NOVEL APPROACHES TO FOCAL THERAPY… Professor John Trachtenberg, Chair of Prostatic Disease, Professor of Surgery, at the University of Toronto delivered this lecture. He indicated no financial connections to the Drug Industry. He reviewed the frequent morbidity that accompanies conventional prostate primary therapy of the several kinds currently in use. He came down on the side of focal therapy approaches when diagnostic information indicates a high probability of successful results from this ‘male lumpectomy approach’. Dr. Trachtenberg reviewed the diagnostic parameters that would allow a physician to conclude that the pt was a candidate for local therapy. These were essentially as indicated by the previous speakers: low volume of disease, Gleason score of 6 or less, PSA < 10 with a slow doubling rate, etc. These types of cancer would be the same ones that Professor Klotz in an earlier paper suggested were the best for “Active Surveillance”. Trachtenberg disagreed with Prof. Klotz because, he argued, there is too much uncertainty in presently structured biopsies. He made the point that “Low risk is not NO risk”. And given enough time, “Low risk can become REAL risk”. “There is uncertainty in our ability to predict individual outcomes by any method.” So given these significant levels of uncertainty connected with either what used to be called “watchful waiting” or what is today called “active surveillance”, there is a very real need for a therapeutic approach that can be applied to low grade disease without incurring any of the heretofore accepted morbidities of incontinence, impotence, rectal damage, etc. He then described an approach being developed by him and associates at the Princess Margaret Hospital in Toronto that utilizes the Indigo® Laser System in combination with an MR guidance system to perform “male lumpectomies” in low risk patients. To conclude his lecture he described the results obtained on a 62 yo man with “low risk” PCa who wanted some kind of “active” treatment in lieu of watchful waiting or “active surveillance”. Immediately following the procedure he had normal continence, normal potency and normal urinary and bowel functions. Professor Trachtenberg concluded by making a strong argument that this kind of less-than-massive-morbidity inducing procedures is the wave of the future and can likely be applied to other tumors than prostate as effectively. Because of the associated MR and other imaging methodologies involved, this approach is not going to appear in other urology clinics any time soon. He identified and thanked a large team of some 20 people involved with the development. To any man interested in dealing with his “low risk” PCa, he should follow this development as it moves into wider application. CLINICAL TRIALS REVIEW- COOPERATIVE GROUP UPDATES This portion of the program involved presentations by active research clinicians on currently active clinical trials for prostate cancer. There were reviews of radiotherapy trials, new chemo drug trials, and miscellaneous others. The interested reader should go to the web site for the NIH where he/she can find a detailed listing of NIH sponsored trials and the sites where they are being conducted. For trials being funded by the drug companies, either see their own web sites or one of the sites that attempts to collect all of them by type. During the Panel session that followed this group of presenters, it was disclosed by Dr. Daniel Petrylak, that some pts on Docetaxel have stayed alive out to 5 years. And some 70% of Docetaxel users are still alive after three years. This is the chemo regimen that has been specifically approved for PCa by the FDA. MOLECULAR PROGRES IN THE CLINIC VIRAL ONGOGENESIS AND GENETIC ALTERATIONS… This opening lecture was presented by Dr. Eric Klein, Professor of Siurgery and Head of the Section on Urologic Oncology at the Cleveland Clinic in Cleveland, Ohio. His subject was the XMRV virus as a possible cause of prostate cancer. It was described as a “novel pathogen” that had to infect man much earlier than at the time of cancer diagnosis. Professor Klein discussed the key postulates that have to be met in order to establish that this virus could induce prostate cancer: Koch’s Postulates -Organism must be regularly associated with the disease and its characteristic lesions [he said that it was] -Organism must be isolated from diseased host and grown in culture [has been done] -Disease must be reproduced when organism introduced to susceptible host [planned for future primate studies] -Organism must be re-isolated from experimentally infected host [planned for primate studies] As this time, Dr. Klein stated that much more work remains to be done before it can be conclusively stated that XMRV is a major factor in creating prostate cancer. Dr. Klein did not report any financial conflicts. STEM CELLS – NEW CONCEPTS AND THERAPIES Dr. Reiter is Professor Urology and Molecular Biology at the UCLA Geffen School of Medicine in Los Angeles, CA. He had no financial conflicts to disclose. The formal title for this paper was “Stem Cell Antigens as Therapeutic Targets in Prostate Cancer”. The hypothesis behind this work was reported as: CANCER STEM CELL HYPOTHESIS - Cancers arise from transformation of stem/progenitor cells. - Cancer stem cells can self renew and give rise to differentiated progeny - Cancer stem cells are tumorigenic whereas progeny are not - Cancer stem cells should be targeted therapeutically to improve results of anti cancer therapy. The rationale behind this line of research is to develop antibodies that would recognize these PSCAs and attack them. To this end he discussed some early research results with antibodies known as 1G8 and a humanized one (as distinct from the mouse model) called 2B3. Dr. Reiter indicated that Merck was supporting their work to develop another antibody identified as MK-4721. This was a good example of the kind of basic research that occurs in some laboratories that take longer range views of the problem. Such basic research will one day allow us to understand the root causes of cancer and then to develop a whole new generation of targeted drugs that can selectively “hit” their targets and reduce cancer burdens. GENOMIC APPROACHES TO GUIDE THERAPY IN PROSTATE CANCER Phillip Febbo is an Assistant Professor in the Dept. of Molecular Genetics and Microbiology in the Duke Institute for Genome Sciences and Policy at Duke University in Durham, N.C. He disclosed financial connections to Bristol, Myers Squibb, Genentech, and Novartis and is on the speakers bureau of Sanofi-Aventis. He opened his lecture by asking whether genomic analysis can: Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.