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By all measures, the 2006 PCRI Conference “Improving Treatment and Quality of Life For Men with Recurrent and Advanced Prostate Cancer” was a great success. Over 320 prostate cancer patients, partners and member of the medical community (from 17 states, Canada and Japan) filled the Golden Eagle Ballroom at California State University – Los Angeles on Saturday, September 9th. Eleven speakers delivered talks on a variety of topics directed toward patients dealing with advanced prostate cancer. Evaluation forms were extremely complimentary regarding the quality of the program, the facility and the event logistics.
While we heard of many current and promising treatments, the highpoint of the conference was a passionate “Call to Action” by Harry Pinchot for the “Raise A Voice” advocacy initiative. We must find a way to obtain access to the promising treatments that are in the pipeline for men who are out of options.
The talks were focused on the pressing interests and needs of those patients afflicted with advanced prostate cancer. Four speakers dealt with chemotherapy and other treatments for advanced prostate cancer. Dr. Mark Scholz provided broad coverage of treatments for Hormone Refractory Prostate Cancer; Dr. Jacek Pinski asked (and answered) the questions: What is the right time to start (and to stop) chemotherapy for Prostate Cancer; and Dr. Mitchell Gross fascinated the audience by describing Novel Therapies for Prostate Cancer and emphasized that The Future is Now. In addition, Dr. Glenn Tisman discussed the issues involved in intermittent vs. continuous hormone blockade for Recurrent Prostate Cancer.
Two speakers concentrated on new developments in imagery for use in staging advanced prostate cancer. Dr. Duke Bahn discussed how Color-Doppler ultrasound with tissue harmonics is used in the early detection of recurrent prostate cancer, and Dr. Hossein Jadvar provided an update on imaging options for Recurrent and Advanced Prostate Cancer and went on to discuss his ongoing studies using positron emission tomography.
Side effects of advanced prostate cancer treatments were also widely discussed. Dr. Stanley Brosman described the diagnosis and available treatment options for urologic emergencies associated with prostate cancer including: retention, blockage, bleeding, and secondary cancers. Dr. Karen Eilber emphasized the surgical treatment options for Incontinence and Impotence in her graphic presentation. And last, but by no means least, Dr. Richard Lam earned the honor of being the 2006 PCRI Outstanding Speaker, based on the evaluations submitted, for his talk on Supportive Care that prevents and treats the side effects of prostate cancer treatment.
Perhaps the conference was best summed up at the end of the day when one of the attendees and his wife paused on their way out and came up to the PCRI information table where he announced, “This was a big help for me and my wife. You PCRI people really know how to stage a conference.”
PCRI wishes to thank all of the speakers and volunteers for sharing their Saturday with the attendees. We also want to thank the conference sponsors: Abbott Oncology, Amgen, Augusta Medical Systems, Prostate Institute of America, Prostate Oncology Specialists, Sanofi-Aventis, TAP Pharmaceuticals and Valera Pharmaceuticals
Discussion of Topics
Intermittent vs. Continuous Hormone Blockade for Recurrent Prostate Cancer
Glenn Tisman, MD
Dr. Tisman discussed when, how and why continuous and intermittent hormonal blockade is employed in the treatment of prostate cancer and that the answer must be patient specific. He stated that there isn’t much difference between single modality androgen withdrawal and combined androgen deprivation therapy but some will receive more benefit from the latter. He reviewed treatment toxicity and efficacy and results from many clinical studies. He emphasized that while Proscar or Avodart may lengthen off-cycles for patients on intermittent therapy, they should be monitored with both PSA and DRE because tumor growth rate may increase despite slowly rising or stable PSA.
Monitoring Locally Advanced Prostate Cancer with Color Doppler Ultrasound
Duke Bahn, MD
Dr. Bahn discussed how the color-Doppler ultrasound with tissue harmonics is used in the early detection of recurrent prostate cancer and can assist in the decision making process for which salvage treatment might be most effective. He also gave a brief discussion of his current work combining immune system stimulation with cryotherapy.
