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The quest for the best cure

New trial seeks to determine best cure for prostate cancer in terms of survival and quality of life

originally posted on September 1, 2002

ANN ARBOR, MI - This year, more than 180,000 American men will be diagnosed with prostate cancer. Another 35,000 will die because of it.

Now, for the first time, a national trial will compare two major forms of prostate cancer treatment to determine which is the most effective cure.

The SPIRIT trial, to take place at multiple prostate cancer centers across North America, will compare seed implant therapy to the surgical removal of the prostate, or prostatectomy, says Martin Sanda, M.D., a urologist and associate director of the University of Michigan Health System's Prostate Cancer Program.

The trial was developed through collaboration between urological surgeons and radiation oncologists at the University of Washington, Princess Margaret and Sunnybrook Hospitals in Toronto, Duke University and University of Michigan. It hopes to enroll 2,000 patients across the United States and Canada.

"We know both options are effective ways to treat prostate cancer," says Sanda. "What we don't know is how they will compare two, five or 10 years after treatment, in terms of their effects on survival and quality of life."

The prostate gland is found only in men. It's about the size of a walnut and is located below the bladder in front of the rectum. The urethra, the tube that carries urine, runs through it.

Cancer occurs when cells in the gland begin to grow out of control. Most of the time, prostate cancer grows very slowly. Occasionally, though, it can grow quickly and spread to other parts of the body like the lymph nodes or other organs.

Because it grows at different rates, how an individual patient's prostate cancer behaves is critical to determining whether he is eligible to participate in the study.

Those who are eligible to participate in the study will be randomly assigned to receive one of the two treatments.

Seed implant therapy involves inserting tiny radioactive seeds into the prostate. The first step, says Patrick Mclaughlin, M.D., a radiation oncologist at the UMHS, is to take a picture of the prostate gland. "Since prostates range in size, we use the image to determine how many seeds should be implanted and where they should be placed."

Several seeds are implanted during an operating room procedure. Checks are done to make sure the seeds are in the right place. This procedure allows the patient to go home the same day, but several additional follow-up scans are necessary to confirm the seeds are indeed where they are supposed to be.

"The outcome of this procedure is directly related to the quality of the implant," says Mclaughlin. "Good implants are very, very effective at curing the cancer."

In contrast to seed implant therapy, prostatectomy involves the removal of the prostate gland during a two- to three- hour procedure. After the prostate is removed, the bladder and the urethra are reattached.

"For most patients, this is the only treatment they'll ever need, and it's unlikely their cancer will ever reoccur," says Sanda.

Some of the common side effects of either prostatectomy or seed implants include erectile dysfunction and temporary urinary problems.

The SPIRIT trial won't just use cancer survival rates to determine the most effective cure. Researchers also will use confidential patient surveys to evaluate patients' quality of life and the presence of side effects after seed implant therapy and surgical removal of the cancer.

"We've come to a juncture where providing quality care goes beyond just curing the cancer," says Sanda. "Now, we want to do more. We want to cure the cancer and know the patient has a high quality of life and an outcome with which he can be happy."

To learn more about research studies conducted at UMHS, contact the U-M Comprehensive Cancer Center at 1-800-865-1125; or visit the Cancer AnswerLine™.

Facts about prostate cancer:

  • One in eight men will develop prostate cancer, making it the most common form of cancer among American men.
  • Roughly 60 percent of prostate cancer cases diagnosed are in men over the age of 60.
  • African Americans and those with a family history of prostate cancer are also at increased risk.
  • Men should begin to consider prostate cancer screening at about age 50. Those who are of African-American origin or with a family history of prostate cancer should begin in their mid-40s.
  • There are usually no symptoms of prostate cancer when it is in its early stages. Symptoms of advanced disease include blood in the urine, unexplained weight loss and pelvic or bone pain.

Written by Gretchen Siebert


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