The Washington Post

A Meeting of the Medical Minds

May 23, 2012

Doctors from different medical institutions and private practices often compete rather than exchange information. The genitourinary multidisciplinary DC regional oncology project known as GUMDROP is a rarity.

Forty kidney, bladder and prostate cancer specialists gather quarterly to share notes about treatments and clinical trials. The District has the highest incidence and death rate of prostate cancer in the country, according to federal health statistics. Despite the disease's prevalence, finding clinical trial information for patients in the area is extremely difficult. And so, GUMDROP was birthed in April 2011.

Genitourinary cancer expert Nancy Dawson is a founding member of GUMDROP and the director of clinical research at the Prostate Cancer Research and Treatment Center, a subsidiary of Georgetown Lombardi Comprehensive Cancer Center.

She answered reader's questions on Wed. May 23rd.

Thank you for joining me for this live chat on clinical trials and prostate cancer. I am a medical oncologist at the Lombardi Comprehensive Cancer Center at Georgetown Hospital specializing in urologic cancer (bladder, prostate, kidney and testicular cancer).  In the interest of full disclosure, I occasionally serve as a scientific speaker on behalf of Dendreon, Novartis, Glaxo Smith Kline, Sanofi Aventis, Bayer, Pfizer and Janssen.

My recent biopsy showed Gleason 6, with 3 cores showing cancer (40 percent, 30 percent, 10 percent) and 3 others suspicious. This compares with last year's results with a Gleason 6 showing 1 core (10 percent) and 3 suspicious. Do you think it's time to stop waiting and get active or how should I determine if it is?

The two reasons to condsider active intervention would be if your Gleason score became higher or if the percentage of cores positive or number of cores positive increase.    I would definitely talk to your urologist about  surgery or radiaition at this time.

What are the risks involved in prostate cancer clinical trials and how do you determine what patient is a good candidate?

The risks of a clinical trial depend on what the intervention is.   It might involve something simple such as completing a questionnaire or having a single tube of blood drawn.  It could have high risks if it involves giving an experimental drug that has been only given to a few other people.  You cannot be part of the study unless you meet the criteria   Every study has specific eligibility in order to paticipate.  To learn more about clinical trials, go to Home Page and then go to Background information.

Off topic I know, but how often do people like Lance Armstrong come back from stage III or IV cancer? Because if it were me, I probably would have just skipped the treatments and moved on to finishing my bucket list. But I would have been completely wrong. How should we as patients make this critical decision to continue awful treatments or to "give up with grace"? Thanks.

Some types of cancer are curable.   Lance Armstrong had testicular cancer which is curable in the majority  of patients even when it is advanced or widespread.  In that case, it is definitely worth it.    On the other hand, many cancers are not curable once they have spread.   Treatment is intended to make the person live longer or improve the quality of their life.    It is important to have a frank conversation with your doctor regarding your goals of care in order to make this very important decision.

Dr Dawson, for those of us men in our 60's --and everyone else--please share your thoughts on PSA testing, patient safety, accuracy, benefits, etc. The AUA says one thing: the American Cancer Society and federal panel something else. What's a guy to do ? I have had a couple of PSA's in the past and know it is painless--just another vial of blood with the CBC, so that's not an issue. I also know that the test generates income for physicians, labs and others. Your thoughts please.

Since I treat men who have prostate cancer and not healthy men I have a different perspective.   I mostly use the PSA test to monitor the response to treatment.  In that setting, it is very helpful.    The problem that has been point out is that if a man has good risk prostate cancer  he may not need to be treated.   From my stand point, it is comparable to wanting to know if the house you ae buying is located on an earthquake fault.  I think it is better to know you have cancer and then decide with your doctor what you should do about it.   Konowing well the risks and benefits, I still support my 62 year old husband having a yeraly PSA test and a prostate exam.

