Cancer, What you need to know.

Lung Cancer
Lung cancer is the leading cause of cancer deaths for both men and women. Each year there will be about 178,000 new cases of lung cancer in the United States. That is about 13% of all new cancers. More than 160,000 people will die of lung cancer. Smoking is by far the leading cause of lung cancer. Up to 90% of lung cancer cases are caused by smoking. At the beginning of this century lung cancer among women was quite rare. With the increasing use of cigarettes by women, the frequency of lung cancer has increased among women until it is now the leading cause of cancer deaths, even exceeding the deaths caused by breast cancer. Clearly the best way to prevent lung cancer is not to smoke. Young people should not start smoking and those who already smoke should quit. Everyone, especially babies and children, should avoid breathing in other peoples smoke.

Symptoms
In the earliest stages, lung cancer causes little or no symptoms or discomfort. As it enlarges, however, it may cause any of the following symptoms: Persistent cough, repeated or persistent bronchitis or pneumonia, hoarseness, blood in the sputum, persistent chest and/or shoulder pain, persistent and progressive shortness of breath.

Diagnosis
A physician may suspect lung cancer based on the symptoms and findings on physical examination and/or a chest x-ray. A CAT scan of the chest may also be utilized. To make a definite diagnosis, some type of biopsy is necessary. This may require a procedure known as bronchoscopy in which a flexible fiberoptic tube is inserted through the nose or mouth into the windpipe to visualize the bronchial structures and to obtain samples. Alternatively, a needle can be inserted between the ribs and directly into the tumor to obtain a sample utilizing a CAT scan or sonogram to guide the needle. Without a proper biopsy, appropriate treatment cannot be started.

Types and Stages of Lung Cancer
There are two broad categories of lung cancer as determined by biopsy: Small cell and non-small cell carcinoma. They are quite distinct in their behavior and their treatment. Lung cancer generally goes through four stages. Stage I refers to a relatively small cancer that is completely restricted to the lung tissue. In Stage II the cancer has spread to the lymph glands that are located at the root of the lung (hilum). Stage III refers to cancers that have spread into the central part of the chest, an area sandwiched in between the two lungs, known as the mediastinum. Stage IV refers to cancers that have spread to other parts of the body (metastasis). In order to accurately determine the stage of the disease, it may be necessary to proceed through an orderly sequence of testing. Mediastinoscopy, in which tissue samples are taken from the lymph nodes along the windpipe, may be required. PET scans, which are still under development, may ultimately replace this invasive procedure as a staging tool. Small cell cancer, also known as oat cell cancer, has only two stages: Limited and extensive disease. Limited stage usually means that the cancer is only in one lung and in the lymph nodes on the same side of the chest.

Treatment of Non-Small Cell Lung Cancer
Treatment of non-small cell lung cancer depends upon the stage of the disease. In general, Stage I and II cancers can be most successfully treated with surgery unless there are contraindications, such as poor lung function. Some Stage III cases are operable but most are treated with a combination of radiation therapy and chemotherapy. Stage IV cases require chemotherapy which can be used either alone or in combination with some radiation therapy. Radiation therapy uses high energy x-rays to kill or shrink cancers. It may also be used to relieve some of the symptoms related to the cancer. These treatments are administered at a radiation center, a facility specifically designed for these treatments. The treatments are usually administered once daily on Monday through Friday for a number of weeks. Chemotherapy involves the use of anticancer drugs to kill cancer cells. These treatments are generally administered intravenously on an intermittent schedule and, usually, at least four sets of treatment are required. There has been a lot of research in this field in recent years. A number of new drugs have been developed which are more effective than the older agents. This includes drugs such as Taxol, Navelbine, and gemcitabine. Even advanced cases of lung cancer are showing favorable response and some improvement in survival.

Current Treatment of Small Cell Lung Cancer
Because of the rapid growth of this type of lung cancer, surgery is not generally recommended. Instead these patients go directly to chemotherapy. If the disease is still in the “limited” stage, radiation treatments are given at the same time. If there is extensive disease, chemotherapy is used alone. The most commonly used treatment program is a combination of etoposide and a platinum compound (either Cisplatin or Carboplatin). The majority of patients will respond favorably and many will go into complete remission fortunately, only a small percentage of patients with this disease are cured at this time. A lot more research will be needed to develop new drugs and new technologies to improve the overall outlook for these patients.

