While male hormone-dependent cancer has been treated for about 125 years by androgen-ablation which has not cured any PC because the estrogen-dependent cancer has always remained untreated. Our new discovery could lead to treating PC without warranting surgery and allow patients to be on watchful waiting. Alternatively, PC patients can be treated for a short period, say about three months concurrently with androgen-and estrogen-ablations before they are put on watchful waiting. This should reduce tumor volume and cancer cells. This may add additional value to watchful waiting as determined by clinical trial.
Our study indicates that PC can be treated with concurrent androgen-ablation and estrogen-ablation therapy, together with inhibition of steroid biosynthetic enzymes. We estimate that concurrent two ablations can successfully treat about 95% of PC. We also recommend that estrogen-ablation treatment should be conducted in consultation with clinicians treating breast cancer. This would allow determination of dosage, etc. and monitoring of treatment effects. Both urologists and breast cancer clinicians need to be involved from the beginning. This would allow monitoring of each treatment response.
There is a wide variation in selection of patients for watchful waiting. Uniform selection of patients would allow assessment of different types of treatment—e.g., watchful waiting, prostatectomy, radiation, and other treatments. While this author is not a clinician, he recommends that patients be selected according to PSA (prostate specific antigen) levels in untreated patients, Gleason histological scores before treatment, and other criteria as deemed suitable by patients and physicians. The treatment effects could be assessed by the reduction in tumor volumes and numbers of androgen- and estrogen-dependent cancer cells in biopsy. We expect that patients with lower volume tumors would do better on watchful waiting than with prostatectomy. This idea, however, needs to be validated by a clinical trial before it is widely used to treat PC patients. We also expect that watchful waiting can save costs in prostatectomy, radiation, hospital care, and the side effects of surgery, while improving the quality of life for men and their families.
There is a great need to educate PC patients about the two types of cancer cells and the fact that each type needs to be treated separately. Drugs exist for treating each type of cancer, but using them together may require FDA approval.
War on Cancer: Success or Failure?. Since the declaration of the War on Cancer by President Richard Nixon in 1971, progress on controlling and treating prostate cancer has been dismal. The act was passed and funds were provided to the National Institutes of Health (NIH) and its National Cancer Institute (NCI) division with the mandate to find a cure for cancer. Every year since 1971, Congress has poured millions to billions of dollars into conquering cancer, with billions more spent each year in the care of patients. Cancer is a big business, with a large constituency, such as research universities, hospitals, and drug manufacturers. All of them have vested interest to support the status quo. This powerful group carries out extensive lobbying in Washington. Money usually talks.
Since 1971 nearly every solid organ cancer has increased in the United States and in the world. The NIH/NCI focused its spending on technology and its interest on ‘precision medicine,’ oncogene hype, and gene therapy instead of basic science. The excessive focus on technology did not lead to a cancer cure in forty years, but more patients are now saddled with cancer. Between 1971 and 2014, the U.S. population increased by 56.8%, diagnosis of cancer by 162.3% and death by 74.8%. In situ breast (62,570) cancers were excluded from 2014 cancer statistics.
The last 30-plus years of research has produced often unconnected data that are not useful in diagnosis or treatment of current cancer patients. Pathologists diagnose cancer using characteristics of cells and their nuclei, including tumor patterns, in tissue sections. Pathologists rarely diagnose cancer using subcellular organelles (such as Golgi, mitochondria, the nucleus, cell membranes, and micro RNA). In the process, biology has become fragmented into molecules and pathways. There is no drug to target specific individual or several pathways.
For example, a miRNA chart showing molecular mechanisms of cancer (by Qiagen Inc.) has illustrated numerous pathways in the cytoplasm, nucleus, and plasma membranes. The graph states that the change of miRNA expressions contributes to the initiation and progression of cancer, and more than 50 percent of miRNAs are located in cancer-associated genomic regions or in fragile sites. There are no drugs that can specifically target one or more pathways to cure cancer. The author regrets that he is unable to publish this chart due to copyright restrictions.
Cancer is a disease of cells and tissues, whereas the NCI has focused on molecular biology. This has limited the role of pathologists, because they usually do not use cellular molecules in diagnosis of cancer. Thus, pathologists’ roles in clinical research are severely limited.
Using PC as a case study, our objective was to describe how we have effectively lost the War on Cancer. Similar case can be made for cancers of breast, colon, lung, brain, and pancreas.
Conclusion: In January 2016, President Barack Obama declared in the State of the Union address that we should make America the country that cures cancer once and for all. Vice President Biden said that America can cure cancer with a new moonshot type of effort. The blue ribbon panel essentially endorsed continuation of the NCI program. My limited examination of the report did not indicate whether the Blue Ribbon Panel critically examined the progress made on President Nixon’s War on Cancer. This requires critical review of the NCI program before funding of the moonshot program.
Both prostate and breast cancers have increased between 1971 and 2015
I recommend that the Moonshot funding be diverted to the Center for Disease Control, that has relatively remarkable history in prevention of many diseases. The increase in incidence of cancer increase speaks loudly. The graph shows prostate and breast cancer related deaths have remained relatively stable while the incidence has greatly increased.
Written by: Akhouri A. Sinha, Ph.D. Professor of Genetics, Cell Biology and Development and Research Scientist at the Veterans Affairs Medical Center, University of Minnesota, Minneapolis MN.
* The article represents the views of the author and not of the United States Government, the Department of Veterans Affairs, or the University of Minnesota. The author is grateful to the Minneapolis VA Research Service for providing research facilities. This work was completed by the volunteer efforts of the author.
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