Where is the evidence that Hormonal Blockade and Radiation are the only treatment for 73 years of age patient with Gleason Score of 4+3 and PSA below 10. What are the circumstances that a patient like this could be managed with active surveillance , when the PSA is dropping since the day of the biopsy.

You are describing intermediate risk prostate cancer.  The choices would be radiation or surgery.    Usually surgery is not offered to men over 70 unless they are very healthy with an expected survival of more than 10 years expected survival.      A short course of 4 to 6 months of hormone therapy has been shown to improve survival  in a recently published clinical trial  by the Radiation Therapy Oncology Group (RTOG).   For the  most recent guidelines a good site is the NCCN guidelines    They are free and  povide standard of care for different types of cancer. 

would you be interested in a retired individual who has a pharmaceutical/medical background who is familiar with medical database searching?

In the war against cancer, volunteers are greatly appreciated.    I can be contacted by email at

Hi. My husband has just been diagnosed with urethral cancer, which we understand is very rare. I have several questions: (1) How might we find others with the same disease for support and information? (2) Treatment (chemo) begins tomorrow. Is it too soon to consider a clinical trial? Does one wait until traditional treatment has proved ineffective? (3) Will his doctor be aware of the clinical trials open to my husband or is it up to us to try to find them? Thanks.

I would recommend contacting BCAN, the Bladder Cancer Advocacy Network.   They support patients with cancer of the urinary tract and is headquartered in the DC area.   Clinical trials are for both early disease as well as late disease.    Once he starts chemotherapy he will not be eligible for earlier stage trials.  If you google  GUMDROP DC it will bring you to our DC reginal site to find trials for your husband.  Please share this with his doctor.

Dr. Dawson, what is your take on the recent change in PSA screening guidelines by USPSTF? Also, what are some of the areas that current prostate cancer clinical trails are focusing on?

Your first question I addressed in an earlier answer.

Current clinical trials are focusing on newer therapies for localized prostate cancer such as cyberknife, natural therapies for early recurrent disease and vaccine therapies and new hormonal therapies for advanced disease.    For a list of some of the trials available in the DC area, please google  GUMDROP DC

I coach soccer with a man in town who just had prostrate surgery in Boston and then was struck by the timing of this announcement. Would his doctors in Bostoon have had this information before deciding on surgery? He's had a tough recovery over the 3-4 weeks.

The controversy about PSA screening is not new.   The current  report is a follow-up on an ealier report that his doctors would be aware of.

I am 14 yrs post radical prost, 13 years post radiation, 11 years post penile implant. 2007- to present psa elevated from .01 to 2.10. I am pro stomp on it if you can. What bothers me is research funding. How can I, as someone fiighting prostate cancer, help with trying to get research dollars? Feel this is the stepchild of cancers "A MAN THING."

There are several prostate cancer groups, most notably US TOO , that are active in lobbying for research dollars for postate cancer.   I would recommend participating in either US TOO or Man to Man.    

Are there any promising prostate cancer drugs in study at this time?

There are several drugs approved that have improved survival for men with advanced prostate cancer.  They are docetaxel, cabazitaxel, sipuleucel-T, and abiraterone.   Two more are pending approval based on completed clinical trials, MDV3100 and alpharadin.  These two are about to be available in expanded access clinical trials, meaning you cn get the drug for free before it is FDA approved based on improved survival.

XL184  is also in trial and very promising.   

Dr. Dawson, My father will have a radical prostatectomy on Friday, after recent biopsy results showed level 9/10 cancerous cells in most of the prostate gland. According to his physician, this is a very aggressive form of prostate cancer. Recent scans indicate that there is no metastasis however, is there a correlation between agressive prostate cancers and developing other urological cancers in the future? Also, what is the recovery time after laprascopic surgery?