Clinical Trials
A clinical trial studies the usefulness of a new treatment for cancer patients. Many of the currently available treatments yield unsatisfactory results and so new treatments need to be developed. After going through extensive evaluation in a laboratory setting and in laboratory animals, the new drug or treatment is then used on humans. Phase I clinical trials determine the safety and toxicities that humans can expect with the use of the new drug. Phase II trials are aimed at determining the optimal dose and schedule for the use of the drug. In Phase III trials the new drug is compared to the standart treatments to determine whether it is superior or not. Participation in clinical trial is purely voluntary but is often encouraged since this is the only way in which we can expect to make progress in the treatment of lung cancer. There are advantages and potential disadvantages to participating in these trials. The physician and/or his research nurse will provide a wealth of information and details prior to including a patient in a study.

James Wilder, M.D. PROSTATE CANCER

Introduction
Prostate cancer is the most frequently diagnosed cancer (excluding skin cancer) and the second leading cause of cancer death in American men. Only lung cancer results in more male cancer deaths in this country. Each year, roughly 180,000 men in the U.S. will be diagnosed with prostate cancer, and about 37,000 will die of this disease. These numbers are remarkably similar to those for breast cancer. However, there seems to be less awareness regarding prostate cancer, and breast cancer receives more research funding. In recent years, though, prostate cancer has been receiving more attention, as a number of public figures have been diagnosed and treated for it.

Risk Factors
The cause of prostate cancer is unknown, but several factors associated with a higher risk for it have been identified. Increasing age is one of the most closely associated variables, with the average age at diagnosis being 72. Fewer than 10 percent of cases are diagnosed in men less than 60 years of age, and more than 75 percent of cases are diagnosed in men older than 65. The incidence of prostate cancer is low in native Chinese and Japanese men but higher among men from Scandinavian countries. African American men have the highest incidence rate of prostate cancer in the world, and they also present with more advanced stages of disease and are more than twice as likely to die of prostate cancer than are white American men. The incidence of prostate cancer is higher in men with a family history of prostate cancer, particularly in those with two or more first-degree relatives having the disease. Diets high in fat content may also increase the risk of developing prostate cancer. Of these risk factors, diet is the only one that, in theory, can be modified.

Symptoms
In most cases, prostate cancer itself causes no specific symptoms, especially in its early stages. It is sometimes diagnosed in men who present with symptoms of urinary obstruction related to benign enlargement of the prostate (benign prostatic hypertrophy, or BPH). BPH is a separate, unrelated process and does not appear to cause prostate cancer. In rare instances, cancer can become advanced within the prostate and cause urinary obstructive symptoms, but these symptoms are much more often due to BPH. Occasionally, prostate cancer can spread to the bones and cause pain prior to diagnosis.

Screening
Since prostate cancer typically causes no symptoms in its earliest, most curable stages, individuals must be screened in order to detect prostate cancer in its early stages of development. Historically, this was accomplished with a digital rectal examination (DRE), in which the physician inserts a gloved finger into the rectum to feel for nodules, hard areas, asymmetry, and other abnormalities. However, many of the abnormalities detected by DRE turn out not to represent prostate cancer, and, conversely, DRE fails to detect some prostate cancers. A blood test known as PSA (prostate specific antigen) is more sensitive and frequently is elevated in patients with prostate cancer who have a normal DRE. However, the PSA is sometimes normal in patients with prostate cancer, so both PSA and DRE should be performed in screening for prostate cancer. Whether widespread screening for prostate cancer should be recommended is controversial. Men, particularly those above age 50, should discuss with their physician whether to undergo screening for prostate cancer. Those at higher risk, such as African Americans and those with a family history of prostate cancer, may wish to consider screening at age 40-45.

Diagnosis
A man with an abnormal PSA or DRE should be evaluated to determine the cause of the abnormality. PSA elevation may be due to prostate enlargement, inflammation or infection of the prostate, prostate cancer, or other causes. A biopsy of the prostate gland is often necessary to determine the cause and to rule out the possibility of prostate cancer. This is usually performed under transrectal ultrasound (TRUS) guidance, a procedure in which a urologist views images of the prostate obtained by inserting an ultrasound probe into the rectum. Needles are inserted through the probe and into the prostate to obtain tissue samples which are analyzed for the presence of prostate cancer. This is usually a simple outpatient procedure. If prostate cancer is found in the biopsy specimens, additional tests, such as a CT scan or bone scan, may be ordered to determine whether the cancer has spread beyond the prostate gland. In some cases, additional testing is not necessary.

