Prostate Cancer

Is It Time For Precision/Personalized Medicine?

This blog was originally published on the Medpage Today website on January 22, 2015. It is reposted here with permission.

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Are we prepared for the genomics revolution?

The President’s proposed Precision Medicine Initiative as mentioned in his recent State of the Union address suggests it’s probably time to get ready for some changes in our daily routines as health professionals.

I’m not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.

And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.

No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It’s not just about cancer, my friends. It will be coming to a primary care practice near … Continue reading →

CanceRX 2014: We Need Innovative Approaches To Support Cancer Drug Development

What if you were sitting in the room with some of the best financial and scientific minds in the country and someone asked how many of you would be willing to contribute a modest sum of money to create a company with the potential of speeding up the evaluation of drugs that could revolutionize cancer treatment?

That was the opening question of a fascinating meeting I attended recently at the Massachusetts Institute of Technology, one where I didn’t want to leave my seat for a moment for fear I would miss another thought-provoking comment or idea.

The meeting was called CanceRX 2014, and for two solid days about 300 participants listened, debated, and engaged in discussion on how to make that scenario happen. No small task, to be certain. But in this era of ever increasing research discoveries of new treatment targets, it is clear that we need some innovative thinking to take what we learn in the laboratory to the bedsides of the patients we care for. And to make that happen we need as much “out of the box” thinking as we can muster. [more]

Let’s assume that we can  continue to accomplish the grand goals … Continue reading →

Breast Cancer Awareness Is About More Than Mammograms: What You Need To Know

It’s October and that means we are about to see a lot of pink for the next 31 days. And virtually all of the work comes down to one simple -some might say overly simple-message: get a mammogram.

But as National Breast Cancer Awareness Month (NBCAM), begins, I find myself one again asking some difficult questions: Are we really looking at the right side of the equation? Is it all about mammograms? Is there more to the story? The answer is absolutely unequivocal and without a moments hesitation: YES! [more]

There’s no doubt NBCAM  is a big deal. In fact it’s probably the biggest cancer care effort for the entire year. It has been enormously successful in bringing attention to breast cancer and creating public focus on a very important issue for women and the men who love them, even as it does crowd out attention to other cancers that also deserve our attention, like lung, childhood cancer, ovarian cancer, and on and on.

And why shouldn’t we highlight mammography’s role? In the bad old days, as a much younger oncologist, I used to dream of a day when we could have not only better treatments for cancer, … Continue reading →

Is It Too Much To Expect More Balance When Discussing Proton Beam Therapy For Cancer Patients?

I had an interesting day this past week. Sadly, it left me wondering why the same “hope and hype” directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed.

In the morning I found out that a story I had been interviewed for a story which appeared on the Kaiser Health News website. A discussion about proton beam therapy for cancer (PBT), it basically pointed out that insurers aren’t necessarily paying for the treatment and that the information supporting its use is not as definitive as some would hope or claim.

Not long after, I was informed of an online discussion  on Twitter (called a “tweet chat” at #protonbeam) being hosted by a major medical institution and a well-known weekly newsmagazine on the very topic of proton beam therapy, or PBT. What I watched unfold over the hour-long discussion was what I call a “scrum” of doctors and public relations people promoting proton beam therapy as the answer to many cancer treatment dilemmas with nary a word about the  limitations of our … Continue reading →

Cancer and the Latino Community: Lessons Learned

I had the privilege this week to serve as the keynote speaker for the 4th Summit sponsored by Latinas Contra Cancer-an organization founded and led by Ysabel Duron, a formidable cancer survivor and news media presence in San Francisco.

Bringing together members of the Latino community, researchers, community health workers, promotores (more on that later) and advocates, the summit focused on the issues facing the Latino community in increasing awareness, access to care, improved treatment and research opportunities among other topics. But what was most impressive was the spirit, engagement and commitment that permeated the room for the two days of the meeting.