A gleason sum of 8,9, or 10 is aggressive.   The cancer is born that way.   The more involvment of the higher score cancer the higher the chance of recurrence.   There are several nomograms out that predict chance of recurrence.   You can google "prostate cancer nomograms' and get a caclulator to predict his risk of recurrence.   I would talk to his surgeon about expected recovery, but the hospitalization is usually a 3-5 days

Hi ! What are some of the treatment possibilities emerging from current clinical trials for other cancer types that could be candidates for treating mRCC ?

There are new vaccine trials, new targetted therapies.

Please google GUMDROP DC to see the trials open in our area.   Click on kidney cancer then click on metastatic.  It will tell you who is doing the study, where it is being done and will link you to the site to give the eligibility, treatment  and contact information.   It will also let you know where the study is being done outside of the DC area.

In its Cancer Control Plan, the DC Cancer Consortium is looking to address the disparities that exist in those who are likely to be approached about participating in a clinical trial. Particularly, those patients from minority groups or who are 65 or older are less likely to be approached, regardless of eligibility. How can this issue be addressed to ensure that clinical trials are made available to all regardless of race and age?

I was just contacted today by someone at the DC Cancer Consortium about addressing just this question.     I have happily offered to part of the solution.

Age 67, 70cm prostate, minor urination symptoms, no pain, PSA reached 5.0, Urologist Dr. recommended biopsy (Sept. 11'), Gleason Score 6 all cores had some cells, no centralized tumor detectable, CT scans show no migration outside prostate. Doctor recommended consultation with radiation oncologist who recommended 5 weeks radiation outside prostate, then 8 weeks at prostate. I declined this recommendation and have chosen to watch and wait. Started Avodart and drinking 8 Oz Pomegranate Juice with 12 Oz Soy Milk daily, April 12' PSA 2.3 x 2 = 4.6, not a cure but heading in right direction.

Since you have chosen surveillance, you should consider a clinical trial such as the MEAL study that looks at diet intervention to delay cancer progression.

For more information google GUMDROP DC and look under trials for localized prostate cancer

Why are 5 AR Inhibitors not a routine part of ADT along with an antiandrogen and LHRH agonist?

Because noone has done a randomized trial of  total androgen blockade , an antiandrogen plus an LHRH agonist,  with or without a 5 AR inhibitor.   This would answer the question as to whether triple hormonal therapy improves survival.

Are some cancers curable (prostrate, breast, etc.) because they are so common that doctors and drug companies get lots and lots of practice with that specific kind of cancer? Or are there just some cancers that are much more aggressive and aren't curable no matter what number of people get it?

Only a few cancers that have spread are curable, such as testicular cancer.   At present the most common cancers, breat, lung, prostate, colon, are not curable once they spread.    That is why clinical trials and clincal research is so important.  It is the only way we will find cures for these cancers

If a man has a family history of prostate cancer, do the new PSA testing recommendations apply to him? My grandfather died of metastatic prostate cancer at age 70. Should my dad (his son) should get regular PSA tests? My husband's father had prostate cancer in his 50's and was cured. Should my husband get regular PSA tests? Thanks.

For every first degree relative with prostate cancer, a brother or father, your chance of prostate cancer doubles.  I would recommend screening for these men.

I know high dose IL-2 is the only non-surgical treatment that offers a possibility of a cure for metastasized renal cell carcinoma but I was wondering how durable are RCC remissions after successful IL-2 treatment. Also, after apparently successful IL-2 treatment with a subsequent reoccurrence is it possible to have additional IL-2 treatment?

IL--2 can lead to long term remissions, defined as greater than 5 years.      Many of those patients appear to be cured.     I have no experience retreating with IL-2.

Thank you for joining me today.    I appreciated the thoughtful questions.



In This Chat
Dr. Nancy Dawson
Nancy Dawson is director of the Genitourinary Oncology Program at MedStar Georgetown University Hospital. At Georgetown, she continues to develop innovative approaches to treating prostate, bladder and kidney cancers. Dawson is a founding member of GUMDROP and now hosts their meetings.
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