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American Reinvestment and Recovery Act

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Additional Recovery Act Resources from NIH

NIH and the Recovery Act
NIH RePORT

Prostate Cancer: Recovery Act Investment Report

November 2009

Public Health Burden

Prostate cancer is the most common cancer in men in the United States. In 2009, it is estimated that more than 190,000 new cases of this disease will be diagnosed among American men, and it will cause more than 27,000 deaths. Prostate cancer incidence and mortality are both substantially higher among African American men than among men of other racial and ethnic groups.

Screening/Diagnosis

The prostate-specific antigen (PSA) test is widely used to screen for prostate cancer, although routine use of this test in prostate cancer screening is controversial. Most men who have an elevated PSA blood level do not have prostate cancer (false-positive test results), whereas some men with a low PSA level actually do have the disease (false-negative PSA test results). Moreover, in most men who have prostate cancer, the disease grows very slowly. Even without treatment, many of these men will not die of prostate cancer, but will live with the disease until they eventually die from some other cause. Consequently, many men with abnormal PSA test results or prostate cancer diagnosed as a result of abnormal PSA tests will be subjected to the harms of invasive follow-up procedures or unnecessary treatments, such as surgery or radiation therapy. Therefore, more accurate ways of detecting prostate cancer early and distinguishing aggressive cancers that should be treated from slow-growing tumors that may not require treatment are needed. ARRA funding is supporting research that addresses both of these issues.  For example:      

  • A project in which patterns of protein fragments (peptides) in blood samples are being analyzed to identify patterns that may be useful in detecting prostate cancer and breast cancer and in distinguishing aggressive from non-aggressive disease.(1)
  • A project to develop a panel of biomarkers that can be assayed in prostate biopsy specimens that contain Gleason grade 3 cancer to predict whether higher-grade disease exists elsewhere in the prostate; such a panel will help distinguish cancers that can be monitored with active surveillance from those that need immediate treatment.(2)

Treatment

Current state-of-the-art treatment for prostate cancer provides prolonged disease-free survival for many patients who have localized disease, but it is rarely curative for patients who have more extensive tumors. In addition, a substantial percentage of patients will develop disseminated disease after local treatment with surgery or radiation therapy, even when the cancer appears confined to the prostate gland. Metastatic disease is currently not curable. Therefore, more accurate ways of identifying the extent of disease and additional treatments for prostate cancer are urgently needed. ARRA funding is supporting research in these areas. For example:

  • A project to develop nanoparticles that will help surgeons better define tumor margins, identify residual tumor cells and micrometastases, and determine more accurately whether a tumor has been completely removed; this work has relevance to prostate and other cancer types.(3)
  • A phase I/II clinical trial, conducted under NCI's Accelerating Clinical Trials of Novel Oncologic Pathways (ACTNOW) program, of metastatic prostate cancer treatment with a monoclonal antibody directed against the type 1 insulin-like growth factor receptor (IGF-1R) and an inhibitor of MTOR; IGF-1R and MTOR are components of signaling pathways that regulate cell proliferation, survival, and motility.(4)

Comparative Effectiveness Research

Little information exists regarding the comparative effectiveness of treatments for early-stage prostate cancer, including their impact on patient health-related quality of life and their cost effectiveness. ARRA funding is helping to address this knowledge gap by supporting the following kind of research:

  • A study to compare the effectiveness of prostatectomy, radiotherapy, and brachytherapy in the treatment of early prostate cancer (i.e., cancer that has not yet spread), taking into account the symptoms and the quality of life that patients experienced before treatment.(5)

Health Disparities

Prostate cancer disproportionately affects African American men, who have incidence and mortality rates that are 1.6- and 2.5-times greater, respectively, than the rates for white men. ARRA funding is supporting activities to address this important health disparity. For example:

  • A project to develop a strong Community Network Program (CNP) that will improve access to and utilization of beneficial interventions to increase screening, early detection and diagnosis, and treatment for prostate and other cancers that adversely affect older, underserved, African American adults.(6, 7)
  • Research to finds ways to improve communication and shared decision-making skills for African American men with low literacy, including the revision of prostate cancer education materials to make them more accessible to men with low literacy skills.(8)

Genomic Research

Identification of the genetic factors that underlie the development and progression of prostate cancer will help us understand why different groups, such as African Americans, have higher rates of this disease and will provide valuable information to inform the development of new treatments. ARRA funding is also supporting this vital research. For example:

  • A study of the global genetic and epigenetic changes that occur in prostate cancer progression; the results of this study should also help facilitate the identification of patients in whom prostate cancer will likely progress and, therefore, who are not candidates for conservative management.(9)
  • A project to identify genetic factors that contribute to prostate cancer risk in African American men.(10)

Selected References

  1.  3U24CA126485-04S1 — Assessment of serum peptide profiling to detect cancer-specific patterns — Tempst, Paul (NY)
  2.  1RC2CA148086-01 — Biomarker prediction of Gleason upgrading — Trock, Bruce J. (MD) 
  3.  1RC2CA148265-01 — Nanotechnology for multiplexed and intraoperative cancer detection — Nie, Shuming (GA)
  4.  U01CA069856 — Phase I/II trial of anti-IGF-IR monoclonal antibody IMC-A12 plus MTOR inhibitor CCI-779 in chemo-naive, castrate metastatic prostate cancer — Spriggs, David (NY)
  5.  1RC1CA146596-01 — Effectiveness of early-stage prostate cancer treatment — Sanda, Martin G. (MA)
  6.  3U01CA114583-05S2; 3U01CA114583-05S3 — CNP for older underserved African American Adults — Albrecht, Terrance L. (MI)
  7.  3U01CA114583-05S2; 3U01CA114583-05S3 — CNP for older underserved African American Adults — Albrecht, Terrance L. (MI)
  8.  1R21CA132671-01A1 — Prostate cancer health literacy in rural versus urban African American men — Kilbridge, Kerry Laing (MA)
  9.  91R01CA133066-01A1 — Global genetic and epigenetic approaches to progression of prostate cancer — Liu, Wennuan (NC))
  10.  101RC2CA148085-01 — Expanding resources for understanding the genetic basis for prostate cancer in AF — Haiman, Christopher Alan (CA