Prognostic Factors
Several variables can aid the physician in predicting the aggressiveness of a particular case of prostate cancer and, in turn, aid in deciding which form of treatment is most appropriate for each individual. These prognostic factors include: PSA, Gleason score, tumor stage, and lymph node status. Higher PSA levels at diagnosis predict a higher likelihood that the cancer will spread or relapse after treatment. The Gleason score is a system in which a grade is assigned to the cancer, based on characteristics of the appearance of the tumor under the microscope. A higher grade or higher Gleason score also predicts a higher probability that the tumor will spread or recur after treatment. The stage of the tumor is a description of the size or extent of the tumor, based of DRE, TRUS, and other measures. Higher stage tumors are more advanced and are less likely to be completely removed by surgery or eradicated by radiation treatment. Conversely, cancers associated with a low PSA level, low Gleason score, and early stage are more likely to behave in an indolent fashion and are more likely to be controlled by surgery, radiation, or other treatments.

Treatment
Several options exist for management of prostate cancer. These include: surgery, radiation therapy, hormonal therapy, and observation (watchful waiting). The decision regarding which treatment is best for an individual can be complex, and many factors influence this decision. The optimal treatment in one case is often not the best choice in another case. Each method of treatment has advantages and disadvantages, and the challenge for physicians and patients is to determine the most appropriate course of action for each patient.

Surgery
Surgical treatment of prostate cancer usually consists of a radical prostatectomy – complete removal of the prostate. This has the potential to cure cancers in which the tumor is confined within the prostate gland. Advantages of this procedure include its potential to cure early stage cancers, avoidance of potential problems associated with radiation, and accurate determination of the tumor’s extent, based on careful microscopic examination of the lymph nodes and prostate gland by a pathologist. The pathologist’s findings can refine knowledge of the patient’s prognosis and may indicate the need for additional treatment, such as radiation therapy or hormonal therapy. Disadvantages of radical prostatectomy include the fact that it is a major operation that requires hospitalization and that it may result in side effects such as impotence or incontinence. Transurethral resection of the prostate (TURP) is a procedure in which tissue is removed from the inside of the prostate in order to relieve obstruction of urinary flow from the bladder. Since it removes only part of the prostate gland, this operation is not designed to cure prostate cancer and is usually done to relieve symptoms related to BPH. It may sometimes be performed for symptom relief if prostate cancer is locally advanced and the patient is not a candidate for radical prostatectomy because of advanced age, medical problems, or advanced stage prostate cancer.

Radiation Therapy
Radiation therapy uses x-rays to kill prostate cancer cells. Like radical prostatectomy, it is capable of curing prostate cancer in its earlier stages. Radiation is delivered by two general methods: external beam radiation therapy and interstitial brachytherapy. External beam irradiation is delivered by a machine called a linear accelerator, which generates a high-energy x-ray beam that is aimed at the prostate gland from outside the body. The patient lies on a table, and the linear accelerator rotates around the table, typically delivering the beam from four or more directions, converging on the prostate gland. Treatments are administered once a day, five days a week, for approximately eight weeds. Each treatment lasts a few minutes, and the patient feels nothing during treatment delivery. External beam radiation therapy may also be given to the prostate bed in patients in whom the cancer recurs there after surgery. Radiation therapy may also be used to treat pain and other problems in advanced cases in which the cancer spreads to the bones or other areas.

Recent advances in computer technology have given rise to more accurate methods of targeting and delivering the radiation beam – three-dimensional conformal radiation therapy (3D conformal radiation) and intensity modulated radiation therapy (IMRT). Proton beam radiation therapy, available only in a few centers nationwide, is another means of delivering radiation more accurately. These newer techniques all facilitate irradiation of the prostate gland while minimizing radiation exposure to surrounding structures such as the bladder and rectum. Advantages of external beam radiation therapy include its potential to cure early stage prostate cancer, avoidance of major surgery, and a lower risk of incontinence and impotence than with radical prostatectomy. Disadvantages include extensive travel associated with the course of treatment and potential complications such as bowel damage.

