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June 2008 Volume 2 #2
 Dr. Goldenberg to speak in Calgary Intermittent hormone therapy PCa prevention with finasteride CPCN executives welcomed in Ottawa |
Treating the whole man: Dr. Larry Goldenberg to speak at the 2008 National Conference  Dr. Larry Goldenberg, founding director of the Prostate Centre at the Vancouver General Hospital, is not one to rest on his laurels. This 2008 recipient of the Order of British Columbia will be a key speaker at the upcoming CPCN national conference in August. (Click here for conference details.) And he is currently championing a new cause---the foundation of a men's health centre at VGH.Goldenberg explains that, although there are women's hospitals or women's health centres in many Canadian cities, organizations focussing on men's health are few and far between in Canada. "Men are 20 years behind women in terms of gender-specific health centres," he says. Of course, there are centres devoted to prostate health. "But," as Goldenberg quips, "there's more to men's health than penises, prostates, vasectomies, and circumcisions." Wise words coming from a dedicated urologic surgeon with an international reputation for excellence in prostate cancer research and treatment! But then, Goldenberg has always had a broad perspective. Even his clinical research demonstrates an interest in the health of the whole man, focussing, as it often does, on quality of life issues and on men's experience of prostate cancer and its treatment. In 2007, for example, he co-authored a study on what factors patients with prostate cancer believed were important determinants in their decisions about whether to participate in clinical trials. (See an abstract of this article.) Some interesting trends emerged. Men reported that they were motivated more by their concern to help future patients with prostate cancer than by their belief that the study treatment would affect their survival. Also, it appears that good and open communication between a man and his medical team was rated as having a very significant effect on clinical trial participation. This study is only one of many indicating Goldenberg's long-term interest in helping men and the medical profession cooperate to achieve premium health care. (See the CPCN article "Dr. Larry Goldenberg: Helping men take an active role in their prostate cancer treatment.") Dr. Goldenberg is also a pioneer in the use of intermittent hormone therapy for the management of prostate cancer. And he continues to be an active researcher in this field. He is particularly interested in the potential of intermittent androgen suppression to improve the quality of life for men who rely on hormone therapy and on the possibility that this treatment will preserve the hormone-dependent state of tumours so that prostate cancer can be controlled longer. Intermittent hormone therapy, also known as intermittent androgen suppression (IAS), is a treatment protocol in which the drugs blocking the production or effects of male hormones are periodically stopped and restarted. A March 2008 article co-authored by Goldenberg concludes that "intermittent androgen suppression is a potentially useful treatment for locally recurrent prostate cancer after radiation therapy with quality of life benefits in the off-treatment interval and no apparent deleterious effects on short- to medium-term survival." (See the abstract.) Goldenberg's other areas of research include evaluating the role of molecular imagery in targeted therapy for prostate cancer, the use of robotic surgery in prostate cancer treatment, and investigating safety issues related to androgen replacement therapy for men. (See the related CPCN article on dietary supplements containing male hormones.) CPCN reached Dr. Goldenberg to ask him four questions of import to our membership: QUESTION: You seem to be very aware of the effects of treatment on a man's quality of life, always considering, primarily, which treatment offers the best chance for a "cure," of course. What innovations do you think are the best bets, in terms of offering men newly diagnosed with localized prostate cancer both a cancer-free future and minimal negative quality of life effects? ANSWER: There are many "innovations" which reach a level of popularity and then fade away as results do not withstand the test of time or the rigours of scientific evaluation. The ultimate test of a new treatment for localized cancer is the ability to eradicate the disease, or to set back its biologic clock in such a way as to minimize the threat to a man's longevity --- all the while minimizing negative impact on quality of life. This is a huge challenge, which physicians around the world are facing. In the midst of the milieu are several technologic advancements that are promising. These include HIFU, photodynamic therapy, intraprostatic injection therapy, and focal therapy or "male lumpectomy" using various sources of energy. All of these are interesting approaches that deserve to be studied in a thoughtful manner, and all continue to be debated by experts worldwide. QUESTION: What about when cancer comes back? What are the current "gold standard" treatments and the most promising areas of research for men in this situation? ANSWER: When cancer comes back it may not be a life-threatening situation. My best advice is to monitor the situation for a while to determine the characteristics of "the beast" prior to deciding on treatment. Many clinical trials of experimental drugs are available for different types and degrees of "recurrence." QUESTION: How about prevention? What are your thoughts on the newly published findings regarding the use of androgen suppression in the prevention of prostate cancer? ANSWER: I am personally convinced that a significant number of men, with the appropriate genetic makeup, can decrease their risks of developing prostate cancer by taking finasteride. There continue to be conflicting reports on micronutrients, diet, and environmental influences. QUESTION: And finally, if you could wave a magic wand, how would you improve the way the Canadian health sector and Canadian men manage prostate health? ANSWER: Awareness is the key and appreciation that not every prostate cancer needs to be treated, at least not immediately. However, there is a subtype of cancer that can kill, and in order to find these we have to look for, and uncover, all types including the benign actors. We need a means of separating the "tigers" from the "pussycats." This will be a blood biomarker (or a combination) or an imaging method (perhaps a form of contrast enhanced ultrasound or MRI) or a genetic test on the biopsy material itself. |
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