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The urologist who headed a five-year effort to objectively condense almost 50,000 studies of prostate cancer into new treatment guidelines says the resulting report is “sure to save lives in this country.”

Ian Thompson, M.D., led effort to provide the new prostate cancer guidelines
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Ian M. Thompson Jr., M.D., professor and chairman of the department of urology at The University of Texas Health Science Center at San Antonio, and also a physician with the Cancer Therapy & Research Center, University Hospital and the South Texas Veterans Health Care System, chaired the expert consensus panel for the American Urological Association (AUA).

Best treatment options
The AUA released the full report May 21 at its annual scientific meeting in Anaheim, Calif. “There are pearls of wisdom here with regard to best treatment for patients,” Dr. Thompson said. “The guidelines go into some detail about what physicians should be expected to offer patients, about what evaluations are appropriate.”

Recommendations
Among the recommendations are:

• All patients with newly diagnosed prostate cancer should have an assessment of their overall health and life expectancy, including their urinary, sexual and bowel function;

• All prostate cancers should be classified as low, intermediate or high risk, with treatment to be considered in light of the classification;

• All patients should be offered watchful care, radioactive seed implants, radiation beam therapy and surgery as options, with discussion of pros and cons of each.

First guidelines published in 1995
In 1995, the AUA first published guidelines on the management of localized prostate cancer. Dr. Thompson co-chaired that initial five-year effort involving a multidisciplinary panel of experts. “At that time, about 12,500 papers had been published on prostate cancer,” Dr. Thompson said. “All were reviewed and those with important data regarding outcomes of individual treatment were extracted into a master database. We objectively condensed that information to the first set of AUA guidelines about the treatment of patients.”

The most recent update, again a five-year process by a team of urologists, medical oncologists, radiation oncologists and other specialists, benefited from the findings of multiple randomized clinical trials completed since the 1995 report.

Randomized clinical trials provide the evidence
“The results that really matter in the way men are treated came from those clinical trials,” Dr. Thompson said. “At the time we did the first report, there really weren’t any. The first guidelines were based on outcomes at institutions, but that was anecdotal evidence, not the highest quality of evidence. Now that the studies have been completed, we can begin to compare treatments and to improve their outcomes.”

The 2007 guidelines make many important comparisons. For example, in patients treated with radiation beam therapy for intermediate- to high-grade prostate cancer, the addition of hormone therapy significantly reduced the risk of death in previous studies, and therefore should be strongly considered. There is also evidence that higher doses of radiation beam therapy are more effective.

“Another recommendation that will have major impact is that, for patients with localized cancer, based on evidence reviewed by the panel, hormone therapy by itself is not a good option,” Dr. Thompson said.

He said investments by academic physicians, patients and funding agencies such as the National Cancer Institute (NCI) are paying off. Today, men and their physicians have much more information with which to set priorities and expectations for detection and treatment.

Prostate cancer is the most common cancer, other than skin cancers, in American men. It is expected to be diagnosed in 219,000 men this year and take the lives of 27,000.

More about Dr. Thompson
Dr. Thompson is chairman of the Prostate Cancer Panel of the American Urological Association and vice chair of the Early Detection Research Network of the NCI, and served as president of the Society of Urologic Oncology. He has published more than 300 scientific articles and 35 book chapters, and has edited four surgical textbooks. He serves as the leader of the Comprehensive Genitourinary Oncology Clinic at the Cancer Therapy & Research Center.

Dr. Thompson holds the Henry B. and Edna Smith Dielmann Memorial Chair at the Health Science Center and the Glenda and Gary Woods Distinguished Chair in Genitourinary Oncology at the CTRC.

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The University of Texas Health Science Center at San Antonio is the leading research institution in South Texas and one of the major health sciences universities in the world. With an operating budget of $536 million, the Health Science Center is the chief catalyst for the $14.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $35 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 22,000 graduates (physicians, dentists, nurses, scientists and allied health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, allied health, dentistry and many other fields.