Clinical Centers of Excellence - Prostate Cancer: Memorial Sloan-Kettering Cancer Center

That will change in the next 10 years for most men, Dr. Scardino said. The MSKCC Sidney Kimmel Center for Prostate and Urologic Cancers is striving to make that happen through aggressive efforts in prevention, detection, diagnosis, research, and treatment.

There are limited options for the prevention of prostate cancer. Lack of a genetic test makes it even more difficult to determine a patient's risk of developing the disease.

MSKCC is conducting studies to identify men at increased risk of developing prostate cancer who might benefit from chemoprevention. Recent trial results indicate that prophylactic use of these agents is not linked to the development of more aggressive tumors, as was shown in a previous study.

"That is the most important thing that is going on in the prevention of prostate cancer today," said Dr. Scardino.

Early diagnostic efforts

Hans Lilja, MD, PhD, a clinical laboratory physician at MSKCC, holds patents for his development of free PSA assays.

"Free PSA is now a standard test worldwide in determining who should have a biopsy if they have prostate cancer," said Dr. Scardino.

In addition, MSKCC researchers are studying how a single PSA test can predict younger men's risk for prostate cancer.

A study by MSKCC and Lund University in Sweden found that a PSA test taken before the age of 50 years can be used to predict advanced prostate cancer in men up to 25 years in advance of a diagnosis. As a result, for men in their 30s and 40s, it might be possible to use the PSA test as a predictive tool to determine their lifetime risk of developing prostate cancer, Dr. Scardino explains.

"We have been extremely interested in understanding the powerful predictive nature of PSA levels, and I think this will eventually lead to profound changes in the way we recommend men use PSA testing," he said.

Specialized treatment protocols

The biggest strength of the prostate cancer program is its depth, which allows patients to find comprehensive treatment regardless of the stage of their disease, says Dr. Scardino.

"When a patient comes to us, what we can do is offer them one-stop shopping to be able to look at all of the different choices in prostate cancer treatment," he said.

MSKCC pioneered the use of high-dose intensity-modulated 3-dimensional conformal radiation therapy (IMRT) and helped develop brachytherapy. MSKCC also played an integral role in the development of a prostate cancer nomogram to predict both the natural progression of prostate cancer and how it will respond to treatment.

Each of the urologic surgeons at MSKCC specializes in only one type of surgical technique for the treatment of prostate cancer and performs that technique exclusively-open, robotic, or laparoscopic. "That is a big strength and unique feature of the program," Dr. Scardino explained.

Based on findings published in the Journal of the National Cancer Institute by Andrew Vickers, PhD, associate attending research methodologist at MSKCC, prostate cancer patients treated by highly experienced surgeons are much more likely to be cancer-free 5 years after surgery than patients treated by surgeons with less experience are.

Patients with advanced prostate cancer will be treated by medical oncologists who are among the world's leaders in developing new treatments. MSKCC hosts the world's largest prostate cancer clinical trial consortium, where researchers are investigating new treatments for advanced disease.