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Source: Abby Sinnott
415-476-2557
17 December 1998
PATIENT PROFILE: FUNDS GENERATED AT "RAISING HOPE" SUPPORTS MUCH NEEDED CANCER RESEARCH
John Steinberg, an appellate lawyer in Berkeley, considers himself to be one of the healthiest people he knows. So when he was diagnosed with prostate cancer fifteen months ago at the age of 46--much younger than the average man who gets the disease--he was shocked. Because he felt so healthy, Steinberg didn’t bother to have a physical for eight years. But in 1993, when former junk bond king, Michael Milken, was diagnosed with prostate cancer at an early age, Steinberg realized that he too could be at risk for the disease and decided to pay a visit to his primary care physician just to be safe.
"When I first went to my doctor, he asked me, ‘Why are you here?’" Steinberg said. "But then it turned out that I had an elevated PSA (prostate specific antigen) level, so I suspected that I might have something wrong with my prostate and had a biopsy." A PSA test is a common blood test used to detect prostate cancer. If a man’s PSA level is higher than normal (0-4 range), a doctor usually recommends that he have a biopsy to determine if he has cancer of the prostate. Three biopsies later, Steinberg’s doctor still hadn’t found anything seriously wrong with his prostate. But Steinberg was still concerned, so his doctor suggested that he visit the world-renowned prostate cancer experts at the University of California San Francisco. "Once I got to UCSF, I could tell that people were much more knowledgeable about prostate cancer and they had the most sophisticated tests available," Steinberg said. "Based on a past sonogram I had, my doctor at UCSF saw suspicious areas that other doctors had missed and told me that I had a 50 percent chance of having prostate cancer. I was extremely fortunate to have had access to the best urologic oncology surgeons and physicians in the country."
The UCSF Cancer Center and Urologic Oncology program, part of UCSF Stanford Health Care, are unique from other facilities in the country because they practice a multidisciplinary approach to treating each individual patient and emphasize translational research. Members of the Urologic Oncology program include faculty from the Departments of Urology, Radiation Oncology, Radiology, and the Division of Medical Oncology. Clinicians and laboratory scientists are collaborating to better understand the genetic mechanisms underlying urologic cancer induction and progression to provide patients with the most effective treatments for the disease, including novel therapeutic methods.
For instance, one focus of current research at the UCSF Urologic Oncology program is the molecular pathology of prostate cancer-induced angiogenesis, which is the formation of new blood vessels that tumors need in order to grow. Researchers are also investigating a prostate estrogen receptor called ER-beta, with the goal of defining its role in the development of prostate cancer and as a possible target for treatment. Novel magnetic imaging technology for evaluating and diagnosing prostate cancer is also being developed at UCSF. In addition, UCSF Urologic Oncology researchers and physicians are leading over 20 clinical trials. The knowledge gained in clinical research translates directly into improved patient care and hopes for the future. In 1997, 91 UCSF prostate cancer patients were enrolled in national trials, and 69 in local clinical trials.
Statewide, the American Cancer Society estimates that there will be 18,860 new prostate cancer cases in 1999. In San Francisco alone, 630 men are expected to be diagnosed with the disease. In 1997, the UCSF Urologic Oncology program treated a total of 548 new prostate cancer patients, up from 489 in 1996.
"UCSF brings together the best researchers and physicians to provide the expanding patient population with timely, compassionate and innovative care incorporating existing and new treatment methods," said Peter Carroll, MD, professor and chair of the UCSF Urology Department, who was Steinberg’s surgeon.
Steinberg said that in the medical community, there is a strong debate about which treatment is more effective for treating prostate cancer--radiation therapy or surgery--because there is insufficient research about the effects of these treatments on younger patients. But for a man Steinberg’s age, most of the doctors he talked to recommended that he have his prostate completely removed through surgery.
"Dr. Carroll and another doctor at Stanford told me that having surgery was the best option for someone in my age group because the cancer was still confined to the prostate," Steinberg said. "But it was a very hard decision to make because there is a lack of research about the medical outcomes for men my age with prostate cancer."
He added that prostate cancer patients his age, although a small percentage of men with the disease, would benefit greatly from further research regarding treatment options so that it is easier for them to make treatment decisions.
Steinberg said that there also needs to be greater emphasis on PSA testing. Men under 50 are normally not encouraged by their doctors to have a PSA test because this population is unlikely to have the disease. In fact, some insurance companies do not even cover PSA tests for younger men because they believe it is unnecessary, he said.
In addition, compared to the amount of money spent on breast cancer research, and the high level of public awareness for women to conduct regular breast self-examinations, Steinberg said that prostate cancer prevention has a long way to go.
A study by the National Prostate Cancer Coalition found that in 1997 alone, more than $250 million in worthwhile prostate cancer research could not be conducted due to a lack of financial resources. In 1997, roughly $1700 was spent on prostate cancer research per death from the disease. This effort lags significantly behind funding for other illnesses such as breast cancer in which nearly $12,800 per death was spent on research. During the past decade, the U.S. spent $2 trillion on defense and $73 billion on the space program. Only $12 billion was spent on cancer research; of that, about two percent was dedicated to prostate cancer research. According to Michael Milken’s philanthropic organization committed to funding prostate cancer research, CaP CURE (The Association for the Cure of Cancer of the Prostate), a life is lost to prostate cancer in this country every thirteen minutes. In 1998, an estimated 39,200 men are expected to die of prostate cancer.
"It is shocking to me that some men don’t even know what a PSA test is," Steinberg said, who is currently disease-free and has an undetectable PSA level. "Men often do not take responsibility for their own health and only wait to get checked out when something is obviously wrong. Prostate cancer is a silent killer, and if you wait until it is already advanced, it’s usually too late."
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