School of Medicine

Wayne State University School of Medicine

Prostate Cancer

Prostate cancer is the most common malignancy and second leading cause of cancer deaths in men. An estimated 340,000 men will be diagnosed with prostate cancer in 1997 and 50,000 will die of the disease. Our philosophy in the management of prostate cancer includes:

  • prevention of prostate cancer
  • early detection of prostate cancer
  • multidisciplinary approach to the treatment of prostate cancer, and
  • basic science and clinically related studies to improve the outcome for patients with prostate cancer.

Through this coordinated approach, we believe, in the near future, we will have a much better understanding of the causes of prostate cancer and therefore, we wll provide better methods of treatment.


Research

Our research in prostate cancer is driven by the Prostate Initiative grant. This 5 million dollar grant is a compilation of funding from Wayne State University (2 million), the National Cancer Institute (1.5 million), and four departments at the Karmanos Cancer Institute (Molecular Genetics, Pathology, Radiation Oncology, and Urology). This money is earmarked to hire eight basic scientists to investigate how prostate cancer invades and spreads to other organs.

Prostate cancer affects men as they age. It is unusual to identify prostate cancer in men under the age of 40 and it is very common in men over the age of 80. Studies at our institution led by pathologist Dr. Wael Sakr have found that in men who have died from other causes, histological evidence of prostate cancer can be found in men as young as age 30. Interestingly the incidence of histological or microscopic (asymptomatic) prostate cancer is approximately 30% in 40 year old men and rises to 80% in 80 year old men. These investigators found that a precursor of prostate cancer called prostatic intraepithelial neoplasia (PIN) is common in younger men and may be the true precursor of clinically obvious prostate cancer. Importantly, they found that PIN is more common in African American men than Caucasian men. This is important because prostate cancer is much more common in African American men than in Caucasian men. Approximately 1 out of 4 African American males will get prostate cancer in their lifetime compared to one out of seven Caucasian males. Further genetic studies on these precursors of prostate cancer may help determine the cause for the high prevalence of this disease.

We have several studies ongoing in our institution with a variety of agents to try to prevent prostate cancer. Dr. Omer Kucuk is investigating the role of natural substances including Lycopene and Selenium in the prevention of prostate cancer. The current study evaluates the effect of these non-toxic oral supplements on the cellular characteristics of prostate cancer in men undergoing radical prostatectomy. We have also recently received funding from the national cancer institute to evealuate the role of Selenium in patients with PIN.

To better treat and identify prostate cancer, it is essential that we have a better understanding of the causes of prostate cancer. We have very active laboratories investigating the genetic causes for prostate cancer, the reasons for spread of prostate cancer, and methods to prevent the growth of prostate cancer. Our Prostate Initiative Grant from the National Cancer Institute is funding these projects. There are numerous basic science and clinical programs involved in the identification and causes of prostate cancer. One such program involves the detection of metastatic prostate cancer cells in patients with apparently localized disease. We have developed sophisticated molecular biology techniques to detect individual metastatic prostate cancer cells in the peripheral blood and bone marrow of men undergoing radical prostatectomy. Approximately 45% of men with clinically localized prostate cancer will have metastatic cells in their bone marrow and the presence of these cells is a strong predictor of disease-free survival.

Clinical Management

Because there is no cure for prostate cancer once it has escaped the confines of the prostate, we strongly believe in the early detection of prostate cancer. Currently, the most effective methods for early detection are a yearly digital rectal examination and a prostate specific antigen (PSA) blood test. We recommend that African American males undergo testing for prostate cancer at the age of 40 and Caucasian American males at the age of 50 because of the difference in incidence and biological behavior of the disease in these two populations. A PSA level of greater than 4.0 ng/ml is suggestive but not diagnostic of prostate cancer. In younger men, this level may be 2.0 ng/ml and we are currently involved in several studies trying to identify the optimal point for early prostate detection cancer. The majority of prostate cancers detected by PSA testing cannot be felt by digital rectal examination. Therefore, a program of early detection combining serum PSA with digital rectal examination is more likely to find prostate cancers that are confined to the prostate itself.

In affiliation with the Barbara Ann Karmanos Cancer Institute, we strongly believe in the multidisciplinary approach to achievement of prostate cancer. There are multiple treatment options for clinically localized prostate cancer including watchful waiting, hormonal therapy, radiation therapy, radiation seed implantation, cryotherapy, nerve-sparing radical prostatectomy, and non-nerve-sparing radical prostatectomy. All of these treatment options are available at our institution. By combining the expertise of medical oncology, radiation oncology and urologic oncology into one multidisciplinary clinic at the Wertz Cancer Clinic (part of the Karmanos Cancer Institute), we individualize the treatment options for each patient.

In general, aggressive therapy in the form of radical prostatectomy is most useful for men in their 50's and early 60's because complete removal of the prostate (in men with cancer confined to the prostate) can usually be curable. In our database of over 1100 radical prostatectomy specimens, only 4% of men will relapse with cancer if their prostate is completely removed and the cancer is confined to the prostate. For younger men, we have excellent results in nerve-sparing radical prostatectomy to preserve potency in the majority of men. With modern surgical techniques, this operation requires only a three day hospital stay, blood transfusions are rarely needed, and there is a small (less than 5%) chance of urinary incontinence.

We are actively involved in newer methods to treat prostate cancer including radiation seed implantation (brachytherapy) and cryotherapy. These techniques have the advantage of being performed as outpatient treatments, and they allow many of our patients to receive potentially curative therapy without a hospital stay. Although these treatments are relatively new, our initial results are encouraging. In addition, through consultation with radiation oncologists in our multidisciplinary clinic, we offer a specialized form of radiation treatment called "neutron therapy." Our policy is to provide detailed explanations of all available treatments to our patients, and to help our patients come to decisions about the most appropriate form of treatment for their individual situation.

Locally advanced prostate cancer and metastatic cancer is treated through consultation in our multidisciplinary clinics. These treatment programs usually involve the combined expertise of urologic oncologists, radiation oncologists, and medical oncologists. Treatments are individualized, and research programs are available involving newer ideas and treatment strategies.