Interstitial brachytherapy is a technique in which radioactive sources are placed into the prostate gland, delivering radiation from within the prostate. The most common method of brachytherapy is known as the “seed implant,” in which multiple radioactive seeds, usually isotopes of iodine or palladium, are inserted into the prostate by needles passing through the base of the scrotum under ultrasound guidance. Other methods of inserting the seeds have also been developed. The seeds remain in the body permanently, although the radioactivity diminishes over time. The seed implant may be performed as the sole treatment modality in very early stage prostate cancers of low aggressiveness, or it may be combined with an abbreviated (five-week) course of external beam radiation therapy, particularly in cases in which the PSA, Gleason score, or tumor stage would predict a lower likelihood of controlling the cancer with the seed implant alone. In some cases, radioactive sources, typically an isotope of iridium, are inserted into the prostate gland temporarily and than removed. This is known in some situations as high-dose rate (HDR) brachytherapy and is usually combined with an abbreviated course of external beam irradiation. An advantage of combining external beam radiotherapy with the seed implant or HDR brachytherapy over external beam irradiation alone is that the former approach delivers a higher total radiation dose to the prostate and may result in a higher probability of controlling the cancer. For patients who are suitable candidates for the seed implant alone, this approach is often attractive, as it avoids both the lengthy course of external beam radiotherapy and the major surgery associated with radical prostatectomy. Disadvantages of the seed implant include its relatively shorter track record than radical prostatectomy or external beam radiation therapy and the fact that it is a minor surgical procedure, which may not be suitable for some patients.

Hormonal Therapy
Prostate cancer’s development and growth is stimulated by testosterone, the male sex hormone. Thus, prostate cancer usually responds favorably to withdrawal of testosterone. In some cases, all clinical evidence of prostate cancer can disappear in response to hormonal therapy. However, hormonal therapy alone is not regarded capable of curing prostate cancer. Hormonal therapy is usually recommended for patients who initially present with the cancer having spread to bones or lymph nodes, patients in whom the cancer spreads to such areas after surgery or radiation therapy, or patients in whom the cancer recurs after radiation therapy. Hormonal therapy may also be recommended for some patients with earlier stage prostate cancer who are not suitable for definitive surgery or radiotherapy. Historically, hormonal therapy was usually accomplished by surgical removal of the testicles (orchiectomy) or administration of female hormones such as DES. DES is not commonly used today, since it may cause heart and blood vessel problems, breast enlargement, and other side effects. Newer pharmaceutical agents are usually better tolerated and do not require removal of the testicles, which men may find objectionable. These agents include injections known as LHRH agonists, such as Lupron or Zoladex, and oral medications known as nonsteroidal antiandrogens, such as Eulexin or Casodex. Orchiectomy remains a simple, expedient option in some cases, though.

Temporary courses of an LHRH agonist, sometimes with an antiandrogen, are sometimes used in combination with radiation therapy. Recent studies have shown that this combination of therapies may result in better cancer control in some cases than radiation therapy alone. A temporary course of hormonal therapy may also be used to shrink the prostate gland if the prostate is initially too large to permit interstitial brachytherapy.

Observation
Also known as watchful waiting, this is a choice not to undergo definitive treatment for prostate cancer, involving an assumption that an individual is likely to die of a cause other than prostate cancer. Prostate cancer sometimes progresses slowly, and the choice of no active treatment may be reasonable, particularly in an elderly patient or one with major medical problems. For patients who are relatively young (less than approximately 70 years old) and otherwise reasonably healthy, physicians in this country are often hesitant to endorse a policy of watchful waiting.

Follow Up/Salvage
After definitive treatment with surgery or radiation therapy, patients are typically followed by their urologist and sometimes by other physicians. The DRE and PSA are repeated at fairly regular intervals, usually a few times each year. Other tests may be ordered if necessary. A progressive rise in the PSA is frequently the earliest sign of relapse after surgery or radiotherapy. Radiation therapy, sometimes in combination with hormonal therapy, may be instituted if the PSA rises after radical prostatectomy. Hormonal therapy is usually initiated for a rising PSA after radiation therapy. Patients on hormonal therapy for advanced disease are followed by their urologist or other physicians. If the disease progresses despite hormonal therapy, palliative radiation therapy, second-line hormonal therapy agents, chemotherapy, or other treatments may be indicated.

Janice Tomberlin, M.D.

Breast Cancer
Breast cancer is the most common cancer in women, representing 183,000 newly diagnosed cases and 46,000 deaths per year in the United States. This accounts for one third of female cancer diagnoses. The risk of developing breast before age 50 is 1 in 50 and increases with age. Nearly 70% of breast cancers are diagnosed in women age 55 and older. Over the course of a lifetime of 85 years, women have a 1 in 8 chance of developing breast cancer. The good news is that deaths from breast cancer are decreasing due to increased awareness and earlier detection of the cancer through screening mammograms.

