New treatment options help battle a killer: prostate disorders

Drug Store News, July 14, 1997 by Ken Rankin

The graying of the U.S. population has produced a disturbing rise in the incidence of disorders of the prostate, resulting in a growing demand for new pharmaceuticals and other treatment options for these conditions.

The prostate, a walnut-size male sex gland located just below the bladder, is vulnerable to a variety of disorders that cause pain and sexual dysfunction in millions of American men, and threaten the lives of hundreds of thousands of others.

These conditions include benign pro static hyperplasia, an enlargement of the prostate that can cause impotence and urinary difficulties, and prostatitis, a non-fatal swelling of the gland that tends to afflict younger men.

The most serious of these disorders, however, is prostate cancer--a disease that accounts for 27 percent of all cancer cases diagnosed in the United States, and that ranks second only to skin cancer as the most common type of cancer afflicting American men.

Every 13 minutes another American man dies of prostate cancer, and every three minutes another case of the disease is diagnosed. According to the American Cancer Society, an estimated 317,000 new cases of prostate cancer were identified during 1996, and this year the forecast is that the number of cases diagnosed will climb to 370,000. More than 40,000 American men die of the disease every year.

Since it is a disease that disproportionately afflicts older men, the number of prostate cancer victims in the United States is rising as the nation's population ages. Between 1973 and 1993, the rate of new cases of prostate cancer climbed an astounding 173 percent. And by the year 2000, the experts warn that the incidence of prostate cancer is likely to increase by another 90 percent.

Lawmakers who are leading the effort to secure higher levels of federal funding for cancer research believe it is a mistake to regard prostate cancer strictly as a disease of the elderly. According to Sen. Ted Stevens (R-Alaska), "The fact is that the number of prostate cancer cases among men in their 40s and 50s has risen dramatically." Moreover, he noted, prostate cancer disproportionately afflicts African-Americans, who run a 50 percent greater risk of contracting the disease than Caucasian males.

Sen. Barbara Boxer (D-Calif.), another congressional advocate of increased federal support for prostate cancer research, calls the latest statistics on the growth of the disease alarming. "Based on current U.S. rates," she said, "about 19 of every 100 men born today will be diagnosed with prostate cancer during their lifetime, while approximately 4 of every 100 men will die from the disease."

The economic impact

The economic implications of the disease are also disturbing. It has been estimated that the annual cost of treating prostate cancer in the United States is now $3.7 billion and rising. The good news is that significant progress is being made in the battle against this disease. And for most men, the diagnosis of prostate cancer today is no longer a death sentence. Indeed, over the past 30 years, the survival rates for all stages of prostate cancer combined have increased from 50 percent to 85 percent, and there's reason to expect further improvement during the next few years.

Much of this progress is a result of increasingly effective diagnostic techniques that have enabled doctors to detect the disease in a preliminary, treatable stage. Medical experts say that with early detection, nine-out of-10 men diagnosed with the disease can be successfully treated for prostate cancer.

The American Cancer Society recommends that every male 40 years of age or older have a digital rectal exam as part of an annual health checkup, and that men over 50 also have a prostate-specific antigen blood test every year.

Significantly, however, cancer experts say that too few men are aware of the need for these tests, and that, too often, physicians fail to advise patients of these procedures.

Boxer is hoping to change that through new legislation designed to keep men informed of their options by requiring physicians, "at the time they perform a prostate examination on men over the age of 50, to inform the patient of the availability of the PSA test and other appropriate diagnostic procedures."

Her bill, which was introduced last month, would also authorize $470 million in federal spending on prostate cancer research and education efforts over the next four years.

But increased government funding and a heavier emphasis on early detection are only part of the reason why many experts are guardedly optimistic about progress in the battle against prostate cancer. Although a cure for this disease is still beyond the grasp of medical science, researchers for the nation's pharmaceutical manufacturers have succeeded in developing a number of promising new treatments for the victims of prostate cancer.

Promising new drugs

Among the most recent to reach the U.S. market are Hoechst Marion Roussel's Nilandron (nilutamide), which was approved by the Food and Drug Administration for use last year, and Zeneca's Arimidex (anastrozole), approved the year before for the treatment of advanced forms of the disease.