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PROSTATE CANCER:
A battle of Herculean proportions and a "United Nations" approach to victory

April 2002

by Amanda Gallagher

A team of more than 30 doctors, scientists and clinicians pore over thousands of pages of data. They make plans to store hundreds of thousands of blood samples. They study the results of pathology specimens from hundreds of men. And they come up with a plan to wipe out prostate cancer.

They are the "United Nations of Science," and they operate here, at the Health Science Center. "Our goal is to make this the premier institution for prostate cancer anywhere," said Ian Thompson, M.D., professor and deputy chair of surgery, and head of urology. "This is our passion."

With an international reputation and more than $4.5 million in annual research funding, Dr. Thompson and his team are well on the way to accomplishing that goal. Their secret is teamwork.
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"We have a group of scientists, geneticists, protein biologists, molecular epidemiologists, specialists in aging, physical therapists and geriatricians working on this," Dr. Thompson said.

Their battle plan centers around three strategies: prevention, early detection and improving treatment for the disease. While the Health Science Center is on the forefront of detection and treatment modalities, it is one of very few U.S. institutions with a focus on prevention.

"People thought, Ďprevention - guys wonít be interested.í They were wrong," Dr. Thompson said. "In the next two and a half years, weíll be publishing the results of the Prostate Cancer Prevention Trial (PCPT). It was so successful, the National Cancer Institute is now in the first year of an even larger study."

Dr. Thompson is the national clinical coordinator of the PCPT. The trial began in 1993 to study the effects of the drug finasteride on 18,882 men. Since then, Dr. Thompsonís team also has launched SABOR, a prevention and early detection trial.

"People thought we were out of our minds when we designed SABOR. Itís a Herculean undertaking," Dr. Thompson said. "We are enrolling 10,000 men in San Antonio and weíre following them for five years or more. Some of these men will develop prostate cancer. The advantage is we can screen for it regularly, and find it early."

The SABOR trial turned into a lifesaver for participant Frank Tobar. His Prostate Specific Antigen (PSA) level had been above normal for the past 10 years - an indication he might have prostate cancer, although earlier biopsies came out clean. "I signed up for the study because I was hoping they could give me something to lower my PSA back to normal," Tobar said. "I was hoping for a miracle."

Instead, Tobar received startling news. His PSA had skyrocketed to almost 20 - anything above four is considered high.

"I had another biopsy and found out I had cancer," Tobar said. "I was scared. I wasnít sure what to do but I wanted the cancer out of my body."

After treatment, Tobar says heís disease-free. "They found it just in time. If I had waited a few more months, it may have been too late," he said.

Approximately 30,000 men die from advanced stages of the disease each year. But they donít have to. "No one really dies of prostate cancer until it spreads," Dr. Thompson said. "If we catch it early, we can treat and cure it."

This brings the "United Nations" team to its second strategy: better diagnosis. Doctors currently use a combination of a digital rectal exam and PSA (a blood test) to screen for cancer. "The PSA is what we call an early diagnostic test. Itís actually the best prostate cancer test there is," said Dean Troyer, M.D., professor of pathology and director of prostate cancer pathology research for the prostate cancer program. "But it didnít turn out to be as good as we thought it was."

Dr. Troyer said about one in four men can have an abnormal PSA and not have prostate cancer. That was Tobarís case for 10 years.

"And that is the reason for SABOR," Dr. Thompson said. "We want one test, where we take either a blood or urine sample, and the outcome of that test tells us if a patient definitely does or does not have prostate cancer."

While scientists have identified a gene they believe is linked to an inherited form of prostate cancer, Health Science Center researchers are going a step further. Professor Robin Leach, Ph.D., has identified genetic variations in some men that increase the risk that cancer will develop. Susan Padalecki, Ph.D., has located a genetic mutation that may allow the cancer to spread.

"The amount of ongoing research is increasing exponentially," Dr. Thompson said. "Our program is like riding a horse thatís running at breakneck speed. You really enjoy the ride, but you have to keep hanging on just to keep up with the pace of discovery."

Prostate cancer is the most common form of cancer in men. More than 180,000 men will receive a new diagnosis this year. While the numbers are troubling, they provide even more inspiration for the Health Science Center team.

"We would like to put ourselves out of business," Dr. Troyer said.

"It may not happen in my lifetime, but I think it will," Dr. Thompson added. "We have so many clues and are working night and day to get the answer. Ultimately, we want to identify those men who will never get cancer and, for the rest, prevent it. When you open Websterís Dictionary in the future, we want to ensure that you canít find prostate cancer in the book."

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Updated 7/30/14