The 2007 National Conference on Prostate Cancer
2007 Conference Earns Accolades
by Jim O’Hara, PCRI Educational Facilitator

When PCRI hosted the 2007 National Conference on Prostate Cancer in Los Angeles on September 7-9, at least one attendee pointed out that describing it as a national conference was a bit misleading since attendees came from at least 11 foreign countries, including England, Sweden, Afghanistan and Argentina. While most of the more than 700 conference attendees came from 34 U.S. states in general and the Los Angeles area in particular, many men, their partners, and family members did travel hundreds or thousands of miles to be part of this unique learning experience.

Overall, the comments from the attendees indicated the event was a resounding success.

• "Excellent roster of speakers; diverse topics covering virtually all areas of interest to PC patients."
• “Best organized and most informative conference we have ever attended. We are saddened and frustrated that more urologists do not make themselves informed of this wealth of information as they are the first and often the only contact with PC patients.”
• “ PCRI is to be congratulated for its leadership in bringing together this comprehensive and professionally run conference.”

The agenda provided a roadmap from diagnosis to advanced disease following the theme - “State of the Art Treatments: Making a Positive Impact on Quality of Life”. The speakers presented a fast-paced, in-depth look into 19 different topics but kept the language at a level that the majority of the audience could comprehend. After the talks, the speakers were available for questions in the Exhibit Hall. All attendees received a data CD containing most of the speaker slides for later review.

Many attendees took the opportunity to participate in support group sessions conducted by UsTOO on Friday evening and during lunch on Saturday and Sunday. Separate groups convened to discuss topics on “General Prostate Cancer”, “Advanced Disease” and “Companions & Family” during each time slot. One attendee commented: “The networks that arise among the participants at the conference … are extremely important to men and significant others.” Our thanks to Jack Hudspeth, Russ Gould, and Elizabeth Cabalka for facilitating these sessions.

A CME program was sponsored by Community Memorial Hospital of Ventura. Up to 20 hours of credit were awarded to medical professionals who participated.

The Gala Dinner on Saturday evening was a major highlight of the conference. Dr. Donald Coffey, the recognized “Dean” of prostate cancer research gave an entertaining and thought provoking look at cancer treatment trends for the future. He was followed by “America’s Tenor”, Steve Amerson, who provided an inspirational program of music from Broadway shows and American favorites.

A number of attendees extended their Los Angeles experience by taking part in three special excursions to the Hollywood Bowl for the opera Boris Godunov, to Warner Brothers for a VIP Studio tour and to Hollywood via a Starline evening tour.

The PCRI wishes to thank all who attended, our volunteers and our 17 speakers. We are especially indebted to our sponsors, partners, exhibitors and special donors whose generous support made the conference possible.

For conference details and complete agenda:

 

Highlights of the Talks

Friday Afternoon: Getting a Perspective

Color Doppler Biopsy Demonstration
Three live procedures demonstrated how “state of the art” imaging visualizes the prostate gland more clearly to improve diagnosis and staging. Dr. Duke Bahn showed that when abnormalities are detected, a needle biopsy can be directed specifically to the area, resulting in more precise findings than random biopsy. Tumor size and location can be measured precisely and can be monitored objectively. Dr. Fred Lee stated that the size of cancer is the most potent factor in predicting survival, regardless of Gleason.

Prostate Pathology

Dr. David Bostwick explained “Triple Immunostain”, which he believes will emerge as the standard for differentiating difficult cases. He also discussed the benefits of the PCA3 urine test that is rapidly being accepted into clinical practice. The Gleason score has long been the standard for evaluating prostate cancer biology. He provided a humorous look at Gleason grading using Krispy Kreme™ donuts (not a PCRI diet suggestion).

Staging, Risk Management, and Active Surveillance

Dr. Mark Scholz discussed the factors and testing that should be considered to properly stage prostate cancer. He discussed the treatment options of surgery, IMRT, seeds, cryotherapy, testosterone blockade, chemotherapy, and active surveillance, pointing out their advantages and disadvantages. When properly monitored, forgoing immediate treatment is rapidly gaining acceptance as a bona fide option. Delaying treatment in this era of rapid technological advances allows time for the development of new, less toxic forms of therapy. Men become motivated to implement positive dietary and lifestyle changes that may alter the course of the disease.

