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Man-ogram for Prostate Cancer.
Effort Launched to Find 'Man-ogram' for Prostate Cancer
Dr. Faina Shtern of the National Institutes of Health, Harvard Medical School, and founder of AdMeTech, a non-profit foundation for the promotion of advanced medical technology, is the driving force behind the conference and public awareness campaign.
The campaign, under the slogan, “Where’s our Manogram(TM)?” involves a partnership between Dr. Shtern, AdMeTech and three advocates who bring their media expertise to the table; Madison Avenue veteran Larry Kopald, physician and TV journalist Dr. Bruce Hensel, and Hollywood producer Stephen Nemeth.
Members of Congress spoke in support of the project, including Rep. Gwen Moore (D-WI), Rep. Tim Murphy (R-PA), and U.S. House Delegate from the Virgin Islands, Dr. Donna Christensen, who lost her father to prostate cancer.
Why a ‘Manogram’?
Conference presenters claimed that since the mammogram has been introduced to detect and locate breast cancer, the size of tumors at diagnosis has been cut by more than half, and often a lumpectomy can be used, where previously a radical mastectomy would have been required.
Current screening for prostate cancer relies on the PSA, a blood test that reveals elevated risk and can save lives, yet is imprecise and can generate uneccesary biopsies, and the DRE, a physical exam many men find uncomfortable, possibly causing some men to avoid screening all together. Prostate cancer treatment involves removal or radiation of the entire prostate, and more often than not results in damage to surrounding nerves and organs involved in urination and proper reproductive function.
The discovery of better imaging technology, and the widespread application of screening technologies now under investigation, could improve this situation and provide other benefits, as described in detail by the many presenters at this three day conference.
What is Imaging Technology?
Prostate cancer imaging involves a group of scanning, targeting and image processing technologies, all designed to reveal the location of cancer cells and create accurate images of cancer tumors. Researchers are developing new scanning tools and new ways to make current tools like MRI, CAT, PET and Ultrasound scans more effective.
The ongoing laboratory discovery of molecular markers and proteins that are specific to, and can help identify prostate cancer, has allowed for the targeting of cancer cells with ingestible radioactive dyes and nanotechnology, giving advanced computer programs data to process into accurate and multidimensional images.
Progress is being made, but more investment is needed to make these technologies available and affordable. Funding for research is key, but so are issues like expiditing FDA approval, standardizing interpretation of results, confirming efficacy through large scale clinical studies, doctor and patient education, and other hurdles to widespread adoption.
Screening and Diagnosis
The PSA test can screen for people who need further examination, and the rate of increase in PSA can suggest faster growing cancers, but a biopsy is still needed to determine if a rising PSA level is due to cancer or other causes. Making imaging tools more available and affordable could improve screening accuracy when combined with the PSA test.
Now, the biopsy involves 6 to 24 or more samples taken from different locations in the prostate, but it is still possible to miss the cancer. Researchers hope using imaging to direct biopsies will reduce the number of samples needed and lower rates of error. (Editor's Note: This can currently be accokmplished by having a color doplar run and if pertinent having the biopsy using this imaging technique..)
Targeting Treatment
In addition to diagnosis, advanced imaging could provide the means to better treat cancer cells without damaging surrounding tissue. Image guided external beam radiation treatment or placement of radioactive seeds increases accuracy. New technology could also help surgeons reduce the area they have to remove to safely treat cancer, or find cancer in other areas that might otherwise have been missed.
Some types of imaging technology locate, reveal and even treat the cancer cells, wherever they are found. Photodynamic drugs attach themselves to cancer cells, and then heat up, killing the cancer cells, when a specific type of light is applied to them. Nanotechnology is being developed that could find cancer cell markers, send out signals revealing their location, and even deliver payloads of cancer killing medications.
Measuring Success
Another role for imaging technology, is that of “surrogate endpoint” for research studies. Currently, prostate cancer clinical research has to use survival rates as the determination for success of a given treatment, requiring years or even decades, to demonstrate results.
Many argue for the use of PSA velocity as an indicator, as it is a sign of disease recurrence that is proving to be more and more useful. Accurate imaging could also reveal the presence and spread of the disease, allowing researchers to determine success of treatment in a shorter time period, accelerating the research process for all prostate cancer treatments.
Questions Remain
Some questions remain about where to go from here. Can ad campaigns increase public demand for products that aren’t yet widely available? Should the government step up funding for imaging research? Should companies invest more in making these technologies available, if they stand to reap profits from their use? What hurdles exist to widespread affordable use, and what can be done to remove them?
Clearly potential exists to improve treatment for prostate cancer and other cancers through better imaging technology. What is less clear is the path ahead. The conference bringing together researchers, advocates and industry representatives raised questions that needed to be raised, and was a solid first step toward finding answers.
Source: Antonia Scatton
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