July 2006-This year alone, nearly 250,000 men will be diagnosed with prostate cancer in the U.S. and almost 30,000 will die as a result of the disease, making it the leading cause of cancer deaths in men in this country. It’s the most common cancer in men, excluding skin cancer, striking 1 in every 6 American men at some point in their lives.

According to a recent survey conducted by the Prostate Cancer Foundation, based in Santa Monica, California, almost one in three men (30 percent) over age 50 – the age when the risk begins to increase rapidly—is mistakenly waiting for symptoms to develop before they get screened for prostate cancer . However, most men experience no symptoms in early stages of the disease, when more treatment options are available. A recent Foundation survey found even that among men with a family history of prostate cancer, 1 in 5 has never discussed this family history with his physician. "We’re in a race against time," notes Leslie D. Michelson, CEO of the Foundation. "Baby boomer men are rapidly moving into the target zone for prostate cancer, and both men and women need to appreciate the significance of this disease.”

But there is much positive news in the battle against this disease. Thanks to early detection and new treatment options, the number of men who die from prostate cancer has decreased 3.5% per year for the past several years. In addition, 91% of prostate cancer is diagnosed when the disease is still confined to the prostate or nearby organs. For men diagnosed and treated at this early stage, the five-year survival rate is nearly 100%.

Cells hold the answer to getting the jump on disease
As scientists have delved deeper into the structure and behavior of human genes, they have discovered a number of molecular changes in tissue affected by cancer. These discoveries are helping doctors refine their diagnoses and more effectively tailor treatment to fight the specific process of diseases and exploit their molecular “weak links.” They are also allowing patients to make important decisions about treatment, for example whether or not to undergo chemotherapy.

One organization at the forefront of this work is the Molecular Profiling Institute, a PinnacleCare resource. Scientists at the institute use the discoveries brought to light by the human genome project to develop and offer laboratory tests that allow physicians to employ treatments that more accurately target each individual’s disease.

“The underlying cause of each patient's disease is typically unique to the individual. We provide advanced analysis and tools to better help the physician determine the molecular characteristics of each patient's disease so that they may better tailor a more effective medical strategy specific to the individual,” states Todd Maney, Director of New Product Development, Molecular Profiling Institute.

One example of their work is the PCA3 ProfileRTM, a new diagnostic tool for prostate cancer. “Until recently, men who had a high PSA level but a negative prostate biopsy didn’t have the tools to determine if the biopsy was a false negative or the PSA level was elevated because of another non-cancerous condition like an enlarged prostate,” Maney explains.

“PCA3 is a gene specific to the prostate that is over expressed in prostate cancer, but unlike PSA, not in response to other prostate conditions. The PCA3 ProfileR measures the expression of messenger RNA (mRNA) from the PCA3 gene via urinalysis, making this test much more specific than the PSA screen,” says Maney. “The goal of this new tool is to help physicians more effectively diagnose prostate cancer as early as possible when faced with patients with high PSA levels and negative biopsies. In fact, the overall accuracy of the PCA3 ProfileR is 70% compared to 35% for the serum PSA test.”

The Institute is also currently investigating the correlation between the PCA3 level and the aggressiveness of the cancer. If proven, this would have a significant impact on how prostate cancer is treated. For example, notes Maney, a large percentage of men in their 70s and 80s have prostate cancer, but for many, the disease in not particularly aggressive and does not necessarily warrant treatment. If a high level of PCA3 equates to more aggressive disease, treatment would be recommended while those with a low level could choose to simply have their disease monitored.

Potential Value in Lowering PSA Level Standard for Biopsy Referrals
Beyond molecular diagnostics, there are a number of advances in the diagnosis and treatment of prostate cancer worthy of note. “As part of the ten-year Prostate Cancer Prevention Trial which studied whether the drug Finasteride could prevent the development of the cancer, an additional important finding was uncovered,” notes Peter Carroll, MD, Professor and Chair, Department of Urology, University of California, San Francisco, a PinnacleCare Center of Excellence.

“The trial did show that Finasteride reduced the risk of developing prostate cancer by 25% for most participants, but it also revealed that the current cut-off of 4 for PSA levels is too high. Fifteen percent of men in the study with normal exams in fact had cancer. A level of 2 to 2.5 is more appropriate for referring patients for biopsies. By lowering the ‘normal’ PSA level, combined with increasing the number of biopsy punches taken per test, we could increase early detection 17%, catch the disease when it is more curable and appropriately match the treatment to the patient and the cancer.”

In the not too distant future, Dr. Carroll also sees the increasing use of novel, multi-modal care for people who have failed standard treatments and an ability to better pinpoint and localize treatment for prostate cancer with advances in imaging which will allow for an approach known as “male lumpectomy.”

“We will use focal therapy and decrease the risk of bowel, bladder, and sexual side effects. Research into genetic markers will help us pinpoint the type of cancer a patient has. Many prostate cancers will be managed as a chronic condition with treatments tailored to the specific type of cancer present,” he adds.

An advocate in your corner can make the difference
PinnacleCare Members have a unique advantage when it comes to facing the questions and concerns a prostate cancer diagnosis raises. Each Member’s personal advocate works with him every step of the journey, from the diagnosis through the research of treatment options and gaining expedited access to the top clinicians and hospitals.

Explains Nik Schliep, a PinnacleCare Member, "My life changed dramatically a couple of years ago. I found out I had an unusual case of prostate cancer, and my doctors presented conflicting treatment options. As I have come to learn, treatment for cancer is often based on subtle sequencing of treatments and dosages that are not written down in a science book. It is more dependent on a level of experience that comes from treating hundreds of similar cases. The great thing about PinnacleCare is that they will be on top of the latest treatments and will help guide you through your options. They are not tied to any one medical institution and that institution’s philosophy of care. They’ll simply find the best and most experienced wherever they may be. My life depends on getting the best new treatments as quickly as possible. I will count on PinnacleCare to make sure that I do."

When another Member joined PinnacleCare, his PinnacleCare Advocate™ noticed he had borderline PSA levels indicating the possible presence of prostate cancer. The Member was not ready to address the situation, but his Advocate felt strongly that he should have further diagnostic testing and discussed the importance of the follow-up with the Member. PinnacleCare was able to get the member to a specialist for a biopsy and consultation. When the tests came back positive for prostate cancer, his Advocate team assisted him in weighing his options for treatment and finding him the best specialists.

“When a person is diagnosed with cancer, the most common reaction is to freeze like a deer in headlights. Even people who run billion dollar companies and make tough decisions every day often aren’t sure what to do when they are diagnosed with cancer,” explains Nuran Saydam, PinnacleCare’s Vice President of Member Services. “What we do is research and bring together information on all the treatment options available. Our goal is to provide both information and support. We help Members understand the disease they are fighting and available treatments, then it’s our job to help carry out their chosen course.”

IMPORTANT NOTE: PinnacleCare does not practice medicine. PinnacleCare holds in high regard the physician-patient relationship as the fundamental key to the finest treatment and compassionate care. Our role is to support that relationship and our Members’ choice with experienced healthcare advocacy, full information and expert coordination of their health providers’ care.