Bob Dole. General Norman Schwarzkopf. Harry Belafonte. Robert Goulet. The willingness of such well-known figures to make public their battle with prostate cancer has brought visibility to an issue that until the last few years, lacked the attention, funding and research interest befitting a disease that will strike more than 180,000 men in the United States this year.
Michael Milken, diagnosed with prostate cancer in 1993, waged perhaps one of the most public battles against the disease, founding CaP CURE to accelerate the progress of prostate cancer research and treatment. Milken appointed his physician, Cedars-Sinai Medical Center urologist Stuart Holden, as medical director of CaP CURE, and the organization has distributed more than $120 million in research grants over the past eight years.
Milken was not Holden's only high-profile patient. Last year, L.A. business leader Louis Warschaw was diagnosed with prostate cancer. Warschaw and his wife, Carmen, longtime supporters of Cedars-Sinai, decided, along with their family, to endow a chair for prostate cancer at the hospital. The couple founded a fundraising group and planned a black-tie gala to launch the project. Tragically, Louis' prostate cancer accelerated so quickly that he died before he could see the dinner come to fruition. But Carmen, a force in Democratic politics, a former chair of The Jewish Federation's Jewish Community Relations Committee and a patron of the arts, pursued the dream.
At a March 10 Skirball Cultural Center event underwritten by Metropolitan West Financial, Warschaw announced that the group had raised $3.1 million in two-and-a-half short months.
Since the event, more commitments have been received, bringing the total to almost $7 million, according to Warschaw. "It's really been booming, and I'm just thrilled," she said. "We'll continue to work with Cedars to raise money and awareness."
The funds will support Cedars-Sinai's new Prostate Cancer Center, which opened last October with Holden as its medical director. Holden recruited as research director Dr. David B. Agus, who had attracted the attention of CaP CURE for his work analyzing the molecular changes that accelerate prostate tumor growth.
The Prostate Cancer Center aims not only to provide cutting-edge treatment for the disease, but to spur the development of new therapies for prostate cancer.
Currently, says Holden, "We've been phenomenally successful in curing cancer in rats and mice and phenomenally unsuccessful in curing cancer in humans. The step is, how do we get the knowledge from the laboratory into the human being? That's called translational research."
In the Prostate Cancer Center's state-of-the-art laboratory, researchers perform translational research by testing experimental treatments on rats that have been injected or implanted with human prostate-cancer tumors. The hospital will also conduct clinical trials of therapies that have already shown promise in the laboratory.
The Prostate Cancer Center's model breaks with traditional research in that it encourages collaboration and sharing of data with other institutions, rather than the hoarding of information sometimes characteristic of the scientific community. With sophisticated equipment, doctors and researchers at Cedars-Sinai are hooked up to Memorial Sloan-Kettering Cancer Center in New York, MD Anderson Cancer Center in Texas, and the University of California at San Francisco, enabling teleconferencing and even the transmission of X-rays and slides from one location to another.
"We are not trying to recreate a UCLA or a Sloan-Kettering. We are trying to serve as a facilitator, to allow rapid development of therapeutics, wherever they are developed," says Agus.
In addition, the Prostate Cancer Center cooperates with pharmaceutical companies to test the effectiveness of potential new cancer therapies. Some frown on the approach of embracing this industry, but Holden sees it as an asset. "When we started inviting the biotechonolgy people to our conferences, people would say, 'Oh my God.' It has kind of a taint of commercialism. We didn't see it [that way]. What happened was, the people that were working in industry started meeting the people who were working in academics, and they developed relationships."
The Skirball fundraising event certainly demonstrated an approach based on relationships. Entertainment was provided by Tracey Ullman, whose husband received care from Holden. And emcees Connie Chung and Maury Povich credited their involvement to their admiration for Agus, who happens to be their son-in-law.
Agus says an "explosion of data and technology" has made this an exciting time in cancer research. The sequencing of the human genome, together with the technology to use this data, he says, are "comparable to the significance of creation of the microprocessor for the computer-science industry."
One promising direction, called gene chip analysis, enables doctors to genetically examine tumor tissue to see which genes are active, giving them what Holden calls "a molecular signature of an individual's cancer."
"Cancer is not the same every time. One person's cancer is dramatically different from another person's cancer. Yet we can only treat them all the same," he says. Because most men will get prostate cancer if they live long enough, he says, the challenge is to determine whether an individual's cancer is aggressive or slow-growing.
Certain hormones, like testosterone, fuel the growth of prostate-cancer tumors, so treatments may involve measures designed to halt hormone production. But at critical stages in the disease's progress, the tumor changes, so that it grows even in the absence of hormones. The goal, Holden explains, is to understand how this change occurs so that it can eventually be reversed or prevented.
He sees prevention as an exciting direction in prostate-cancer research. "There's a lot of evidence based on diet, nutrition and all of these areas that [indicates] these are tremendously important factors.... One of the beauties of these models [is that] we can take animals and feed them [a promising substance, such as] Vitamin E and see what happens to the tumors, and what things we can do to prevent them from occurring."
In the meantime, new treatments give patients more options than ever before. For example, Cedars now offers laparoscopic surgery for prostate cancer, although, Holden cautions, the still-experimental procedure is too new for doctors to know whether it truly yields fewer long-term side effects than conventional surgery. He suspects that, with time and technical advances, it will eventually prove to be a viable alternative. Another novel procedure now in clinical trials, ablation therapy, uses heat to destroy prostate tumors. Still other procedures utilize cryogenics (freezing) and microwave technology.
Fittingly, as someone committed to collaborative endeavors, Holden uses baseball rather than battle as an analogy to describe currently available prostate-cancer treatments. "I don't think any of them is a home run at this point, but there's lots of singles. I just say we've got a lot of men on base. And that's good. Because in the beginning, we didn't have anyone in the batter's box."