The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri.

Thank You for Supporting David’s Cure Challenge 2011.

Gerald L. Andriole, M.D.

Robert K. Royce Distinguished Professor
Chief of Urologic Surgery
January 27, 2011

To Mr. and Mrs. Cash Nickerson

Dear Cash and Evie:

I am writing to thank Cash and Evie for the support they have provided to the Division of Urologic Surgery through the David H. Nickerson Foundation and David’s Cure Challenge Golf Tournament. As you know your support has been instrumental in allowing us to develop our research portfolio for men with prostate cancer. Over the past few years we have devoted considerable resources to our work with the Genome Sequencing Center. Their support has allowed us to sequence the genome of patients with prostate cancer and to identify mutations found in these patients. The goal of these projects is to enable us to develop specific therapies targeted for a specific genetic mutation. We now have an adequate number of patients and controls to see this work come to fruition.

Another major focus of our research over the past decade has been to develop the optimum strategy for the early detection and diagnosis of prostate cancer. In this regard, we have led in the use of the PSA blood test. We started the Washington University PSA Cancer Screening Trial in 1989 and this 35,000 patient trial has been influential around the world in establishing the appropriate PSA cut-points for biopsy. Also, we have led the National Cancer Institute randomized PLCO Cancer Screening Trial. This trial of 150,000 men and women has been ongoing since 1993. We have also been interested in identifying the best way to biopsy the prostate. In this regard we have developed and received FDA approval for a novel stereotactic 3 dimensional prostate ultrasound biopsy system. This has allowed us to perform targeted biopsies of the prostate and also targeted ablations for small prostate cancers.

Going forward, we now want to further enhance our ability to biopsy and treat prostate cancer by fusing MRI images to the 3 dimensional prostate ultrasound images that we presently obtain with our system. This is important work as current biopsy approaches are sub-optimal: since they are essentially random, they often miss prostate cancers and/or mischaracterize prostate cancer by underestimating its true size, aggressiveness and location. One new technique that has improved our ability to “see” prostate cancer is MRI using a 3 tesla (3T) magnet. The problem is that it is presently not feasible to perform MRI-guided biopsy because it requires non-metallic needles and is time-consuming. Office-based biopsy using transrectal ultrasound is the preferred method and the standard of care.

The major focus of our work in the next year will be to develop a multidisciplinary collaboration with Biomedical Engineering, Radiology and Urology to fuse 3T MRI prostate images with real time transrectal ultrasound images. By fusing these two imaging modalities we will be able to accurately target and biopsy both MRI and ultrasound abnormalities in the office under local anesthesia. This should enhance the overall accuracy of prostatic biopsy as all suspicious abnormalities seen by both 3T MRI and ultrasonography will be sampled. Moreover, we could use the information from 3T MRI to guide later ablation of prostate cancer as it would maximize the possibility of destroying all malignant areas within the prostate. This focal ablation of prostate cancer would substantially improve care of men with this disease as it is typically not associated with significant side-effects such as impotence and incontinence and is an outpatient procedure.

sincerely appreciate your support for our efforts. We are devoted to advancing the care of men with prostate cancer and to seek innovative means of diagnosis and treatment.

If I may provide additional information, please let me know.

Very sincerely,

Gerald L. Andriole, M.D.

What is your risk level?

Prostate cancer is the most common cancer among US men. It’s not always life threatening, but it forces many men to weigh the risks and benefits of its treatment. To estimate your risk of prostate cancer and learn about ways to lower that risk, click on the link below:
The Prostate Cancer Questionnaire

Prostate Cancer

Prostate cancer is the most common type of cancer found in American men, other than skin cancer and it is the second leading cause of cancer death in men. Lung cancer is the first. One man in 6 will get prostate cancer during his lifetime, and 1 man in 35 will die of this disease. The American Cancer Society estimates that there were approximately 186,320 new cases of prostate cancer in the United States in 2010. An estimated 32,050 died in 2010.

Timetable for a Cure.