The exact cause of breast cancer is unknown. Researchers have different theories about what causes breast cancer and most suspect that a combination of lifestyle, environmental and genetic factors can increase a woman’s risk of developing the disease. There is also a pronounced variability in breast cancer rates in different countries around the world. There are roughly 100 cases of breast cancer per 100,000 women in western countries such as the United States compared to 10-15 cases per 100,000 women in Asian countries. This is thought to be in part due to the differences in diet between these two regions. Several studies have suggested that a diet high in fat may increase the risk of breast cancer.

The genetics of breast cancer are also intriguing. Any woman with a first-degree relative (mother, sister or daughter) with breast cancer is at increased risk of the disease herself. This familial tendency does not necessarily imply a genetic transmission of the disease. The BRCA1 and BRCA2 genes have been mapped and are linked to the truly genetically transmitted cases. Genetically linked cases are thought to represent only 5-10% of all cases, however, and breast cancers occurring in some families probably represent common environmental risk factors. True BRCA1 cases typically occur at earlier ages and are also linked to ovarian cancer. Carriers of a BRCA1 mutation apparently have roughly an 85% risk of developing breast cancer by age 70, and a 45% risk of developing ovarian cancer by the same age.

Several hormonal factors increase the risk of developing breast cancer. Beginning menstruation early, entering menopause late, or waiting until after age thirty to have your first child or not having children at all, increase a woman’s risk of developing breast cancer. All of these factors are linked to the female hormone, estrogen. Breast cancer has also been associated with estrogen replacement therapy after menopause. Most doctors strongly believe that this therapy does not cause breast cancer, but may accelerate the growth of a tumor that is already present. Many women worry that the use of oral contraceptives (“the pill”) may increase the risk of developing breast cancer. After reviewing 54 studies, the conclusion of a panel of experts report that “the pill” did not appear to cause breast cancer. In fact, some doctors suspect that the use of “the pill” during a woman’s reproductive years may actually protect her from developing breast cancer after menopause.

Screening
Mammography is a very successful screening tool for breast cancer. There is considerable controversy in the medical community, however, over when mammographic screening should begin. There is no doubt that annual mammographic screening in women over the age of fifty is beneficial. Some studies indicate that the routine use of screening mammograms in women over fifty is beneficial. Some studies indicate that the routine use of screening mammograms in women over fifty can decrease breast cancer deaths by one-third. The American Cancer Society (ACS), the American College of Radiology and the American College of Obstetricians and Gynecologists all recommend annual mammograms for women in their forties. In March 1997, based on their review of scientific data, the National Cancer Advisory Board recommended that women should have a screening mammogram every one to two years beginning at age forty. Another group of experts gathered by the National Institutes of Health (NIH) in January of 1997 concluded that based on their review of the same studies, mammograms should be optional until age fifty. In view of this controversy, women should discuss their particular risk factors with their doctor and decide when they feel comfortable beginning a screening program.

A monthly breast self-exam is another part of a successful screening program. The best time for a woman to examine her breasts is during the week after her period when her breasts are the softest and the least tender. The following is the three-step technique for breast self-exam published by the Susan G. Komen Breast Cancer Foundation:

In the shower: Raise one arm and place your hand on the back of your head. Slowly and methodically, move the pads of your fingertips over the breast in a circular pattern. Don’t forget to feel in the armpit area. Repeat on the other side.

Lying down: Lie down and put a pillow under your right shoulder and your right arm behind your head. Using the pads of your fingertips, make the same circular pattern of your right breast as you did in the shower. Don’t forget to feel the armpit and the chest area from the collarbone to the area below the breast. Repeat, using firmer pressure. Squeeze the nipple gently to see if there’s any discharge. Repeat the procedure on the left breast. Report any strange findings or changes to your doctor immediately.

Detection
Once an abnormality is detected on mammogram or exam, a physician should evaluate whether or not a biopsy is indicated. While 90 percent of breast lumps are not cancerous, any lumps should be examined immediately. There are many ways of obtaining a piece of the tumor to make an accurate diagnosis. Biopsies can be obtained under ultrasound or stereotactic localization. Sometimes the entire lump is removed at the time of the biopsy. Lumps commonly occur in the lobules or small sacs that produce milk or in the ducts that carry milk to the nipple. Cancers beginning in these structures represent the vast majority of breast cancer and are called lobular and ductile carcinomas. Each category has many subtypes.

