone therapy. “I’m still here,” he says, adding
that many treatments are still left in
the arsenal, including chemotherapy
and several new immunotherapy
drugs nearing approval.
One company in South San Francisco, Novacea, has developed a
new investigational therapy, DN-101,
also known as Asentar™. Asentar™
is a novel, proprietary, high-dose
oral formulation of calcitriol, a potent hormone that exerts its effects
through the vitamin D receptor. For
years, researchers have speculated
that high doses of calcitriol might
be able to stop the spread of cancer
when combined with the anticancer drug docetaxel (Taxotere®).
Read the information you get with AVODART
before you start taking it and each time you refill
your prescription. There may be new information.
This information does not take the place of talking
with your doctor.
What is AVODART?
AVODART is a medication for the treatment of
symptoms of benign prostatic hyperplasia (BPH)
in men with an enlarged prostate to:
• Improve symptoms
• Reduce the risk of acute urinary retention
(a complete blockage of urine flow)
• Reduce the risk of the need for BPH-related
AVODART is not a treatment for prostate cancer.
Who should NOT take AVODART?
• Women and children should not take AVODART.
A woman who is pregnant or capable of becoming
pregnant should not handle AVODART capsules.
• If a woman who is pregnant with a male baby gets
enough AVODART into her body after swallowing it
or through her skin after handling it, the male baby
may be born with abnormal sex organs.
• Do not take AVODART if you have had an allergic
reaction to AVODART or any of its ingredients.
What are the special precautions
about AVODART?
• Men treated with AVODART should not donate
blood until at least 6 months after their final dose
to prevent giving AVODART to a pregnant female
through a blood transfusion.
• Tell your doctor if you have liver problems.
AVODART may not be right for you.
• A blood test called PSA (prostate-specific antigen)
is sometimes used to detect prostate cancer.
AVODART will reduce the amount of PSA
©2007 The GlaxoSmithKline Group of Companies
All rights reserved. Printed in USA. AVO915R0 June 2007
measured in your blood. Your doctor is aware of
this effect and can still use PSA to detect prostate
cancer in you.
What are the possible side effects
Possible side effects are impotence (trouble
getting or keeping an erection), a decrease in
libido (sex drive), enlarged breasts, a decrease
in the amount of semen released during sex, and
allergic reactions such as rash, itching, hives,
and swelling of the lips or face. These events
occurred infrequently.
Talk with your doctor if you have questions about
these and other side effects that you think may
be related to taking AVODART.
If you don’t have prescription coverage,
visit, or call 1-888-4PPA-NOW
But continuous high-dose exposure
to calcitriol at levels thought to be
needed for treatment was shown to
be toxic to humans. It was not until recently that two oncologists at
Oregon Health Sciences University
developed a means to give patients
calcitriol in high doses while possibly avoiding drug-related toxicities. Asentar™ has been evaluated
in early-phase clinical trials and is
now being tested on hundreds of
patients with advanced metastatic
prostate cancer in a Phase 3 clinical study, called Ascent-2 (www. Novacea has formed
a partnership with Schering-Plough,
who will lead all global commercialization efforts of Asentar™ pending
the results from the Phase 3 trial and
review and approval by government
health authorities. “It’s exciting that
we’re taking a normal hormone and
developing it for the treatment of advanced prostate cancer,” says Nova-
cea’s president and chief medical officer, Dr. John G. Curd. “If the results
of the clinical testing are positive,
this may be a significant medical
advancement that will help people
with advanced prostate cancer.”
For their part, prostate cancer
survivors Damon Cormier and Paul
Schellhammer are optimistic about
the new less-invasive treatments
coming into the pipeline. While a
cure for prostate cancer may be
years away, they say, the chances of
living a full and productive life while
undergoing treatment are becoming
better and better. “We used to use
the metaphor of a battle when talking about controlling prostate cancer,” says Schellhammer. “Now we
talk about living well with it.”
To advertise in our Prostate sections, contact Laurie Evans at
212.522.4632. To order reprints,
contact Jo Mattern at 212.522.2582.
Prostate Online
his month the American Urological
Association Foundation will host
four one-hour online “webinars.” Each
will feature physicians and national
experts discussing the causes of,
diagnoses of, and treatment options for
common prostate conditions. An online
Q&A period will follow. To pre-register
go to:
The schedule (all EST):
Sept. 12, 8 p.m. Topic: Prostatitis
Sept. 18, 7 p.m.Topic: Localized
Prostate Cancer
Sept. 19, 7 p.m.Topic: Advanced/
Recurrent Prostate
Sept. 25, 8 p.m.Topic: Enlarged
Prostate Hyperplasia
We’re Putting Advanced Prostate Cancer On Trial.
Novacea is taking a stand against advanced prostate cancer* that
does not respond to hormone therapy. In observance of National Prostate
Cancer Awareness Month, we renew our commitment to find better ways
of treating this serious disease and other cancers.
That’s why we dedicate ourselves to developing drugs to improve
outcomes for cancer patients. To help determine whether new cancer
therapies are effective and safe for patients, clinical trials are conducted.
Currently, Novacea is sponsoring the ASCENT-2 trial of the investigational
drug, ASENTARTM (DN-101), in advanced prostate cancer.
*Prostate cancer that has spread to another part of the body; also called metastatic prostate cancer.
Join the fight against prostate cancer.
If you or a loved one has advanced prostate cancer, talk with your doctor
to find out if the ASCENT-2 trial is the right option, and learn more by visiting
our website at
Novacea, Inc.
601 Gateway Boulevard, Suite 800. South San Francisco, CA 94080
©2007 Novacea, Inc. All rights reserved.
UCLA offers prostate cancer treatment options as unique as you are.
Beating prostate cancer is a highly personal battle. That’s why at UCLA,
we put you, the individual, first. And since you’re not like anyone else, we
specialize in not just one, but all treatment options, including some of
the newest treatments for more advanced cases. This allows us to take into
account the things most important to you. After all, our job is to save
not just life, but quality of life. And as 1 of only 11 Specialized Programs
of Research Excellence, designated by the National Cancer Institute,
UCLA stands out from the crowd. Just like you. For more information, call
310.794.7700 or visit us at