| Tracks 1-9 |
| Track 1 |
Introduction |
| Track 2 |
A clinical investigator’s experience
with the diagnosis and treatment
of prostate cancer |
| Track 3 |
Differences in reaction to prostate
cancer versus other chronic
diseases |
| Track 4 |
Coping with the fear and
uncertainty associated with
prostate cancer |
| Track 5 |
Translating personal
experience with prostate
cancer to patient care |
|
| Track 6 |
Clinical benefit of docetaxel
in prostate cancer |
| Track 7 |
Barriers and initiatives to
increase clinical trial
participation |
| Track 8 |
Use of PSA doubling time
to identify candidates for
clinical trials |
| Track 9 |
Selection of hormonal therapy
when sexual functioning is
not a patient concern |
|
|
Select Excerpts from the Interview
Track 2
DR LOVE: You were diagnosed with prostate cancer in 1999, and since
then you have spoken with us several times about your experience. Can
you review the clinical course of your disease and update us on your
current situation?
DR SCHELLHAMMER: Since age 50, my PSA has regularly been tested and the
scores were quite stable with a PSA level of 2-3 ng/mL. Although at the time
I was happy with those scores, I know from the information we have now that
a 50-year-old with a PSA score of two to three is at increased risk. My PSA
went up after 1999, and in 2000 I underwent a radical prostatectomy.
I was found to have organ-confined but high-grade disease. Three expert
pathologists examined my tissue, and based on their variable readings, the sum
of the Gleason scores interpreted ranged from a seven to a nine. It was quite
different, depending on the pathologist who looked at the tissue.
Within a year I had a PSA rise. I received androgen deprivation for six months with salvage radiation therapy, did well for almost three years with an
undetectable PSA level, and then most recently the PSA level has started to
rise. Obviously, I’ve been looking for the next step.
DR LOVE: How recently was it that it your PSA level started to rise?
DR SCHELLHAMMER: It started going up about six months ago and has risen
at a pace that is somewhere between a three- and six-month doubling time.
Rather than wait and observe, I wanted to do something proactive. I was
interested in clinical trials and also felt an obligation to my patients for whom
I had repeatedly urged participation in trials.
Not many trials are available for rising PSA levels in hormone-naïve circumstances,
but an ECOG trial is using a breast cancer drug, lapatinib, for patients
with a rising PSA and a doubling time of less than 12 months. So I’ve initiated
that trial and I’m about two months into it. We’ll have to see what it does
with regard to the PSA kinetics.
Track 4
DR LOVE: You and urologic oncologist Paul Lange wrote a book recently
— A View from the Other Side. How did this come about?
DR SCHELLHAMMER: We were both diagnosed with the disease, and we were
able to spend many hours together during our summer vacation talking about
how to advise patients about prostate cancer and about the issues we personally
were facing, such as selection of our own therapies, dealing with the issues of
rising PSA levels, the issues of hormone therapy, the changes in quality of life,
the issues of complementary medicine and fear. It seemed reasonable to get
together and take a dual approach to these issues.
DR LOVE: What are some of the main ideas that you wanted to communicate?
DR SCHELLHAMMER: I don’t think we appreciate as much as we should the
fear factor for patients diagnosed with this disease. The uncertainty about
which treatment may be best leaves patients hanging as to how they should
proceed. We should listen more carefully to our patients, for example,
regarding their use of complementary medicines and how they would like to
integrate them into their treatment.
By ignoring this issue, I believe we sometimes allow patients to use supplements
and vitamins to excess or in an inappropriate way. I consider it better
to guide than to ignore, and I believe it is important to appreciate the overall
issues surrounding quality of life, which is inevitably reduced by primary and
secondary therapy.
DR LOVE: Over these last few years when you’ve encountered difficult times
and challenges, how did you cope?
DR SCHELLHAMMER: It’s always helpful to consider other patients, such as
those with virulent benign disease or those with other cancers with a poor prognosis, and put into perspective the fact that a patient with prostate cancer
can expect a longer life span than can be expected with most maladies.
In addition, not only are good therapies currently available, but therapies may
also come up in the future. As someone once said, a cure for prostate cancer is
not insurance against any other bullet that might be headed your way, so you
can’t look at this disease as the only impediment to good living.
Track 5
DR LOVE: Any specific insights you have gained about taking care of
patients with prostate cancer or lessons that you have learned that you
think are relevant to physicians?
DR SCHELLHAMMER: I realize that offering a number of positive possibilities
without specific direction to one therapy is the best way to advise. It helps to
offer a number of good therapies, explain them to the patient and allow the
patient to decide in a reasonable period of time what he is most comfortable
with.
I have no doubt that if my own experience is brought up or is eventually
talked about and I give him the monograph we’ve written, this provides a
bond that tells the patient I know somewhat where I am coming from — from
a scientific and from an emotional standpoint.
DR LOVE: What are some of the directions in clinical research that you feel
the most optimistic about in prostate cancer?
DR SCHELLHAMMER: I hope that in the next five years the so-called fourth
modality of therapy, immunotherapy, might find a role and complement our
current options of surgery, chemotherapy and radiation therapy that we’ve
used for so long and with good or reasonable success.
Better information about when to begin androgen deprivation and whether
intermittent schedules remain positive with no downsides would also be
helpful. In addition, the use of chemotherapy at earlier stages of disease may
show promise in the near future, particularly as adjuvant therapy for patients
with high risk factors such as PSA doubling time, time to recurrence and
Gleason score.
Select publications
