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Advances In Prostate Cancer Prevention And Treatment is pleased to present the forward to the second edition of Dr. Peter Scardino’s Prostate Book. The noted prostate cancer specialist has completely revised his guide to overcoming prostate cancer, prostatitis and BPH. When I mentioned that I was working on a new edition of this book, friends and patients were surprised. The last one came out only five years ago. Has that much changed in the field? Are there important new studies? Has the management and understanding of these diseases really progressed enough to warrant a new book? From inside the field, down in the trenches, the need for a major update was clear. For those of us working in the office with patients, attending research meetings with scientists, going to medical conferences with other physicians and teaching students and fellows, this has been an exciting time. New studies roll out almost weekly that profoundly challenge our old assumptions about prostate diseases or promise breakthroughs in prevention, detection, and treatment. Many major advances, fascinating new possibilities and tantalizing missteps that have yielded important insights are detailed in its pages. Here are some highlights: Research has revolutionized our understanding of the molecular changes that drive the development and growth of prostate cancer and enable it to become resistant to hormone therapy. In 2004, Charles Sawyers discovered the key to “hormone resistance.” He found that prostate cancer was able to flourish in the absence of androgens (male hormones) because of the action of the androgen receptor. When this internal amplifier that spurs cell activity is turned up in advanced prostate cancer, cancer cells do not need male hormones to thrive. Armed with this knowledge, Sawyers went on to develop a more powerful antiandrogen to block the androgen receptor. Called MDV3100, this new pill is in the final stages of testing for FDA approval. An even stronger antiandrogen is at an earlier stage in the pipeline. In 2005, Arul Chinnayian discovered an unusual “fusion” gene that stimulates cell growth in response to androgens. Such fusions had rarely been found in any of the common cancers, such as breast or lung, and new drugs are being developed to target this mutant gene. For decades, researchers have sought a way to prevent prostate cancer, and most clues pointed to diet. In large, government-sponsored trials of dietary supplements, vitamin E and selenium—the prime candidates—proved disappointing. The good news: finasteride (Proscar), a well-known drug that has been used to shrink the prostate, proved highly effective in reducing the risk of developing prostate cancer, and its cousin dutasteride (Avodart) works as well. “Active surveillance” is gaining popularity as more men and more doctors recognize that small, early cancers found in men of any age can be closely watched, with regular checkups and occasional biopsies, with little risk that the cancer will spread before there are clear signs that the time to begin active treatment has come. Robotic surgery burst onto the scene amid great marketing fanfare claiming that the side effects of surgery would disappear with the use of the da Vinci robot. Unfortunately, studies found that robotic prostatectomy is no safer than the open operation, and the long-term results no better, leaving little to justify the increased costs of the robotic operation. Similarly, proton beam radiation has been touted as highly curative with virtually no side effects. Careful comparisons with high-dose, image guided radiation have yet to show any real benefit of this expensive new technology. For advanced prostate cancer that has spread to bones or other organs, the treatment possibilities are multiplying. New antiandrogens are most promising, and fifty to one hundred new drugs for prostate cancer are currently being studied in the laboratory or early clinical trials. One of the most astonishing is a drug that had been sitting on the shelf for years, which was capable of completely shutting down the body’s ability to synthesize male hormones. Abiraterone, recently acquired by Johnson & Johnson for nearly $1 billion, has proven remarkably effective against “hormone resistant” prostate cancer, even though it works by blocking the production of male hormones. Vaccines and antibodies that enhance the immune system are in the final stages of testing. And metastases in bone are being eliminated with a single dose of radiation. The best news of all: The death rate from prostate cancer continues to fall nationwide. Mortality from this disease in the United States has declined more than 40 percent since 1993, much faster than in Great Britain or Scandinavia, reaching levels not seen since the early 1970s. If the tools of modern medical science can help us to better understand the threat posed by each man’s cancer, we may soon be able to determine with greater certainty which cancers can be safely monitored, without unnecessary therapy and its side effects, and which need to be treated immediately. Also, now that we know that many prostate cancers can be prevented with a simple medication, the risk of getting this cancer may steadily fall over the next generation and become one fewer worry for our grandchildren. About the authors: Peter T. Scardino, MD is chairman of the Department of Surgery at the Memorial Sloan-Kettering Cancer Center in New York City and a practicing urologist, specializing in prostate cancer surgery. Dr. Scardino has written hundreds of medical articles and textbooks. Judith Kelman is the author of hundreds of articles, the award-winning author of seventeen novels, and the founder of Visible Ink, a one-on-one writing program for cancer patients at MSKCC. Article reprinted from Dr. Peter Scardino’s Prostate Book by Peter T. Scardino, MD, and Judith Kelman by arrangement with Avery, a member of Penguin Group (USA) Inc., Copyright © 2010 by Peter T. Scardino, MD and Judith Kelman.