Navigating Medicare

Dr. Arthur Lurvey identified the diagnostic and therapeutic services related to benign prostate disease and prostate cancer detection and treatment available under the Medicare program.  He reviewed the Internet access to navigate the system and obtain the available benefits.

 

Saturday Morning: Prostate Cancer Essentials

Minimizing Prostate Cancer through Diet

Dr. T. Colin Campbell discussed research that suggests a diet low in animal protein can prevent the development of cancer. His research also shows that this type of diet suspends or even reverses cancer growth in its late stages. Moreover, Dr. Campbell spoke about plant-based diets and how they can help ward off a plethora of chronic illnesses.

Magnetic Resonance Imaging

Dr. John Kurhanewicz explained how Magnetic Resonance Spectroscopic Imaging (MRSI) combined with traditional MRI can significantly improve the clinical assessment of prostate cancer including location, volume and aggressiveness. The use of stronger magnetic field scanners increases the ability to detect even smaller cancers by improving spatial resolution. Several research centers are also developing other methods to further improve the accuracy of prostate MRI/MRSI.

Impact of Supplements

Dr. Charles (Snuffy) Myers stated that, while antioxidants and anti-inflammatory agents are reported to slow the progress of prostate cancer, these agents remain unproven as treatment for prostate cancer. He commented on a number of supplements offered via the internet that are problematic. His experience with vitamin D suggests that the supplement industry, with few exceptions, cannot be depended on to deliver a quality product. He went on to describe the Mediterranean diet as one that has been demonstrated to promote male longevity and slow the growth rate of prostate cancer. He discussed various elements including fish, tomatoes, wine and pomegranates. He reviewed the need for measuring and supplementing Vitamin D in his patient population.

Low-Impact Pharmaceuticals

Dr. Stephen Strum stated the prime directive in medicine relates to the concept of Therapeutic Index, Benefits of Treatment ÷ Adverse Effects of Treatment. Combination therapies open the door to the possibility of synergism between drugs—including both conventional anti-cancer drugs and others that function through various mechanisms such as signal transduction, apoptosis, and anti-angiogenesis. He discussed a variety of common pharmaceuticals that may provide significant benefit at each stage from prevention to advanced disease including: Proscar/Avodart, statins, alpha-blockers, Celebrex, and calcitriol.

 

Saturday Afternoon: Intermediate Risk Disease

Robotic Surgery

Dr. Mark Kawachi presented an intriguing look at robotic prostatectomy through a series of videos showing key procedures of actual operations. He clearly demonstrated the capabilities and also the requirement for significant experience. He stated that there are about 500 robots in the USA yet most are doing less than 20 prostatectomies per year. He suggested 250 procedures as a good base level in seeking a surgeon.

IMRT/Brachytherapy

Dr. Christopher Rose discussed advances in MR and CT imaging technology that have provided unequivocal localization of the prostate gland, seminal vesicles, and associated lymph nodes. Now, IMRT radiation can be deposited, at higher doses, directly in the vicinity of tumor bearing structures while limiting the dose to the surrounding bladder and rectum. “Image-Guided Radiation Therapy”, such as “Helical tomotherapy”, allows the patient to be relocated immediately before or during treatment to allow for prostate movement.

Brachytherapy represents absolute conformality and the ultimate form of motion management. Computer algorithms that can run on powerful laptop computers in the operating room have provided radiation oncologists a way to do real time intra-operative planning.

Focal Cryotherapy

Dr. Bahn reviewed the results for “focal” cryoablation, the partial freezing of the gland in patients whose prostate cancer is unilateral. Recent studies indicate that focal cryoablation may be more effective than bilateral nerve-sparing prostatectomy in preserving potency in appropriately selected patients. He also discussed his research in immunotherapy that takes advantage of antigens displayed by cancer cells destroyed by cryotherapy. Dendritic cells injected into the tumor site at the end of the cryotherapy procedure have resulted in regression of metastatic tumors in pilot studies. A clinical trial is expected to start in 2008.