Prostate cancer is caused by changes in the DNA of a prostate cancer cell. A small percentage (about 5% to 10%) of prostate cancers has been linked to inherited traits and other cancers may also be linked to higher levels of certain hormones.

While we do not yet know exactly what causes prostate cancer, we do know that certain risk factors are linked to the disease.

Risk factors for prostate cancer

Age: Age is the strongest risk factor for prostate cancer. The chance of getting prostate cancer goes up quickly after a man reaches age 50.

The PSA Blood Test

PSA (prostate-specific antigen) is a substance made by the prostate gland. Most healthy men have levels under 4 ng/mL (nanograms per milliliter) of blood. The chance of having prostate cancer goes up as the PSA level goes up. If your level is between 4 and 10, you have about a 1 in 4 chance of having prostate cancer. If it is above 10, your chance is over 50%. But some men with a PSA below 4 can also have prostate cancer.
Factors other than cancer can also cause the PSA level to go up, including:
• BPH (benign prostatic hyperplasia), a non-cancerous swelling of the prostate that many men get as they grow older.
• Age: PSA levels go up slowly as you get older, even if you have no prostate changes.
• Prostatitis: an infection or inflammation of the prostate gland
• Ejaculation can cause the PSA to go up for a short time, and then go down again.
Not all doctors agree on how to use these new PSA tests. You should talk to your doctor about your cancer risk and any tests that you are having.

DRE (Digital Rectal Exam)

The DRE is less effective than the PSA blood test in finding prostate cancer, but it can sometimes find cancers in men with normal PSA levels. For this reason, ACS guidelines recommend that when prostate cancer screening is done, both the DRE and the PSA should be used.

Race

For unknown reasons, prostate cancer is more common among African-American men than among men of other races. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than in non-Hispanic whites. The reasons for these racial and ethnic differences are not clear.

Nationality

Prostate cancer is most common in North America, northwestern Europe, and a few other places. It is less common in Asia, Africa, Central and South America.

Family History

Prostate cancer seems to run in some families. Scientists have found several inherited genes that seem to raise prostate cancer risk, but they probably account for only a small number of cases overall.

Diet

Men who eat a lot of red meat or high-fat dairy products seem to have a greater chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables. Doctors are not sure which of these factors causes the risk to go up.

Can Prostate Cancer Be Prevented?

Because we don’t know the exact cause of prostate cancer, it is not possible to prevent most cases of the disease. But some cases might be prevented.
Diet: While the results of research studies are not yet clear, the ACS suggests eating less red meat and fat and eating more vegetables, fruits, and whole grains. Tomatoes, pink grapefruit, and watermelon are rich in substances called lycopenes. Lycopenes help prevent damage to DNA and may help lower prostate cancer risk. Scientists have found some substances in soybeans that may help to prevent prostate cancer. Research on this is still going on.

Vitamins

Some studies suggest that taking vitamin E daily may lower the risk of prostate cancer. Selenium, a mineral, may also lower risk. On the other hand, vitamin A (beta-carotene) supplements may actually increase prostate cancer risk. Before starting any vitamins or other supplements, you should talk with your doctor. Although many people believe that vitamins are natural and cause no harm, recent research has shown that high doses may be harmful. One study found that men who take more than 7 multivitamin tablets per week may have an increased risk of developing advanced prostate cancer.

Medicine: A study of the drug finasteride (Proscar) found that men taking the drug were less likely to get prostate cancer than men taking a placebo (“sugar pill”). The drug can cause side effects such as lower sex drive and trouble getting an erection. The results of the study will become clearer over the next few years. Other drugs that may help prevent prostate cancer are now being tested in clinical trials.

American Cancer Society Recommends:

ACS believes that doctors should discuss the pros and cons of testing with men so each man can decide if testing is right for him. If a man chooses to be tested, the tests should include a PSA blood test and DRE (digital rectal exam) yearly, beginning at age 50, for men at average risk who can be expected to live at least 10 more years.