Duke physicians and scientists are continually investigating ways to improve outcomes for men with prostate cancer and to discover novel therapies to better treat prostate cancer.

Some highlights:

• Duke is one of the first sites in the country to offer men a novel non-surgical therapy for early stage prostate cancer: high-intensity focused ultrasound (HIFU).
• Ongoing clinical trials at the Duke Prostate Center (DPC) are being used to test a drug that inhibits the mTOR protein, which can be a pathway for prostate cancer cell growth in approximately 50 percent of advanced prostate cancer cases. DPC scientists hypothesize that targeting mTOR may benefit many patients with advanced prostate cancer.
• Researchers are clinically testing a novel combination of chemotherapy (Docetaxel) and targeted therapy (Xinlay) in men with advanced prostate cancer to determine their safety and anti-tumor effects.
• Duke’s recently renovated radiation oncology department offers state-of-the-art treatments for prostate cancer patients, including intensity modulated radiation therapy (IMRT) and prostate brachytherapy.
• Geneticists are examining patterns of gene expression within tumors to learn more about the biology of prostate cancers and the prospects for subsequent clinical behavior.
• Researchers are working to tailor anti-cancer treatments to individuals based on the characteristics of their cancer by studying the molecular characterization of certain prostate cancer tumors to determine what makes some tumors more susceptible to specifically targeted therapy.
• Scientist have learned that the diagnostic criterion -- the rate of rise in PSA (i.e. PSA velocity) -- currently used to indicate prostate cancer needs to be age-adjusted in order to more effectively detect cancer in young men.
• Investigators are analyzing the reasons for mortality differences between African-American men and white men with prostate cancer. African-American men are not only more likely to develop prostate cancer, but are also more than twice as likely to die from the disease as white men.
• A clinical trial is underway to determine if radiation therapy given before surgery will reduce the chance of tumor relapse in patients who have locally advanced prostate cancer.
• Researchers have discovered that waiting up to six months to treat low-risk prostate cancer poses little or no threat to disease progression, thus allowing time for patients and their doctor to determine the best treatment plan.
• All patients being seen at the DPC and offered to enroll in Longitudinal Prostate Cancer Outcomes database. This database maintains records on all men being seen, allowing clinicians to track long-term outcomes among their patients. Analyzing data from this database, a set of decision making tools will be developed to help Duke clinicians identify variables that predict which patients will have good or bad outcomes and ultimately help optimize which treatment patients should receive.
• Researchers from the DPC have identified that the rate rise of the PSA after surgery or radiation is the best available marker for aggressive prostate cancer.
• Researchers have found that when men with a rapidly rising PSA after surgery (i.e. doubling within 12 months) are given hormonal therapy early, it can help delay the development of metastasis (i.e. cancer spread to the bones).
• Duke scientists, working with scientists from the University of Pennsylvania and Howard University, are developing a tumor-guided biopsy system. This new system overlaps a three-dimensional reconstructed prostate cancer atlas with radical prostatectomy specimens to an ultrasound machine. The purpose is to use a statistical model for guidance to the biopsy site for detection of small volume or microscopic disease.
• Scientists and clinicians are studying the prognostic factors associated with health disparity, including race and ethnicity, age, socioeconomic status, education, obesity, dietary habits, access to health care, insurance status, geography, and cultural beliefs. The purpose is to promote individualized and optimized protocols in prostate cancer screening, clinical interventions, and general health.
• Scientists have discovered that obese men are more likely to have a cancer recurrence after radical prostatectomy. Ongoing work is aimed at identifying the exact reasons why.
• Duke scientists have identified that obese men have larger sized prostate, making it more difficult to find the cancer. Therefore, obese men may have their cancers diagnosed later, resulting in more aggressive cancers at the time of diagnosis.
• Scientists are studying the effects of various diets on prostate cancer growth, both in animals and humans. There is special interest in the role that a low-carbohydrate diet may play in slowing the growth of established cancers.
• A clinical trial evaluating flaxseed for men with prostate cancer is currently ongoing and several other dietary clinical trials are currently being planned.
• Duke scientists, clinicians, nutrition experts, and exercise physiologists are leading the way to understand the complex association between diet, nutrition, obesity, physical activity, and prostate cancer. It is anticipated that experiments being conducted in the research laboratory will lead to new clinical treatments for prostate cancer patients in the near future.