National Proactive Surveillance Network for Prostate Cancer Announced
PCF to launch national online program aimed at better treating men diagnosed with prostate cancer
May 27, 2010 -- The Prostate Cancer Foundation (PCF), in conjunction with Johns Hopkins Medical Center in Baltimore and Cedars-Sinai Medical Center in Los Angeles, today outlined plans for a National Proactive Surveillance Network (NPSN). Aimed at reducing overtreatment of patients and enabling healthcare services to direct more resources to those patients with more aggressive, life-threatening varieties of prostate cancer, the NPSN will provide a nationwide program for medical professionals to provide better tracking and prediction of disease progression in patients whose prostate cancer has a higher probability of being slow-growing and non-life threatening.
The $5 million program funded by PCF will utilize an effective proactive surveillance protocol developed by physicians at Johns Hopkins University Medical Center and a secure online site that patients and their physicians can privately access to enter, review and track their data on a regular basis. Built to be HIPAA compliant for patient privacy, the online interface will be available for use by the close of this year and available to any physician/patient team that wishes to access the network. Stuart Holden, MD, director for the Louis Warschaw Prostate Cancer Center at Cedars-Sinai Medical Center, and Ballantine Carter, MD, director of Adult Urology at Johns Hopkins, will serve as co-principal investigators for the program.
“We are excited to announce the formation of the National Proactive Surveillance Network,” explained Jonathan W. Simons, MD, president and CEO of PCF. “Until we have a better biomarker at our disposal for distinguishing between slow-growing and aggressive, life-threatening varieties of prostate cancer, this program will help us prevent overtreatment of patients, giving them more confidence in the screening tools we have today and their treatment decisions.”
According to Dr. Carter, older men with a PSA that is less than 15 percent of prostate volume and who have evidence of small-volume, low-grade cancer (Gleason score <6) on needle biopsy are candidates for proactive surveillance. Following enrollment, patients receive digital rectal exams and have their PSA levels analyzed at six-month intervals. An annual biopsy is also used to monitor disease progression. If the prostate biopsy reveals adverse features such as a high-grade cancer (Gleason score >7) or more extensive disease, patients are then advised to undergo curative treatment with radiation or surgery.
“Since inception of the program at Johns Hopkins, 800 men with an average age of 67 years have been enrolled in the program at a rate of 50-100 per year,” outlines Dr. Carter. “Fifty-six percent have remained active, 32 percent have undergone curative intervention and two percent have died of causes other than prostate cancer. Ten percent have either been lost to follow-up or have withdrawn from the program.”
In addition to providing an efficient model for proactive surveillance, the NPSN will collect and sort data blindly—with absolutely no patient name association—so researchers can analyze trends and the success of the program. Patient samples, including blood and urine, will also be analyzed and banked by Johns Hopkins University Medical Center on the east coast and Cedars-Sinai Medical Center in the west. Since Johns Hopkins’ program began in 2007, it has stored 2,439 samples from 472 men. The repository of blood and urine will support future biomarker and genetic studies.
Recent debate over PSA testing has stirred controversy and confusion over screening men for prostate cancer. But as Dr. Simons at PCF explains, “Every man has the right to know if he has cancer and to make informed decisions with his urologist. This requires a thorough dialog between patients, family members and urologists that weighs the pros and cons of screening and treatment options. Sometimes the best treatment is deciding that treatment is not needed. We believe the NPSN represents real solutions for the current problem and for healthcare reform overall.”
PCF experts have calculated that having the ability to distinguish between lethal and non-lethal or indolent varieties of prostate cancer might have saved an estimated $30 billion dollars between 1986 and 2005. With the tools to identify which patients had aggressive prostate cancer, overtreatment could have been avoided and more lives would have been saved by directing intensive care to those who needed it most.
Last year more than 27,000 American men died of prostate cancer; one every 19 minutes—and more than 192,000 new cases were diagnosed. There is also good news—with advances in awareness, new treatments and earlier detection and treatment, the death rate for prostate cancer has dropped by 40 percent of what was once projected.