Staging and Treatment
Once a cancer is detected, the next step is usually a surgical procedure. The standard surgical procedure for breast cancer was once the radical mastectomy – total removal of the breast and the surrounding fat, muscle, and lymph nodes. Many women whose cancer is detected early now are offered a lumpectomy or partial mastectomy where the tumor and lymph nodes under the arm are removed, but the majority of the breast tissue is spared. This has been shown in early cases to be as effective as a mastectomy at curing the disease. Many women will choose to have a modified radical mastectomy – removal of the breast and lymph nodes, which leaves most of the chest wall muscle intact. This can be combined with reconstructive surgery either immediately at the time of the mastectomy or at a later date. Advances in surgical techniques, reconstructive surgery, radiation therapy and chemotherapy have led to many more options for treatment for a newly diagnosed breast cancer patient. Many patients want to research their decisions, seek second opinions and become involved in the decision making process. Generally, a brief delay between diagnosis and treatment will not compromise the effectiveness of treatment.

Certain tests to detect if the cancer has spread are often ordered and these help doctors determine if chemotherapy or hormone therapy will be recommended. These tests are generally ordered by the Medical Oncologist – an Internist with specialized training in treating cancers. They will determine from the size of the tumor as well whether the lymph nodes are involved or not, whether chemotherapy or hormone therapy would be beneficial. Certain tests done on the cancer cells give an indication of how fast or aggressively it was growing and determine if the female hormone estrogen had influenced its growth. All of these factors help the Medical Oncologist decide what treatment to recommend. Radiation is almost always used to treat the remainder of the breast when a lumpectomy is performed, and is sometimes used after a mastectomy in certain cases. These treatments are recommended and prescribed by a Radiation Oncologist, a physician who specializes in the treatment of cancer with radiation. The overall treatment can involve a team of doctors made up of the primary care physician, the diagnostic radiologist, the surgeon, medical oncologist and radiation oncologist.

The good news is that through the efforts of cancer researchers and patients’ involvement in clinical trials, the overall death rate from breast cancer has decreased by five percent in the past decade. For information on ongoing clinical trials relating to breast cancer, please click on the Texas Oncology banner at the beginning or end of this web page.

Sue Graham, RN CCRA
RESEARCH STUDIES
Research studies, also called clinical trails, are conducted to answer important medical and scientific questions to find better ways to treat diseases such as cancer. Clinical trials evaluate study or investigational drugs, combinations of investigational and standard drugs or different ways of giving drugs. Researchers must believe that a study drug or method will be as good as or better than what is currently being used or they would not offer it to patients.

Cancer research studies are divided into several types. Studies that are considered Phase One are generally the first time a drug is given to cancer patients. In Phase One studies, physicians want to know the best dose of drug to give a patient. More importantly they want to know how well a patient tolerates the drug and any side effects the drug may cause. They also want to know what dose of the drug is best at killing cancer cells and what kind of cancers are best killed by a study drug. In Phase Two, a small number of patients with a particular type of cancer receive the study drug at the dose that was found to be safe and most effective in the Phase One studies. The purpose of Phase Two studies is to better define the effectiveness and safety of study agents in treating different types of cancer.

Only a small number of patients participate in Phase One and Phase Two studies. The next step, Phase Three studies have greater numbers of patient participation. They are designed to confirm the findings of the Phase One and Phase Two studies in a larger group of patients. They also compare the study treatment with drugs physicians are currently using or what is considered the standard treatment. Your physicians are involved in several of these Phase One, Two and Three studies and offer patients treatment as part of a clinical trial if your physician feels it is the best treatment option.

Even though your physicians are involved in cancer research, the final decision to participate in a research study is made by you. Patients choose to take part in clinical trials for many reasons. Some may hope for a cure, for a longer time to live and for a way to feel better. Others want to be among the first to received research treatments and investigational drugs because standard therapies are not optimal for their cancer. Most people want to know that their efforts will make a difference for future cancer patients.

While you are being treated as part of a clinical trial, your physician is closely monitoring every aspect of your care. Your physician fully understands the study treatment plan and what important questions are being addressed. A special research nurse who works directly with your physician is also dedicated specifically to patients who are on a clinical trial. At the same time, your needs as a patient come first. If there is no improvement in your condition, or if the treatment or drug causes intolerable side effects, you and your physician can decide to discontinue the study and proceed with other treatments. Should you decide to stop participating in the clinical trial, your wishes are respected without any effect on future treatment plans.

For more information on research trials, click on the banner at the beginning or end of this web page.

Additional Information
The American Cancer Society is an excellent resource for information and support for prostate cancer patients and their families. They can be contacted locally or on the web. Man to Man (sponsored by the American Cancer Society) and Us Too, prostate cancer education and discussion groups, are also excellent resources.

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