I would like to share with you some of what I learned during the preparation for that lecture, as well as some observations that tie together the impact and calls to action that are relevant to the Latino community and many other ethnic and socioeconomic groups in the United States. (You may wish to refer to the American Cancer Society’s “Cancer Facts and Figures for Hispanics/Latinos 2012-2014” which contains a wealth of information relative to cancer for this community.) [more]

When one takes a closer look at the Latino community, one finds there are … Continue reading →

In An Era Of Bold New Cancer Treatments An Older Drug Shows Real Promise For Advanced Prostate Cancer

The annual meeting of the American Society of Clinical Oncology here in Chicago is a place where many commercial interests jostle for attention to make their latest promising therapy the star of the show. But this weekend, a standard widely available generic drug stole the show by producing incredible results in improving survival for men with advanced prostate cancer. And that has some of us asking, “Why did it take so long to find out? [more]

The drug is docetaxel, which for decades has been used to treat a number of cancers, including prostate cancers. We have known for some time that it is helpful in the treatment of men who have prostate cancer that has spread and no longer responds to hormone treatments (which are called “androgen deprivation therapy” or ADT and are the first line of treatment for most men when their prostate cancer first recurs). But we didn’t know if docetaxel would benefit men with advanced prostate cancer if it was used earlier, when used in combination with ADT at the time of first recurrence.

To find out, researchers studied men who developed or presented with prostate cancer that had spread to the bone … Continue reading →

The Haunting Memories When Screening Doesn’t Work

I had the opportunity earlier this week to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called “80 by 2018” designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence and deaths from this disease.

But I am haunted by two of the comments I tweeted during the session chat that won’t leave my conscience:

“As a doc, you don’t forget the patients you couldn’t help. And you celebrate those you did. #CRCawareness is key #80by2018

“Let’s remember that screening doesn’t help everyone, so don’t forget the need for more research in understanding #CRC #80by2018

While we celebrate the opportunity to save more lives with screening, we cannot ignore or forget those for whom screening for colorectal cancer (or other cancers, for that matter) couldn’t or didn’t make a difference. [more]

Let me share a couple of stories with you. These are obviously people I have remembered over the years and who have had a continued impact for me personally.

The first person … Continue reading →

It Helps To Know What Watchful Waiting Really Means In Prostate Cancer Treatment

News reports covering a prostate cancer study this week in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to “watchful waiting” after they were diagnosed.

But guess what? There’s a critical fact that seemed to be missing in much of the coverage I saw. And that fact is this: the men who were given the “watchful waiting” as described in the study never received any curative treatment. Let me repeat: No curative treatment. That is a much different approach to watchful waiting than we currently recommend in the United States, where watchful waiting after a diagnosis of prostate cancer usually means offering curative treatment when the prostate cancer changes its behavior. [more]

The study was performed in Sweden, Iceland and Finland. Between 1989 and 1999, 695 men were entered into the study after they were diagnosed with prostate cancer. Half were assigned to undergo a radical surgical removal of the prostate gland, and half were assigned to “watchful waiting.” Now, watchful waiting today means we watch, and if a patient’s prostate cancer changes its characteristics, … Continue reading →

If PSA Tests Don’t Impact Survival, Why Do Insurance Companies Do The Test Without Your Knowledge?

A discussion on Twitter caught the eyes of my colleagues yesterday, and raised a very interesting question: should insurance companies be allowed to do PSA testing to detect prostate cancer on men as a condition of getting insurance?

What started the discussion was a blog post by a well-known and respected medical blogger who goes by the name “Skeptical Scalpel.” In his blog he detailed the saga of a 56 year old man who had a pre-employment physical in order to be covered by his new company’s health insurance plan. He was not informed that he was going to have a PSA test. It was just done as part of the process. No informed consent, no nothing, just stick out your arm, have blood drawn, and register your surprise that the test was done once the results come back.

The United States Preventive Services Task Force recommends against any man having the test to detect prostate cancer. Even among those who say the test is an option, -including the American Cancer Society-recommend that a man have a full, informed understanding of the pros and cons of PSA testing before getting the test, given the uncertainties of whether it really … Continue reading →

New Update On Prostate Cancer Prevention With Finasteride Creates A Dilemma For Patients

 

We’ve all heard the phrase, “When you come to a fork in the road, take it.”  Well, that saying may hold particular relevance while reviewing a new research report published today in the New England Journal of Medicine.

The report is an important one. It is an 18 year follow-up of a study designed to show whether the use of the drug finasteride could reduce the incidence and deaths from prostate cancer. The study was called the Prostate Cancer Prevention Trial and when it was initially reported in 2003 it showed that the drug could reduce the incidence of prostate cancer by almost 25%.  However, there was a catch: there was actually an increase of almost 27% in the number of high grade-or more serious-prostate cancers in the group treated with finasteride compared to those men who did not get the drug. The men in this trial were followed very closely. Since this trial was done in an era when PSA testing to find prostate cancer “early” was part of routine care, these men were screened regularly with the PSA test.

The originally reported results of the trial meant two things to the researchers: first, finasteride was successful … Continue reading →