Update: Imaging for Recurrent and Advanced Prostate Cancer
Hossein Jadvar, MD, PhD, MPH
Development of an accurate, noninvasive imaging technique to detect residual, recurrent, and metastatic prostate cancer is critical to the effective management of the growing numbers of men with this disease. Current imaging tests, including ultrasound, CT, MRI/MRS, bone scintigraphy, and ProstaScint scanning were briefly discussed followed by a discussion of the his ongoing studies using positron emission tomography (PET) in this important clinical setting.
Treatment of Hormone Refractory Prostate Cancer
Mark Scholz, MD
Dr. Scholz discussed the parameters for determining hormone refractory prostate cancer such as a rising PSA or one that fails to drop below 0.05 using Testosterone Inactivating Pharmaceuticals. He reviewed the pros and cons of available secondary hormonal manipulations including: anti-androgens, ketoconazole and estrogens. He emphasized these should normally be used only for men with slow-growing cancer. He also discussed the use of drugs that enhance the immune system and/or provide anti-angiogenic activity like Thalidomide, Revlimid and Leukine.
Chemotherapy for Prostate Cancer:
When is the Right Time to Start? When is the Right Time to Stop?
Jacek Pinski, MD, PhD
In recent years, numerous clinical trials have evaluated new treatments for prostate cancer. Dr. Pinski reviewed the implications of the clinical trials that led to approval for mitoxantrone and Taxotere which suggest appropriate candidates, dosing, timing and sequencing. In addition, he discussed novel systemic therapies currently under clinical investigation for prostate cancer including: Atrasentan, Avastin, DN-101 (Vitamin D), oxaliplatin and pemetrexed. He stated that chemotherapy is indicated for men with symptomatic, and possibly for asymptomatic, metastatic HRPC. For others, clinical trials are needed to determine appropriate timing.
Simplifying the Search for Clinical Trials: A new partnership between PCRI and EmergingMed to help prostate cancer patients find the right clinical trials
Jim O’Hara, Educational Facilitator, PCRI
Jim discussed clinical trials and a clinical trials matching service, EmergingMed.com, that may help patients to identify trials that could be available to them based on their disease status and prior therapies. Information is in the Resources section of www.pcri.org.
Novel Therapies for Prostate Cancer: “The Future is Now”
Mitchell Gross, MD, PhD
Dr. Gross described the laboratory and clinical development of several agents in active investigation (clinical trials) for the care of patients with prostate cancer. In particular, he reviewed several agents which target molecular pathways that promote cancer-specific changes in cellular proliferation, survival, and blood vessel formation (angiogenesis) including: Avastin, Thalodimide, Cilengitide, Sorafenib and mTOR inhibitors like RAD001. He also discussed strategies to incorporate molecularly targeted therapies that appear to be synergistic with conventional therapies for patients with prostate cancer.
Emergencies in Advanced Prostate Cancer: What Every Patient Should be Aware of
Stanley Brosman, MD
Dr. Brosman discussed the diagnosis and available treatment options for urologic emergencies associated with prostate cancer including: retention, blockage, bleeding, secondary cancers, etc.
Supportive Care: Preventing and Treating the Side Effects of Prostate Cancer Treatment
Richard Lam, MD
A successful prostate cancer treatment plan involves not only effectively controlling the disease, but also minimizing the side effects and maintaining an excellent quality of life.
Key points relayed to:
- Countering the symptoms associated with androgen deprivation syndrome.
- Maintaining bone health during hormone blockade.
- Review of the potential long-term toxicities of local therapy.
- Milder forms of androgen deprivation for those who find the side-effects intolerable.
- The importance of exercise & dietary habits in maintaining an excellent quality of life.
Surgical Treatment of Incontinence and Impotence
Karyn Eilber, MD
Dr. Eilber provided an entertaining review of the different types and treatments of urinary incontinence commonly experienced as a result of treatments for prostate cancer. She emphasized the surgical treatment options using the male sling and the artificial urinary sphincter. Additionally she gave a brief overview of erectile dysfunction with a description of the use surgical implants.