Prostate cancers are initially dependent on the presence of androgens such as testosterone for their ability to grow. The first line of treatment for metastatic prostate cancer is to deprive them of androgens (androgen blockade using drugs to decrease androgen levels). Unfortunately however, with time, these cancers invariably become resistant to this treatment. Our studies of why this occurs have implicated the Bag1L gene product which, in prostate cancers with mutated p53 genes, may sensitize the androgen receptor to very low levels of androgens, permitting the continued growth of these cancers (Nesslinger, Shi, Gumerlock and deVere White, presented at the American Association for Cancer Research, April 2001).

Analysis of alterations in the androgen receptor in prostate cancer is usually laborious and time-consuming. We have developed a rapid method of analysis that involves transferring androgen receptors from prostate cancers into yeast. Our studies can rapidly determine the type of hormone that aberrant androgen receptors respond to, the hormone concentrations to which they are responding, and the presence of mutations in the androgen receptor (Shi, Ma, Kung, deVere White, to be presented at the American Urologic Association meeting, June, 2001).

Problems with the prostate gland

• Enlarged prostate gland (called benign prostatic hyperplasia or BPH)
  • Affects 80% of men over 40.
  • Affects the flow of urine.
  • Can be treated by a urologist using medicine or surgery
• Inflammation of the prostate (called prostatitis)
  • Can develop in men of any age
  • Should be treated by infection-fighting medication
• Prostate Cancer
  • Is the most common male malignancy in the U.S.
  • Occurs in 1 out of 10 men over 40.
  • Is usually curable when caught early.
  • Is detected by an abnormal serum PSA and/or physical exam of the prostate.

Who should have a prostate exam?

• The American Urological Association recommends a yearly prostate exam for:
  • Every man over age 40.
  • Men who have a father or brother with prostate cancer.

The PSA test

• PSA (prostatic specific antigen) is an enzyme produced by the prostate gland that may enter the blood stream.
• Normal PSA values are less than 3.0 ng/ml.
• Repeated PSA values greater than 3.0 ng/ml should be evaluated by a urologist.
• Normal level can vary with age so what is abnormal at 40 may well be normal at 70.

Treatment for prostate cancer

• The method of treatment depends on:
  • The age and general health of the patient.
  • Whether the cancer is still confined to the gland (localized), or has escapted to lymph nodes or bone (metastatic disease). This is called the stage of the disease.
  • the appearance of the cancer as determined by the pathologists (the grade of the disease).

Choices of treatment for prostate cancer

• Surgery — radical prostatectomy for localized disease.
• Radiation Therapy — external beam or Brachytherapy for localized disease.
• Hormone Therapy — mostly used for those with metastatic disease.
• Cryoablation — experimental therpy, freezing the prostate.
• Chemotherapy — experimental protocols to improve treatment of prostate cancer.
• Active Surveillance — for low-risk patients.

General overview

• Fourth most common cancer among men.
• Ninth most common cancer among women.
• More than 50,000 new cases of bladder cancer are detected each year.
• Can be treated without major surgery.
• Early detection is vital.
• The earliest clue of a bladder tumor is blood in the urine.

Detecting bladder cancer

• Intravenous Pyelogram (IVP) is a test that allows the urologist to see images of the kidneys, ureters, and bladder.
• cystoscopy allows the urologoist to view the lining of the bladder and remove tissue samples for biopsy.
• Urinary cytology is where the urine is viewed under a microscope to search for cancer cells.

Treatment of bladder cancer

• Superficial: located in the bladder lining (epithelium), treated with tumor removal; medication in bladder.
• Invasive: cancer in the epithelium and extending into deeper layers; treated with removal of the bladder, chemotherapy. Radiation therapy is more frequently used in Europe than in the U.S.
• Metastatic (cancer has spread): Spreading beyond the bladder (lymph nodes, liver, lungs, etc); treated with chemotherapy.

Ralph W. deVere White, M.D.
Professor of Urology
Director, UC Davis Cancer Center
Assistant Dean for Cancer, UC Davis School of Medicine

Christopher P. Evans, M.D.
Professor and Chair, Department of Urology

To make an appointment, whether a new or returning patient, with a urologic oncologist please call the UC Davis Cancer Center appointment line at (916) 734-5900.