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HSC researcher heads panel defining prostate cancer care (3-6-00)

Prostate cancer killed actor Bill Bixby. It forced New York Yankees Manager Joe Torre to miss part of last season. Now physicians have new guidelines on the best ways to catch the disease early, thanks to a nationwide panel headed by a specialist at The University of Texas Health Science Center at San Antonio.

Ian Thompson, M.D., head of the Division of Urology in the Department of Surgery at the Health Science Center, oversaw development of a Best Practice Policy on prostate cancer diagnosis for the American Urology Association (AUA).

The policy report was developed by a multidisciplinary panel of physicians and was released as an article in the February issue of the journal Oncology. Dr. Thompson chaired the panel that included physicians from medical disciplines such as urology, internal medicine, family practice, gerontology and radiation oncology.

According to the report, a combination of prostate specific antigen (PSA) testing and digital rectal examinations is the best method for early detection of prostate cancer. Physicians are advised to consider a biopsy when a PSA test reading falls within a certain range, when the PSA level significantly increases from one test to another or when results from a digital examination are abnormal. The policy discusses the use of PSA testing to detect disease recurrence and as a guide in pre-treatment staging (determining whether the cancer has spread beyond the prostate gland).

"PSA not only has been extremely helpful in identifying those at risk for prostate cancer early enough to successfully treat the disease, but it also has dramatically improved our ability to stage and follow the disease," said Dr. Thompson. "Because PSA is such an excellent indicator of the extent of the disease, this simple blood test has dramatically reduced the number of additional tests that are required—reducing the time and expense of the evaluation of patients with newly diagnosed prostate cancer."

Dr. Thompson added that the PSA test is an important follow-up tool for physicians as well. "A man who has had surgery for prostate cancer should have a PSA level of zero," said Dr. Thompson. "The follow-up is a periodic blood test only. The blood test also is helpful to follow men after radiation treatment. A rising PSA after either of these two treatments generally indicates failure."

The AUA report also cites a dramatic increase in prostate cancer detection between 1986 and 1991 as a result of the increased use of PSA testing. Prostate cancer is the second leading cause of cancer mortality in males, contributing to approximately 30,000 deaths each year, according to the AUA.

"The PSA Best Practice Policy deals with the most common cancer in U.S. men," said Dr. Thompson. "Although institutions such as the Health Science Center are investigating many new avenues to prevent prostate cancer and innovative new treatments to manage the disease itself, many feel that early detection and treatment are key to controlling the disease. With the advent of PSA, a blood test that is one of the most powerful screening tests for any cancer, we have not only witnessed a tremendous leap forward in early diagnosis, but have also seen the beginnings of a fall in the death rate from the disease."

The Best Practice Policy report is designed to focus on issues, such as PSA testing, that lack data for evidence-based guidelines. The prostate detection policy is the first Best Practice Policy developed by the AUA. In March, the entire report will be available on the Internet at <www.cancernetwork.com>.

Contact: Will Sansom or Heather Feldman