Prostate Priorities

By Sanjay Gupta

NEXT TO SKIN cancer, prostate cancer is the most common cancer in men--so common that a man in the U.S. is 33% more likely to get prostate cancer than a woman is to get breast cancer. Yet in many ways, treatment of prostate cancer lags behind that of breast, colon and brain cancer. That's why the Prostate Cancer Foundation last week issued a call for a new approach to the disease, which already afflicts 2 million American men and will strike 230,000 more this year.

These are confusing times for prostate-cancer patients and doctors alike. The field was rocked this summer when a study in the New England Journal of Medicine reported that the widely used PSA (prostate-specific antigen) test had a major problem: 15% of patients with scores low enough to be considered cancer free turned out to have prostate cancer, and 15% of those had aggressive, high-grade tumors. It now seems that the PSA's rate of increase over time may be a more valuable measure than the raw number itself. But doctors clearly need to develop better diagnostic tests, says Dr. Peter Carroll, executive editor of the foundation's report. They also need better ways to determine which cancers are growing so quickly that they must be removed and which are growing slowly enough to be left in place.

Doctors also need to start talking to one another. I was surprised to learn that the various specialists who get involved in treating prostate cancer--urologists, radiation oncologists, medical oncologists--rarely consult with one another. The team approach has become standard in treating breast, colon and brain cancer, mainly because it works. "Having multidisciplinary care leads to a better outcome," says Carroll. His foundation emphasizes in particular that patients who are undergoing hormone therapy and have rising PSAs should consult a medical oncologist.

One in 6 American men contract prostate cancer at some point in their life. And although there is no shortage of famous people who have succumbed to the disease--punk rocker Johnny Ramone, who died at age 55 two weeks ago, immediately comes to mind--there are also plenty of prominent survivors, including John Kerry (who had his prostate removed) and Rudy Giuliani (who opted for radiation therapy). Both men are doing just fine.