Prostate Cancer Specialists: Clinical Trials at MUSC

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Guest: Dr. Thomas E. Keane – Urologist

Host: Dr. Linda Austin – Psychiatrist

Dr. Linda Austin: I am Dr. Linda Austin speaking with Dr. Thomas E. Keane, who is Professor and Chairman of Urology at MUSC. Dr. Keane, you are a noted authority in prostate cancer, what research programs and clinical trials do we have going on now at MUSC in this important area?

Dr. Thomas E. Keane: Well, there is a number of clinical trials that are available some of which focus on localized disease, some focus on high-risk localized disease, and some focus on advanced prostate cancer. Just looking at the localized disease itself, we are now one of the major participants in the FACT study and that is a study whereby we are looking at how patients have been informed of their options for prostate cancer and we are looking to see if all of the options were given to the patients. It’s a Multicenter National Study and MUSC has been one of the chief recruiters to this because of the volume of patients, particularly the volume of African-American patients that we have managed to attract to Charleston.

Dr. Linda Austin: Could you spell that please?

Dr. Thomas E. Keane: FACT study. It has proven a very successful study and so far as we are gaining very clear knowledge on how patients make the decisions, the factors which influence them, and whether or not they get the full option profile given to the method of diagnosis, then we have both Dr. Stephen Savage and myself are involved in the Multicenter Study, which looks at high-risk prostate cancer patients. Every patient is given the standard treatment. In other words, they have high-risk features in their prostate and if they recur, they will get hormonal treatment as their initial treatment because we feel that when high-risk disease, when the disease -- if it recurs, it tends to be small-volume metastatic disease rather than just a local recurrence, so with that thing set in a high-risk patient, they get standard hormonal treatment for a period of time, on the second arm, gets hormonal treatment plus chemotherapy again given on a temporary basis in an effort to sterilize any remaining disease, that has proven a highly successful trial also. One should remember that the treatment of prostate cancer is not the exclusive preserve of the urologist. We also have our radiotherapists and our medical oncologists and at MUSC, we make every effort to deliver a multimodality treatment. By multimodality, I mean that you will get talk to the surgeons, the radiotherapists, and the medical oncologists. Medical Oncology itself has a number of very good studies looking at both chemotherapy and hormonal options for the patients as well as some of the new novel treatments, particularly the Velcade study, which is being run by Dr.Andrew Kraft, who is the Head of Hollings Cancer Center and this is a proteasomal pump inhibitor, the theory being that the proteasomal pump would clear out the debris out of a cancer cell thereby enabling it to survive. If one inhibits that pump, you allow this debris to collect within the cell and then the cell self-destructs. My own opinion is that this study needs to be done. I think it is well into accrual. It is certainly possible that we will need further treatment combined with this agent in order to achieve cures, but we have to start somewhere and this study is accruing well and the other arm is hormonal therapy and if you do qualify for us and you aren’t responding to the Velcade, you will get the hormonal therapy option as well.

Dr. Linda Austin: So when you say arm, you mean that one group will get hormonal treatment and one will get the experimental drug?

Dr. Thomas E. Keane: Yes, followed by the hormones afterwards and that’s just to name a few of the studies, which are currently prostate cancer. Dr. Uzair Chaudhary is another of the medical oncologists with extensive of GU expertise and he also has been very important in developing a number of trials again in the advanced disease area. So, my advice would be if you end up with advanced disease, I would certainly contact a medical center, it does not have to be MUSC, but if you are in the area, you should certainly give them a call and see what trials are on offer and what are the options that are currently available. As I tell most of my patients, if you are going to buy a house or buy a car, you will always do diligence so what stands for your health. If you have a health problem, it makes sense to find out all you can before you make a definitive decision because that decision may turn out to have very serious precautions for the rest of your life.

Dr. Linda Austin: Dr. Keane, thank you very much.

Dr. Thomas E. Keane: You’re welcome.

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