Primary Intermittent Testosterone Deprivation

Dr. Strum stated that ADT is the only primary treatment that has a therapeutic effect on microscopic metastasis, the cancer cells that may have already spread outside the prostate. Unlike surgery and radiation, the side effects of ADT are generally reversible. Treatment with ADT suppresses cancer growth while opening up the possibility for future yet-to-be-discovered treatments that will be less toxic. He reviewed the importance of enhancing “Therapeutic Index” by understanding how the side effects of ADT can be minimized. He emphasized the significance of reaching and maintaining a low PSA nadir.

 

Sunday Morning: Management of Aggressive Prostate Cancer

Cardiac Issues for Prostate Cancer Patients

Dr. Matthew Budoff stated that the first sign of problems is often a heart attack. Risk can be reduced 80% with appropriate life-style changes and medication. Stress tests only identify heart conditions when it is too late to treat prophylactically. The “calcium scan” is a simple non-invasive test that allows measurement of the plaque building up in the heart. The ability to detect coronary artery calcification allows physicians to implement lifestyle changes and start effective medications at an early stage so that progression to overt symptomatic heart disease can be prevented. For patients with known heart disease, a measure of the degree of blockage can be obtained by doing a “Virtual Angiogram.” The images obtained enable the physician to visualize the inner contour of the arteries and to detect “soft” (non-calcified) plaque.

Adjuvant Chemotherapy and Taxotere Combinations

Dr. Richard Lam discussed how good results obtained with Taxotere alone can be further enhanced when Taxotere is used in combination with other active agents, He reviewed the results of ongoing study including: Carboplatin, Avastin, calcitriol & DN101, Thalidomide, Xeloda, DMXAA, and Quadramet. He also discussed Satraplatin as a secondary chemotherapy agent. He commented on treatment side effects and summarized with the statement that “Hormone- refractory prostate cancer can still be managed as a chronic disease”.

IMRT for Oligo-metastasis and Lymph nodes

Dr. Rose explained how the treatment of both the primary and limited numbers of metastatic sites may allow for both long-term survival and good quality of life. He provided information on the use of IMRT and IGRT with innovative imaging to treat lymph nodes and small numbers of bony metastases with the same technology that is used to target localized prostate cancer.

Oral Agents

Dr. Myers explained that the increase in the number of oral agents is because some drugs work by mechanisms that require the drug to be present continuously. Also, changes in how Medicare pays for cancer treatment may mean that the costs of administering intravenous drugs may not be covered.

Oral drugs for prostate cancer that are available, or in development, attack the cancer in one of several ways. Celebrex at high doses has a mild antiangiogenesis effect. Sutent is much more active and blocks VEGF, the major protein controlling angiogenesis in patients. Phenylbutyrate and phenylacetate work by forcing the cancer back toward more normal behavior resulting in slower cancer growth and less chance of metastatic spread. Revlimid is a new and improved thalidomide with fewer side effects and greater anticancer activity. Ketoconazole and the antiandrogens are active agents that block the androgen receptor or adrenal production of testosterone precursors. Satraplatin shows promising activity in patients who fail Taxotere. Zyflamend, however, has not demonstrated acceptable level of activity or safety.

Harnessing the Immune system

William Cavanagh gave an insightful look into the immune system components and functions. Successful immunotherapy of cancer requires not only the stimulation of the “cytotoxic” immune system – vaccine and cytokine therapy – but also a targeted depletion of the “regulatory” immune system. The first step is to identify tumor associated antigens as target for the cytotoxic system. Active agents that modulate the “regulatory” system are presently on the market (Leukine®, Cytoxan®) or are in the late stages of developmental research (dendritic cells, CTLA-4).

 

Sunday Afternoon: What’s in Store for the Future

Exciting New Agents in the Research Pipeline

Dr. Howard Soule discussed major advances in technology that have propelled the biological understanding of cancer to unprecedented levels. But he sounded an alarm that Federal support is waning at this hopeful time. He identified several drugs in the pipeline with much promise including: (1) BMS 641988, a direct androgen receptor antagonist; (20 Medivation 3100, which blocks androgen receptor binding to DNA; and (3) Abiraterone, which blocks steroid hormone synthesis so effectively that serum testosterone becomes undetectable.

The conference closed with a Multi-Disciplinary Round Table featuring case presentations and questions from the audience.

 

Prostate Cancer Research Institute (PCRI)

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