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29 October 2001
Prostate Cancer Screening Creates New Dilemma
by George Atkinson

Between 70 and 80 per cent of prostate cancer was now being diagnosed at a stage where it may be curable, a press conference at ECCO 11 - The European Cancer Conference in Lisbon heard today (Wednesday, October 23, 2001).

"We used to have a situation in which one of every two patients diagnosed with the disease would die. Today only three to five per cent of newly diagnosed patients have advanced disease. The figure used to be 20-25 per cent", said Professor Fritz H. Schröder, professor and chair of the Department of Urology, Erasmus University, Rotterdam.

"We still don't know if the increased rate of earlier diagnosis will result in reduced mortality".

But PSA (protein specific antigen) screening, the professor added, had resulted in increased diagnosis and over-treatment.

Only about one man in six diagnosed as having prostate cancer in the USA was estimated to be at risk from dying. In the controlled situation of a randomized screening study in Europe, due for completion by 2008, the proportion of men diagnosed to those at risk from dying had been put at 14 to one.

What will happen in the interim? Professor Schröder added: "The national healthcare policies being developed in relation to screening are very variable. It's roulette - just like Las Vegas.

"In a situation of uncertainty, there is no way that one can refuse to offer PSA screening to well informed men. But screening does result in some men taking the wrong decision and having unnecessary aggressive treatment which carries the risk of loss of potency and the risk of urinary problems like incontinence."

Commenting on treatment, Professor Schröder, said that the only survival advantage shown in prospective randomized studies had been in so-called T3 disease - local extensive disease in which there is no evidence of metastases (spread to other parts of the body). This "significant advance" had been achieved by combining endocrine (hormonal) treatment and radiotherapy.

A recently published meta analysis of studies with 8000 patients had shown that androgen blockade in the initial treatment of metastatic disease "made no sense". Professor Schröder added. "There is also an important cost factor here because maximal androgen blockade is very expensive. The state of the art treatment in metastatic hormone sensitive disease is castration".

More than 130 drugs needed to be evaluated. The professor said that treatment of GIST (gastrointestinal stromal tumour) through signal transduction inhibition of the endothelial growth factor receptor was looking very promising. GIST a rare form of cancer that has become the focus of immense excitement among cancer specialists: it is one of the first cancers to be successfully treated with a new class of targeted agents known as tyrosine kinase inhibitors.

"But in prostate cancer it is unlikely that there will be one molecular mechanism that is going to be the target. A report of new drugs in prostate cancer has identified 135 different agents that need to be evaluated in the near future - mostly targeted against molecular mechanisms, and mostly related to signal transduction."




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